title: Load balancing (computing)

text: Assignment to a particular server might be based on a username, client IP address, or random. Because of changes in the client's perceived address resulting from DHCP, network address translation, and web proxies this method may be unreliable. Random assignments must be remembered by the load balancer, which creates a burden on storage. If the load balancer is replaced or fails, this information may be lost, and assignments may need to be deleted after a timeout period or during periods of high load to avoid exceeding the space available for the assignment table. The random assignment method also requires that clients maintain some state, which can be a problem, for example when a web browser has disabled the storage of cookies. Sophisticated load balancers use multiple persistence techniques to avoid some of the shortcomings of any one method.


title: Load balancing (computing)

text: Another solution is to keep the per-session data in a database. This is generally bad for performance because it increases the load on the database: the database is best used to store information less transient than per-session data. To prevent a database from becoming a single point of failure, and to improve scalability, the database is often replicated across multiple machines, and load balancing is used to spread the query load across those replicas. Microsoft's ASP.net State Server technology is an example of a session database. All servers in a web farm store their session data on State Server and any server in the farm can retrieve the data.


title: Load balancing (computing)

text: In the very common case where the client is a web browser, a simple but efficient approach is to store the per-session data in the browser itself. One way to achieve this is to use a browser cookie, suitably time-stamped and encrypted. Another is URL rewriting. Storing session data on the client is generally the preferred solution: then the load balancer is free to pick any backend server to handle a request. However, this method of state-data handling is poorly suited to some complex business logic scenarios, where session state payload is big and recomputing it with every request on a server is not feasible. URL rewriting has major security issues because the end-user can easily alter the submitted URL and thus change session streams.


title: Load balancing (computing)

text: Yet another solution to storing persistent data is to associate a name with each block of data, and use a distributed hash table to pseudo-randomly assign that name to one of the available servers, and then store that block of data in the assigned server.


title: Load balancing (computing)

text: Hardware and software load balancers may have a variety of special features. The fundamental feature of a load balancer is to be able to distribute incoming requests over a number of backend servers in the cluster according to a scheduling algorithm. Most of the following features are vendor specific:


title: Load balancing (computing)

text: Load balancing can be useful in applications with redundant communications links. For example, a company may have multiple Internet connections ensuring network access if one of the connections fails. A failover arrangement would mean that one link is designated for normal use, while the second link is used only if the primary link fails.


title: Load balancing (computing)

text: Using load balancing, both links can be in use all the time. A device or program monitors the availability of all links and selects the path for sending packets. The use of multiple links simultaneously increases the available bandwidth.


title: Load balancing (computing)

text: TRILL (TRansparent Interconnection of Lots of Links) facilitates an Ethernet to have an arbitrary topology, and enables per flow pair-wise load splitting by way of Dijkstra's algorithm, without configuration and user intervention. The catalyst for TRILL was an event at Beth Israel Deaconess Medical Center which began on 13 November 2002. The concept of Rbridges [sic] was first proposed to the Institute of Electrical and Electronics Engineers in the year 2004, whom in 2005 rejected what came to be known as TRILL, and in the years 2006 through 2012 devised an incompatible variation known as Shortest Path Bridging.


title: Load balancing (computing)

text: The IEEE approved the IEEE 802.1aq standard in May 2012, also known as Shortest Path Bridging (SPB). SPB allows all links to be active through multiple equal-cost paths, provides faster convergence times to reduce downtime, and simplifies the use of load balancing in mesh network topologies (partially connected and/or fully connected) by allowing traffic to load share across all paths of a network. SPB is designed to virtually eliminate human error during configuration and preserves the plug-and-play nature that established Ethernet as the de facto protocol at Layer 2.


title: Load balancing (computing)

text: Many telecommunications companies have multiple routes through their networks or to external networks. They use sophisticated load balancing to shift traffic from one path to another to avoid network congestion on any particular link, and sometimes to minimize the cost of transit across external networks or improve network reliability.


title: Load balancing (computing)

text: Another way of using load balancing is in network monitoring activities. Load balancers can be used to split huge data flows into several sub-flows and use several network analyzers, each reading a part of the original data. This is very useful for monitoring fast networks like 10GbE or STM64, where complex processing of the data may not be possible at wire speed.


title: Load balancing (computing)

text: Load balancing is widely used in data center networks to distribute traffic across many existing paths between any two servers. It allows more efficient use of network bandwidth and reduces provisioning costs. In general, load balancing in datacenter networks can be classified as either static or dynamic.


