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The National Ambulance Service of New England (NASNE) is the sole emergency medical services (EMS) provider for the Republic of New England. As of October 2023, NASNE has 3,900 ambulances capable of handling 911 calls and interfacility transportation (IFT) ambulance service at the advanced life support (ALS) and basic life support (BLS) levels to all communities, hospitals, and nursing facilities in New England. The National Ambulance Service is headquartered at the MetroHealth Complex in Stoneham, Massachusetts, and has many divisions acting to supplement regular EMS operations.

History
NASNE was founded in 2019 after the establishment of the Republic of New England. The new government's goal was to consolidate the patchwork of public and private emergency medical services operating throughout the region, along with the nationalization of the rest of the country's healthcare system. The Ambulance Act, signed into law on January 1, 2020 effectively nationalized all prehospital emergency care services in the country.

Consolidation of Private Ambulance Services
The first organizations to be nationalized were the private for-profit ambulance companies. All for-profit ambulance services ceased operations on June 1, 2020. All staff and personnel from the private companies were laterally transferred into the National Ambulance Service. All 911 contracts between the companies and municipalities were effectively cancelled, though dedicated units and staff levels were kept the same.

Integration of third service and fire-based EMS units
On July 5, 2020, all publicly operated 911 ambulance services, including those operated by fire departments, police departments, municipal EMS agencies, and non-profit and volunteer organizations were consolidated into the National Ambulance Service. Municipalities which operated the ambulance under the fire or police department continued to staff the ambulances until NASNE personnel could be hired to staff them. The two largest municipal EMS agencies, Boston EMS and Worcester EMS, while having been fully integrated into the national system, are still functionally separate from the rest of the system's regional operations.

Municipal Service
NASNE provides advanced life support services to nearly all cities in towns in New England through it's 911 based service. The agency dedicates a certain number of ambulances to each municipality as deemed necessary based on population and call volume.

Interfacility Transport
NASNE provides all medical Interfacility Transport (IFT) services to the citizens of New England, between hospitals and nursing homes, long term care facilities, and patient's homes. If medical transport is not deemed necessary, the patient will be transported by chair car via the Department of Public Health's Division of Alternative Transportation (AlTrans).

Long Distance Transport
NASNE has units that are specially equipped to provide long distance medical transport for patients who need specialty care at a New England hospital, or to one abroad. NASNE will provide both interstate and international transport services, often crossing the borders into New York or Canada.

Emergency Services/Special Hazards Unit
The Emergency Services & Special Hazards Unit is the arm of NASNE that is tasked with overseeing all special rescue services divisions.

Mass Casualty Incident Response Team

Mass Casualty Incident (MCI) response units are stationed strategically in large population centers and near or at large venues around the country. These typically include Mobile Intensive Care Units (MICUs), Medical Evacuation Units (MEUs), which are busses specially fitted to carry the wounded, Mobile Laboratories capable of testing blood and other fluids for poisons or contaminants, various support vehicles, and trailers of supplies.

Event Standby Services

In accordance with the Ambulance Act, NASNE provides medical standby services at large scale public events with more than 300 people in attendance. These typically include BLS and mobile first aid units, but if an event has more than 600 people, ALS and Mass Casualty assets will be deployed to the event.

Search & Rescue Team

The NASNE Search & Rescue Team utilizes specially trained personnel and off-road equipment to perform search and rescue activities in both urban and rural environments. The team is a part of the National Interagency Search & Rescue Team (NISART), and will respond if activated by the team.

Technical Rescue Team

The NASNE Tech Rescue Team is a supplemental division of EMTs & Paramedics, specially trained in technical rescue operations, that is attached to the Federal Civil Defense Administration's Technical Rescue Service. Members of the division are on call to respond 24/7.

Water Rescue Unit

The Water Rescue Unit works closely with local emergency services and the Coast Guard to perform emergency medical rescues on the water. Units are strategically located in coastal communities and near large lakes, such as the Winnipesaukee Region of New Hampshire, and the lakes regions of Maine, where boating and recreation activity is seasonally high.

RAC Unit

The RAC Unit, short for Recuperation and Care, is responsible on-scene rehab services at major incidents in the country, including fires, search and rescue efforts, and other prolonged incidents. The unit works closely with Civil Defense units to perform it's duties.

Motor Unit

The NASNE Motor Unit is a platoon of motorcycles outfitted with medical equipment that can respond urgently in congested areas. The motor units will often beat most other emergency units to the scene, because of their ability to maneuver through traffic. Units are strategically staged in major cities where congestion is worst, including Boston, Providence, Hartford, Bridgeport, Worcester, Springfield, and New Haven, with additional units stationed on Cape Cod, Martha's Vineyard, and two units on Nantucket that were inherited from the Nantucket Fire Department.

