level of assistance, while providing pre-arrival instruction of CPR. Firefighters, with EMT training, respond first to deliver immediate Basic Life Support (BLS), pending the arrival of the paramedics. Specially trained paramedics arrive within minutes to provide Advanced Life Support (ALS) and, if needed, can provide transportation to the nearest appropriate Medical Center. The system is successful due to the blended cooperation between the fire department and paramedic/ambulance services, as well as, a strict policy of meticulous measurement of system performance and cardiac arrest survival information. Strong leadership and regional programs promote uniformity in medical care and response, regardless of jurisdiction. Another critical element to the Medic One program is the comprehensive training program for the paramedics, one of the most stringent anywhere, making their paramedics some of the most thoroughly trained in the world. Only paramedics with at least three years of prior firefighter or EMT experience may enter the program. Medic One paramedics receive 2,000 hours of instruction, using both “book” studies and hands on field and clinical application through both the University of Washington and Harborview Medical Center. The national standard for paramedic training is just 1,100 hours. Medic One paramedics will have more than 700 patient contacts during their training, which is three times the national standard. Upon completion of training Medic One paramedics are considered to be an extension of the ER doctors and may perform advanced medical care, open airways and administer a variety of medications. The final component is an emphasis on community based CPR training, called Medic Two. The Seattle/King County area has the highest per capita number of citizens that are trained in the administration of CPR techniques, approximately 50% of its residents. Leadership Medic One is operated as a partnership between physicians and administrators. Medical directors review patient care by paramedics and can make recommendations including decertification and termination. Administrators act upon the recommendations of the medical director. Response The major components of Medic One's response system are universal access, dispatcher triage, basic life support services, advanced life support services, and transport to hospitals. A medical 9-1-1 call is handled by one of the following communication centers Seattle Fire Department Alarm Center, Valley Communications Center, North East King County Regional Public Safety Communication Agency, or Port of Seattle Police Department Communications Center. Medic One dispatchers use criteria based dispatch guidelines to send the most appropriate care providers. The three response levels