title: Load balancing (computing)

text: Static load balancing distributes traffic by computing a hash of the source and destination addresses and port numbers of traffic flows and using it to determine how flows are assigned to one of the existing paths. Dynamic load balancing assigns traffic flows to paths by monitoring bandwidth use on different paths. Dynamic assignments can also be proactive or reactive. In the former case, the assignment is fixed once made, while in the latter the network logic keeps monitoring available paths and shifts flows across them as network utilization changes (with arrival of new flows or completion of existing ones). A comprehensive overview of load balancing in datacenter networks has been made available.


title: Load balancing (computing)

text: Load balancing is often used to implement failover—the continuation of service after the failure of one or more of its components. The components are monitored continually (e.g., web servers may be monitored by fetching known pages), and when one becomes unresponsive, the load balancer is informed and no longer sends traffic to it. When a component comes back online, the load balancer starts rerouting traffic to it. For this to work, there must be at least one component in excess of the service's capacity (N+1 redundancy). This can be much less expensive and more flexible than failover approaches where every single live component is paired with a single backup component that takes over in the event of a failure (dual modular redundancy). Some RAID systems can also utilize hot spare for a similar effect.


title: Grumman F-9 Cougar

text: The Grumman F9F/F-9 Cougar was a carrier-based fighter aircraft for the United States Navy and United States Marine Corps. Based on Grumman's earlier F9F Panther, the Cougar replaced the Panther's straight wing with a more modern swept wing. Thrust was also increased with the installation of a newer, more powerful engine. The Navy considered the Cougar an updated version of the Panther, despite having a different official name, and thus Cougars started off from F9F-6.


title: Grumman F-9 Cougar

text: Rumors that the Soviet Union had produced a swept-wing fighter had circulated a year before the Mikoyan-Gurevich MiG-15 first appeared at air shows in 1949. Despite the level of activity taking place with swept-wing aircraft, the Navy was not initially focused on the development of such aircraft. This was largely because the Navy's focus at the time was defending the battle group against high speed, high altitude bombers with interceptors, as well as escorting medium-range carrier-based bombers in all weather conditions. Air-to-air combat was of less interest. Nonetheless, the Navy appreciated the importance of getting a capable carrier-based swept-wing jet fighter. Grumman was awarded a contract for the development of a swept-wing fighter jet in 1951. The arrival of the MiG-15, which easily outclassed straight-wing fighters in the air war over North Korea, was a major factor.


title: Grumman F-9 Cougar

text: Prototypes were quickly produced by modifying Panthers, and the first (XF9F-6) flew on 20 September 1951. The aircraft was still subsonic, but the critical Mach number was increased from 0.79 to 0.86 at sea level and to 0.895 at 35,000 ft (10,000 m), improving performance markedly over the Panther. Instead of using conventional ailerons for roll control, the F9F-6 uses spoilers on the upper surfaces of the wing. Wing fences were soon added and the spoilers extended from the fences to the tips of the wing. The rudder pedals controlled the part of the rudder below the horizontal tail surface, while the upper portion of the rudder was controlled by a yaw damper. This allowed the Cougar to fly safely and easily without the upper portion of the tail.


title: Grumman F-9 Cougar

text: Initial production (646 airframes) was the F9F-6, delivered from mid-1952 through July 1954. The F9F-6 first flew on September 20, 1951, seven months after Grumman signed a contract with the Navy for swept-wing fighter. The first 30 production aircraft used the same J42 P-6 engine used in the F9F-5, but was then replaced by the more powerful J42 P-8 with of thrust. The J42 was a licensed version of the Rolls-Royce Nene.


title: Grumman F-9 Cougar

text: Armament was four 20 mm (.79 in) AN/M3 cannons in the nose and provisions for two bombs or drop tanks under the wings. Most were fitted with a UHF homing antenna under the nose, and some were fitted with probes for inflight refuelling. The F9F-6 used an Aero 5D-1 weapons sight with an APG-30A gun-ranging radar. The F9F-6 was later designated F-9F in 1962. Sixty were built as F9F-6P reconnaissance aircraft with cameras instead of the nose cannon.


title: Grumman F-9 Cougar

text: After withdrawal from active service, many F9F-6s were used as unmanned drones for combat training, designated F9F-6D, or as drone controllers, designated F9F-6K. The F9F-6K and the F9F-6D were redesignated the QF-9F and DF-9F, respectively.


title: Grumman F-9 Cougar

text: The F9F-7 referred to the next batch of Cougars that were given the Allison J33 also found in the F9F-4, instead of the Pratt & Whitney J48. A total of 168 were built, but the J33 proved both less powerful and less reliable than the J48. Almost all were retrofitted with the J48 engine, and were thus indistinguishable from F9F-6s. These were redesignated F-9H in 1962.


