assessment services. Some paramedics have begun to specialize their practice, frequently in association with the environment in which they will work. Some early examples of this involved aviation medicine and the use of helicopters, and the transfer of critical care patients between facilities. While some jurisdictions still use physicians, nurses, and technicians for transporting patients, increasingly this role falls to specialized senior and experienced paramedics. Other areas of specialization include such roles as tactical paramedics working in police units, marine paramedics, hazardous materials (Hazmat) teams, Heavy Urban Search and Rescue, and paramedics on offshore oil platforms, oil and mineral exploration teams, and in the military. The majority of paramedics are employed by the emergency medical service for their area, although this employer could itself be working under a number of models, including a specific autonomous public ambulance service, a fire department, a hospital based service, or a private company working under contract. In Washington, firefighters have been offered free paramedic training. There are also many paramedics who volunteer for backcountry or wilderness rescue teams, and small town rescue squads. In the specific case of an ambulance service being maintained by a fire department, paramedics and EMTs may be required to maintain firefighting and rescue skills as well as medical skills, and vice versa. In some instances, such as Los Angeles County, a fire department may provide emergency medical services, but as a rapid response or rescue unit rather than a transport ambulance. The provision of municipal ambulance services and paramedics, can vary by area, even within the same country or state. For instance, in Canada, the province of British Columbia operates a province-wide service (the British Columbia Ambulance Service) whereas in Ontario, the service is provided by each municipality, either as a distinct service, linked to the fire service, or contracted out to a third party. Scope of Practice Common skills While there are varying degrees of training and expectations around the world, a set of skills practiced by paramedics in the pre-hospital setting commonly includes: Advanced cardiac life support, or ACLS, including cardiopulmonary resuscitation, defibrillation, cardioversion, transcutaneous pacing, and administration of cardiac drugs Patient assessment, including acquisition of vital signs, physical exam, chest auscultation, history taking, electrocardiogram acquisition and interpretation, capnography, pulse oximetry, point-of-care ultrasound and basic blood chemistry interpretation (glucose, lactate) Airway management techniques including tracheal intubation, cricothyrotomy, rapid sequence induction, supraglottic airway insertion, manual repositioning, sterile suctioning,