Mounted Unit

The NASNE Mounted Medical unit patrols highly congested areas, usually at major events, and carries first aid and basic life support equipment. The purpose of the unit is to be able to easily maneuver through crowds, and to serve as a public relations tool for the agency. The unit also participates in search and rescue efforts.

Medical Decontamination Unit

The Medical Decontamination Unit works closely with Civil Defense Decontamination units to decontaminate victims of hazardous materials incidents who may be especially vulnerable to contamination due to their injuries. The unit has special equipment to decontaminate victims with open wounds or who are not ambulatory.

Organ Transport Team

The Organ Transport Team consists of 25 members who are specially trained as expert drivers to deliver organs, blood, plasma and other lifesaving human elements between medical facilities. The members of the unit are regular employees working in other areas of the agency who are on call 24/7 to respond urgently. Two members respond in one of the agency's specially equipped 10 Organ Transport vehicles.

Mobile Laboratory Team

The Mobile Laboratory team consists of several vehicles set up for blood and plasma donations, as well as analyzing clinical specimens for diseases, poisons, and toxins. While regular operations consist of teams traveling the country to get blood and plasma donations, the teams are also ready to deploy to large scale incidents.

Mobile Pharmacy Team

The Mobile Pharmacy Unit serves as a pharmaceutical delivery service for citizens who are not able to go to a pharmacy to pick up their prescriptions. The unit only delivers medications deemed necessary to sustain life by a doctor; any other medications are delivered by the DPH Mobile Health Service. The unit will also accompany mobile health teams when deployed to low income neighborhoods to provide medications to those who do not receive regular medical care. Individual mobile pharmacies are typically staffed by one or two pharmacists and a pharmacy technician, as well as one or two community care technicians.

Community Medicine
NASNE's Division of Community Medicine delivers care and services to patients in an out‐of‐hospital environment in coordination with healthcare facilities and family doctors. The division utilizes doctors, nurses, social workers, mental health professionals, paramedics and EMTs to deliver this care in the home and on the street. Community Medicine Practitioners are the first to be dispatched to behavioral health emergencies.

Education
The National Ambulance Service is responsible for educating all individuals seeking to become medical first responders in New England. The National EMS Academy, based at the former Wrentham State School in Wrentham, Massachusetts, teaches and certifies individuals at all levels of emergency medical care. Additionally, further instruction in interpersonal skills, public speaking and social engagement, self defense tactics, incident de-escalation, and emergency vehicle driving skills are also taught at the academy and at multiple field locations around the country.

Dispatching
The dispatching of emergency medical services is still done by local and regional 911 call centers. However, 911 calls for medical services are filtered and prioritized by emergency medical dispatchers based on urgency, if not enough units are available.

Staffing
Of the approximately 23,000 staff members of NASNE, about 10,000 are Full-Time EMTs & Paramedics working on ambulances. A further 3,000 are Paid-on-Call employees, many of whom were Part-Time or Per Diem employees of private ambulance companies prior to nationalization. Another 3,000 are members of all-volunteer ambulance squads and rescue units, unable to be hired as full time employees due to a lack of funding. A further 4,000 are members of dedicated Special Operations and Emergency Services units. Finally, About 3,000 members are part of the administration and support staff, including billing clerks, acquisition specialists, mechanics, building repair workers, and administrative officers.

Both 911 and Interfacility Transport Units are staffed 24 hours a day. In more sparsely populated areas and where the staffing shortage situation is more urgent, IFT units are staffed Between 8 AM and 8 PM.

Units that are staffed 24/7 are staffed in 3 shifts per day, 8 hours each: 12 AM to 8 AM, 8 AM to 4 PM, 4 PM to 12AM. EMTs & Paramedics are not allowed to work more than one consecutive shift at a time.

Quarters
Most 911 units are stationed with the local fire department, at a nearby hospital, or in the original stations they were assigned to before the merger. Due to the ongoing conflict, NASNE has not been able to build any permanent structures for any of it's EMS units since its establishment.

Most IFT and specialty units are housed at the original garages owned by the private companies they belonged to pre-merger. The service has also made use of abandoned hospitals, schools and malls to store additional units in when not needed.

NASNE also inherited many facilities that were run down and in poor condition long before the merger; many crews were forced to sleep outside or in their rigs due to such poor building conditions; the agency has been active in addressing these infrastructure issues, dedicating any extra funds or donations that can be sourced into improving station conditions. The Defense Engineering Corps has also dedicated limited resources to repairing facilities that need the most repair.