title: Grumman F-9 Cougar

text: The Navy used two modified F9F-7s to conduct experiments landing on British-inspired flexible decks which did not require the use of landing gear. The reasoning was that since an airplane's landing gear comprises some 33% of the total weight, a plane without landing gear would gain a greater range and would be able to carry more ordnance. The aircraft were fitted with a false bottom under the center fuselage to help balance the plane during landings on the flex-deck made up of a lubricated rubberized fabric. The deck, built by Goodyear was thick and featured several arresting cables. The planes were launched using a ramp and a handling dolly which served as temporary landing gear. The two F9F-7 aircraft in the test were equipped with the powerful J48-P8 engine instead of the Allison J33 engine originally used with the F9F-7. While the landing tests yielded positive results and proved that landing was clearly possible, the project was terminated in 1955 as it would have been difficult to move the aircraft around the carrier deck once they landed. It also required a highly skilled pilot to perform the landings and would have made it impossible to divert to a land base if necessary.


title: Grumman F-9 Cougar

text: Work on the F9F-8 began in April, 1953 with three goals: lower the airplane's stall speed, improve aircraft control at high angles of attack, and increase range. It featured an 8 in (20 cm) stretch in the fuselage and modified wings with a greater chord, an increased area (from ), and a dogtooth. The airframe changes improved low-speed and high angle of attack flying, and gave more room for fuel tanks. The top speed was and minimum catapult speed was lowered to . It also was now capable of breaking the sound barrier in a steep dive. All four ammunition boxes were mounted above the guns, in contrast to the split location of most previous F9Fs including the Panther. Visibility, which was already very good was improved with the F9F-8. 601 aircraft were delivered between April 1954 and March 1957. Late production F9F-8 aircraft were given the ability to carry four AIM-9 Sidewinder air-to-air missiles under the wings (the first Navy aircraft to deploy with the missiles). Most earlier aircraft were later modified to carry Sidewinders. A number were given also nuclear bombing equipment. The F9F-9 was redesignated F-9J in 1962. The F9F-8B aircraft were F9F-8s converted into single-seat attack fighters, later redesignated AF-9J. The Navy acquired 377 two-seat F9F-8T trainers between 1956 and 1960. They were used for advanced training, weapons training, and carrier training, and served until 1974. They were armed with twin 20 mm (.79 in) cannon and could carry a full bombs or missiles load. In the 1962 redesignation, these were later called TF-9J.


title: Grumman F-9 Cougar

text: A total of 110 F9F-8Ps (photo-reconnaissance) were produced with an extensively modified nose carrying cameras. They were withdrawn after 1960 to reserve squadrons. In 1962, remaining F9F-6P and F9F-8P aircraft were re-designated RF-9F and RF-9J respectively.


title: Grumman F-9 Cougar

text: The F9F was known to be highly maneuverable and easy to fly. Corky Meyer, who flew both the F9F Cougar and North American FJ-3 Fury, noted that compared to the latter the Cougar had a higher dive speed limit (Mach 1.2 vs Mach 1), a higher maneuvering limit of 7.5-g (compared to 6-g), and greater endurance.


title: Grumman F-9 Cougar

text: "[The] Combat Air patrol mission was for two hours on station at from the carrier. This required 2+30 takeoff, cruise, and landing endurance plus reserves. The F9F-6 could perform a three-hour CAP mission on internal fuel. The FJ-2 and -3 with external tanks had less that 1+30 mission time and the FJ-4 just met the mission requirement."


title: Grumman F-9 Cougar

text: The F9F Cougar was also a capable multi-role aircraft, which may explain why it was deployed less often than dedicated fighters. In spite of engine problems that plagued the FJ-3, it was deployed for a longer period than the F9F Cougar. This was more likely attributable to the fact the F9F had an attack role that was being superseded by new jets such as A4D-1 Skyhawk, rather than any deficiency as a fighter.


title: Grumman F-9 Cougar

text: "The reason the FJ-3 was deployed a little longer and a little more often (19 times vs 16) in fighter squadrons than the F9F-8 probably wasn't because it was the better fighter. More likely it was because it has a minimal capability as an attack aircraft, whereas the F9F-8 was good for that too, including nuclear weapon delivery. In effect the F9F-8 was a jet attack placeholder along with the F7U-3M, while the pipeline was being filled with the FJ-4Bs and A4Ds. As a result, the FJ-3 was the designated day fighter by default on most deployments."


title: Grumman F-9 Cougar

text: The first F9F-6s were assigned to fleet squadron VF-32 at the end of 1952. The first F9F Cougar squadron to actually deploy was VF-24, assigned to in August 1953 but arrived too late to the Korean theater to participate in the air war.


title: Grumman F-9 Cougar

text: F9F-8s were withdrawn from front-line service in 1958–59, replaced by F11F Tigers and F8U Crusaders. The Naval Reserves used them until the mid-1960s, but none of the single-seat versions were used in the Vietnam War.


title: Grumman F-9 Cougar

text: The only version of the Cougar to see combat was the TF-9J trainer (known as F9F-8T until 1962) during the Vietnam War. Detachments of four Cougars served with US Marines Headquarters and Maintenance Squadron 11 (H&MS-11) at Da Nang and H&MS-13 at Chu Lai, where they were used for fast-Forward Air Control and the airborne command role, directing airstrikes against enemy positions in South Vietnam between 1966 and 1968.


title: Grumman F-9 Cougar

text: The TF-9J two-seat trainer had a long service with the U.S. Navy. It served as the Navy's advanced flight trainer for more than two decades. The proposed Cougar modification (reengined with a J52 engine) was rejected, and the Navy selected the TA-4F Skyhawk. The last Cougar was phased out when Training Squadron 4 (VT-4) re-equipped in February 1974. A F9F-8T, BuNo 14276, is displayed at the National Naval Aviation Museum at NAS Pensacola, Florida.


title: Grumman F-9 Cougar

text: The US Navy used the F9F Cougar to set the transcontinental crossing record on April 1, 1954. Three pilots from fleet fighter squadron VF-21 completed the flight in under four hours with LCDR F.X. Brady setting the quickest time of 3 hours, 45 minutes and 30 seconds. This was the first time the distance had been covered in under four hours. The three F9F-6 aircraft refueled over Kansas from a North American AJ Savage, using an experimental refueling probe mounted on the nose.


title: Grumman F-9 Cougar

text: The U.S. Navy's flight demonstration team, the Blue Angels flew four different variants of F9Fs from the F9F-2 Panther to the F9F-8. The Blue Angels replaced their six F9F-5 Panthers with six F9F-6s in 1953. This was short lived however and the Navy subsequently took them for fleet use without using the planes in an air show. The F9F-6s were then replaced with overhauled F9F-5s until 1954 when the Blue Angels switched to the F9F-8. The Blue Angels used the F9F-8 until 1957 they were replaced by the Grumman F11F-1 Tiger, although one two-seat F9F-8T was retained for press and VIP flights.


title: Grumman F-9 Cougar

text: The only foreign air arm to use the F9F Cougar was the Argentine Naval Aviation, who also used the F9F Panther as well. Two F9F-8T trainers were acquired in 1962, and served until 1971. The Cougar was the first jet to break the sound barrier in Argentina. One aircraft (serial 3-A-151) is on display at the Naval Aviation Museum (MUAN) at Bahía Blanca, while the other was sold to a customer in the United States and subsequently lost in an accident on 31 October 1991.


title: Mahamat Déby

text: Mahamat Idriss Déby Itno (; born 1 January 1984), also known as Mahamat Kaka, is a Chadian army general serving as the transitional president of Chad. He is the son of the late Chadian President Idriss Déby. He gained power as the president of the Transitional Military Council on 20 April 2021 when his father, Idriss Déby died in action while commanding troops in the Northern Chad offensive. He previously served as the second in-command of the military for the Chadian Intervention in Northern Mali (FATIM).


title: Mahamat Déby

text: Mahamat Déby is polygamous and has three wives. His first wife is an ethnic Zaghawa woman. In 2010, Déby married his second wife, a Central African woman and the daughter of Abakar Sabon, a former Central African Republic government minister, advisor to Michel Djotodia, and leader of the Movement of Central African Liberators for Justice rebel group. It is believed that Déby and his second wife have five children.


title: Mahamat Déby

text: Mahamat Déby's third wife, Dahabaya Oumar Souni, is a journalist and media advisor who is considered the First Lady of Chad. Souni worked closely with her late father-in-law, President Idriss Déby, and was promoted to director of public relations for the office of the presidency from December 2019 until his death. In May 2021, Dahabaya Oumar Souni was appointed as media advisor to the presidency of the Transitional Military Council and now works alongside her husband, President Mahamat Déby, as a member of his group of technical advisors.


title: Mahamat Déby

text: Mahamat Déby first enrolled at the Joint Grouping of military schools in Chad. He subsequently received training in France, at the military school of Aix-en-Provence. Upon his return he was enrolled in second promotion of semi direct of the school of officer inter arme and later was appointed to the service branch for the Security of State Institutions (SERS), as a deputy commander of the groupement of infenterie. His first combat experience took place in April 2006 when rebels attacked the capital city of Chad and later participated in combat in eastern Chad along with General Abu Bakr al Said, then director of gendarmery, Mahamat was given the rank of major afterward. He led forces when he took part in the command of Chadian forces during the Battle of Am Dam, where his army defeated the rebels.


title: Mahamat Déby

text: Following his victory, he was appointed in command of the armored squadrons and bodyguards of the SERS. In January 2013, he was appointed second in command of the Chadian special forces in Mali under general Oumar Bikimo. On 22 February, he led his army against rebels in the Adrar al-Ifoghas mountains in Northern Mali leading to the Battle of al-Ifoghas. They eliminated a rebel base said to be of "significant importance", inflicting heavy losses upon the rebels but also losing twenty-six men in the process, including Abdel Aziz Hassane Adam, a commander of special forces. Mahamat took full command of the FATIM and has since been leading operations against rebels in the North.


title: Mahamat Déby

text: After Mahamat's father, Idriss Déby, died at the hands of FACT on 20 April 2021, the military announced that the elected government and National Assembly have been dissolved and that a Transitional Military Council led by Mahamat will lead the nation for 18 months. A new charter replaced the Constitution of Chad, making Mahamat the interim President and head of the armed forces.


title: Mahamat Déby

text: Some political actors within Chad have labeled the installing of the transitional military government a "coup", as the constitutional provisions regarding the filling of a presidential vacancy were not followed. Namely, according to the constitution, the President of the National Assembly, Haroun Kabadi, should have been named Acting President after president Idriss Déby's death, and an early election called within a period of no less than 45 and no more than 90 days from the time of the vacancy. However, one of Chad's main foreign policy allies, France, has defended the development as necessary, citing the "exceptional circumstances" caused by the rebellion. Furthermore, the FACT rebels have issued an open threat to the new government, stating that "Chad is not a monarchy" and vowing to continue fighting until they reach N'Djamena and depose Mahamat Déby from power.


title: Mahamat Déby

text: After initially refusing to negotiate with insurgent groups, Déby softened his stance in August 2021, proposing a national dialogue. After his proposal was met with approval by rebel groups, talks between government and rebel representatives started two months later. The national dialogue between Déby's government and the opposition was supposed to prepare the country for elections scheduled for the second half of 2022.


title: Emergency medical services

text: Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.


title: Emergency medical services

text: In most places, the EMS can be summoned by members of the public (as well as medical facilities, other emergency services, businesses and authorities) via an emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource for the situation. Ambulances are the primary vehicles for delivering EMS, though some also use squad cars, motorcycles, aircraft, or boats. EMS agencies may also operate a non-emergency patient transport service, and some have rescue squads to provide technical rescue services.


title: Emergency medical services

text: As a first resort the EMS provide treatment on the scene to those in need of urgent medical care. If it is deemed necessary, they are tasked with transferring the patient to the next point of care. This is most likely an emergency department of a hospital. Historically, ambulances only transported patients to care, and this remains the case in parts of the developing world. The term "emergency medical service" was popularised when these services began to emphasise diagnosis and treatment at the scene. In some countries, a substantial portion of EMS calls do not result in a patient being taken to hospital.


title: Emergency medical services

text: Training and qualification levels for members and employees of emergency medical services vary widely throughout the world. In some systems, members may be present who are qualified only to drive ambulances, with no medical training. In contrast, most systems have personnel who retain at least basic first aid certifications, such as basic life support (BLS). In English-speaking countries, they are known as emergency medical technicians (EMTs) and paramedics, with the latter having additional training such as advanced life support (ALS) skills. Physicians and nurses also provide pre-hospital care to varying degrees in different countries.


title: Emergency medical services

text: Emergency care in the field has been rendered in different forms since the beginning of recorded history. The New Testament contains the parable of the Good Samaritan, in which a man who has been beaten is cared for by a passing Samaritan. Luke 10:34 (NIV) – "He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him." During the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield.


title: Emergency medical services

text: The first use of the ambulance as a specialized vehicle, in battle came about with the "ambulances volantes" designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte's chief surgeon. Larrey was present at the battle of Spires, between the French and Prussians, and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, and set about developing a new ambulance system. Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the (active) battlefield "after" they had received early treatment in the field. Larrey's projects for 'flying ambulances' were first approved by the Committee of Public Safety in 1794. Larrey subsequently entered Napoleon's service during the Italian campaigns in 1796, where his ambulances were used for the first time at Udine, Padua and Milan, and he adapted his ambulances to the conditions, even developing a litter which could be carried by a camel for a campaign in Egypt.


title: Emergency medical services

text: A major advance was made (which in future years would come to shape policy on hospitals and ambulances) with the introduction of a transport carriage for cholera patients in London during 1832. The statement on the carriage, as printed in "The Times", said "The curative process commences the instant the patient is put in to the carriage; time is saved which can be given to the care of the patient; the patient may be driven to the hospital so speedily that the hospitals may be less numerous and located at greater distances from each other". This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, displays itself in modern emergency medical planning.


title: Emergency medical services

text: The first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio (now the Cincinnati General) by 1865. This was soon followed by other services, notably the New York service provided out of Bellevue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine.


title: Emergency medical services

text: Another early ambulance service was founded by Jaromir V. Mundy, Count J. N. Wilczek, and Eduard Lamezan-Salins in Vienna after the disastrous fire at the Vienna Ringtheater in 1881. Named the "Vienna Voluntary Rescue Society," it served as a model for similar societies worldwide.


title: Emergency medical services

text: In June 1887 the St John Ambulance Brigade was established to provide first aid and ambulance services at public events in London. It was modelled on a military-style command and discipline structure.


title: Emergency medical services

text: Also in the late 19th century, the automobile was being developed, and in addition to horse-drawn models, early 20th century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. However, the first motorized ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated by 500 prominent local businessmen, in February 1899. This was followed in 1900 by New York City, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two automobile ambulances were electrically powered with 2 hp motors on the rear axle.


title: Emergency medical services

text: During World War I, further advances were made in providing care before and during transport; traction splints were introduced during the war and were found to have a positive effect on the morbidity and mortality of patients with leg fractures. Two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Prior to World War II, there were some areas where a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses, the only available vehicle that could carry a recumbent patient, and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars.


title: Emergency medical services

text: Prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations. City governments in many cases turned ambulance services over to the police or fire department. No laws required minimal training for ambulance personnel and no training programs existed beyond basic first aid. In many fire departments, assignment to ambulance duty became an unofficial form of punishment.


title: Emergency medical services

text: Advances in the 1960s, especially the development of CPR and defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances. In Belfast, Northern Ireland the first experimental mobile coronary care ambulance successfully resuscitated patients using these technologies. Freedom House Ambulance Service was the first civilian emergency medical service in the United States to be staffed by paramedics, most of which were black.


title: Emergency medical services

text: One well-known report in the US during that time was "", also known as "The White Paper". The report concluded that ambulance services in the US varied widely in quality and were often unregulated and unsatisfactory. These studies placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. The government reports resulted in the creation of standards in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), and the equipment (and thus weight) that an ambulance had to carry, and several other factors.


title: Emergency medical services

text: In 1971 a progress report was published at the annual meeting, by the then president of American Association of Trauma, Sawnie R. Gaston M.D. Dr. Gaston reported the study was a "superb white paper" that "jolted and wakened the entire structure of organized medicine." This report is created as a "prime mover" and made the "single greatest contribution of its kind to the improvement of emergency medical services". Since this time a concerted effort has been undertaken to improve emergency medical care in the pre-hospital setting. Such advancements included Dr. R Adams Cowley creating the country's first statewide EMS program, in Maryland.


title: Emergency medical services

text: The developments were paralleled in other countries. In the United Kingdom, a 1973 law merged the municipal ambulance services into larger agencies and set national standards. In France, the first official SAMU agencies were founded in the 1970s.


title: Emergency medical services

text: Depending on country, area within country, or clinical need, emergency medical services may be provided by one or more different types of organization. This variation may lead to large differences in levels of care and expected scope of practice. Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.


title: Emergency medical services

text: Operating separately from (although alongside) the fire and police services of the area, these ambulances are funded by local, provincial or national governments. In some countries, these only tend to be found in big cities, whereas in countries such as the United Kingdom, almost all emergency ambulances are part of a national health system.


title: Emergency medical services

text: In the United States, ambulance services provided by a local government are often referred to as "third service" EMS (the fire department, police department, and separate EMS forming an emergency services trio) by the employees of said service, as well as other city officials and residents. The most notable examples of this model in the United States are Pittsburgh Bureau of Emergency Medical Services (PEMS), Boston EMS, New Orleans Emergency Medical Services, Austin-Travis County Emergency Medical Services, Cleveland EMS, Wake County Emergency Medical Services and Honolulu EMS . Government ambulance services also have to take civil service exams just like government fire departments and police. In the United States, certain federal government agencies employ emergency medical technicians at the basic and advanced life support levels, such as the National Park Service and the Federal Bureau of Prisons.


title: Emergency medical services

text: In countries such as the United States, Japan, France, South Korea and parts of India, ambulances can be operated by the local fire or police services. Fire-based EMS is the most common model in the United States, where nearly all urban fire departments provide EMS and a majority of emergency transport ambulance services in large cities are part of fire departments. It is somewhat rare for a police department in the United States to provide EMS or ambulance services, although many police officers have basic medical training. One notable example is New Orleans Emergency Medical Services, which was formed as a hospital-based service, was operated by the New Orleans Police Department from 1947 to 1985, and is currently operated by the New Orleans Health Department and the New Orleans Office of Homeland Security and Emergency Preparedness, separate from the New Orleans Fire Department.


title: Emergency medical services

text: Charities or non-profit companies operate some emergency medical services. They are primarily staffed by volunteers, though some have paid personnel. These may be linked to a volunteer fire service, and some volunteers may provide both services. Some ambulance charities specialize in providing cover at public gatherings and events (e.g. sporting events), while others provide care to the wider community.


title: Emergency medical services

text: The International Red Cross and Red Crescent Movement is the largest charity in the world that provides emergency medicine. (in some countries, it operates as a private ambulance service). Other organisations include St John Ambulance, the Order of Malta Ambulance Corps and Hatzalah, as well as small local volunteer agencies. In the United States, volunteer ambulances are rarer, but can still be seen in both metropolitan and rural areas (e.g. Hatzalah). Charities such as BASICS Scotland, specialise in facilitating training medical professionals to volunteer to assist the statutory ambulance services in the care of patients, through their attendance at those with serious illnesses or injuries.


title: Emergency medical services

text: A few charities provide ambulances for taking patients on trips or vacations away from hospitals, hospices or care homes where they are in long-term care. Examples include the UK's Jumbulance project.


title: Emergency medical services

text: Some ambulances are operated by commercial companies with paid employees, usually on a contract to the local or national government, Hospital Networks, Health Care Facilities and Insurance Companies.


title: Emergency medical services

text: In the USA private ambulance companies provide 911 emergency services in large cities as well as most rural areas by contracting with local governments. In areas that the local County or City provide their own 911 service, private companies provide discharges and transfers from hospitals and to/from other health related facilities and homes. In most areas private companies are part of the local government Emergency Disaster plan, and are relied upon heavily for the overall EMS response, treatment and recovery.


title: Emergency medical services

text: In some areas, private companies may provide only the patient transport elements of ambulance care (i.e. non-urgent), but in some places, they are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy. This may mean that a government or other service provide the 'emergency' cover, whilst a private firm may be charged with 'minor injuries' such as cuts, bruises or even helping the mobility-impaired if they have for example fallen and simply need help to get up again, but do not need treatment. This system has the benefit of keeping emergency crews available at all times for genuine emergencies. These organisations may also provide services known as 'Stand-by' cover at industrial sites or at special events. In Latin America, private ambulance companies are often the only readily-available EMS service


title: Emergency medical services

text: These are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where demand or budget is too low to support separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.


title: Emergency medical services

text: Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.


title: Emergency medical services

text: Many large factories and other industrial centres, such as chemical plants, oil refineries, breweries and distilleries have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.


title: Emergency medical services

text: Emergency medical services exists to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery.


title: Emergency medical services

text: This common theme in medicine is demonstrated by the "star of life". The Star of Life shown here, where each of the 'arms' to the star represent one of the six points, are used to represent the six stages of high quality pre-hospital care, which are:


title: Emergency medical services

text: Although a variety of differing philosophical approaches are used in the provision of EMS care around the world, they can generally be placed into one of two categories; one physician-led and the other led by pre-hospital allied health staff such as emergency medical technicians or paramedics. These models are commonly referred to as the Franco-German model and Anglo-American model.


title: Emergency medical services

text: Studies have been inconclusive as to whether one model delivers better results than the other. A 2010 study in the Oman Medical Journal suggested that rapid transport was a better strategy for trauma cases, while stabilization at the scene was a better strategy for cardiac arrests.


title: Emergency medical services

text: Many systems have tiers of response for medical emergencies. For example, a common arrangement in the United States is that fire engines or volunteers are sent to provide a rapid initial response to a medical emergency, while an ambulance is sent to provide advanced treatment and transport the patient. In France, fire service and private company ambulances provide basic care, while hospital-based ambulances with physicians on board provide advanced care. In many countries, an air ambulance provides a higher level of care than a regular ambulance.


title: Emergency medical services

text: The most basic emergency medical services are provided as a transport operation only, simply to take patients from their location to the nearest medical treatment. This was historically the case in all countries. It remains the case in much of the developing world, where operators as diverse as taxi drivers and undertakers may transport people to hospital.


title: Emergency medical services

text: The Anglo-American model is also known as "load and go" or "scoop and run". In this model, ambulances are staffed by paramedics and/or emergency medical technicians. They have specialized medical training, but not to the same level as a physician. In this model it is rare to find a physician actually working routinely in ambulances, although they may be deployed to major or complex cases. The physicians who work in EMS provide oversight for the work of the ambulance crews. This may include off-line medical control, where they devise protocols or 'standing orders' (procedures for treatment). This may also include on-line medical control, in which the physician is contacted to provide advice and authorization for various medical interventions.


title: Emergency medical services

text: In some cases, such as in the UK, South Africa and Australia, a paramedic may be an autonomous health care professional, and does not require the permission of a physician to administer interventions or medications from an agreed list, and can perform roles such as suturing or prescribing medication to the patient. Recently "Telemedicine" has been making an appearance in ambulances. Similar to online medical control, this practice allows paramedics to remotely transmit data such as vital signs and 12 and 15 lead ECGs to the hospital from the field. This allows the emergency department to prepare to treat patients prior to their arrival. This is allowing lower level providers (Such as EMT-B) in the United States to utilize these advanced technologies and have the doctor interpret them, thus bringing rapid identification of rhythms to areas where paramedics are stretched thin. While most insurance companies only reimburse EMS providers for transporting patients to 911 receiving facilities (e.g. Emergency Departments),the Center to Medicare and Medicaid Services is in the process of evaluating a payment model to enable reimbursement for patients evaluated and treated on-scene.


title: Emergency medical services

text: The essential decision in prehospital care is whether the patient should be immediately taken to the hospital, or advanced care resources are taken to the patient where they lie. The "scoop and run" approach is exemplified by the MEDEVAC aeromedical evacuation helicopter, whereas the "stay and play" is exemplified by the French and Belgian SMUR emergency mobile resuscitation unit or the German "Notarzt"-System (preclinical emergency physician).


title: Emergency medical services

text: The strategy developed for prehospital trauma care in North America is based on the Golden Hour theory, i.e., that a trauma victim's best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This appears to be true in cases of internal bleeding, especially penetrating trauma such as gunshot or stab wounds. Thus, minimal time is spent providing prehospital care (spine immobilization; "ABCs", i.e. ensure "a"irway, "b"reathing and "c"irculation; external bleeding control; endotracheal intubation) and the victim is transported as fast as possible to a trauma centre.


title: Emergency medical services

text: The aim in "Scoop and Run" treatment is generally to transport the patient within ten minutes of arrival, hence the birth of the phrase, "the platinum ten minutes" (in addition to the "golden hour"), now commonly used in EMT training programs. The "Scoop and Run" is a method developed to deal with trauma, rather than strictly medical situations (e.g. cardiac or respiratory emergencies), however, this may be changing. Increasingly, research into the management of S-T segment elevation myocardial infarctions (STEMI) occurring outside of the hospital, or even inside community hospitals without their own PCI labs, suggests that time to treatment is a clinically significant factor in heart attacks, and that trauma patients may not be the only patients for whom 'load and go' is clinically appropriate. In such conditions, the gold standard is the door to balloon time. The longer the time interval, the greater the damage to the myocardium, and the poorer the long-term prognosis for the patient. Current research in Canada has suggested that door to balloon times are significantly lower when appropriate patients are identified by paramedics in the field, instead of the emergency room, and then transported directly to a waiting PCI lab. The STEMI program has reduced STEMI deaths in the Ottawa region by 50 per cent. In a related program in Toronto, EMS has begun to use a procedure of 'rescuing' STEMI patients from the Emergency Rooms of hospitals without PCI labs, and transporting them, on an emergency basis, to waiting PCI labs in other hospitals.


title: Emergency medical services

text: Physician-led EMS is also known as the Franco-German model, "stay and play", "stay and stabilize" or "delay and treat". In a physician-led system, doctors respond directly to all major emergencies requiring more than simple first aid. The physicians will attempt to treat casualties at the scene and will only transport them to hospital if it is deemed necessary. If patients are transported to hospital, they are more likely to go straight to a ward rather than to an emergency department. Countries that use this model include Austria, France, Belgium, Luxembourg, Italy, Spain, Brazil and Chile.


title: Emergency medical services

text: In some cases in this model, such as France, there is no direct equivalent to a paramedic. Physicians and (in some cases) nurses provide all medical interventions for the patient. Other ambulance personnel are not non-medically trained and only provide driving and heavy lifting. In other applications of this model, as in Germany, a paramedic equivalent does exist, but is an assistant to the physician with a restricted scope of practice. They are only permitted to perform Advanced Life Support (ALS) procedures if authorized by the physician, or in cases of immediate life-threatening conditions. Ambulances in this model tend to be better equipped with more advanced medical devices, in essence, bringing the emergency department to the patient. High-speed transport to hospitals is considered, in most cases, to be unnecessarily unsafe, and the preference is to remain and provide definitive care to the patient until they are medically stable, and then accomplish transport. In this model, the physician and nurse may actually staff an ambulance along with a driver, or may staff a rapid response vehicle instead of an ambulance, providing medical support to multiple ambulances.


title: Emergency medical services

text: Ambulance personnel are generally professionals and in some countries their use is controlled through training and registration. While these job titles are protected by legislation in some countries, this protection is by no means universal, and anyone might, for example, call themselves an 'EMT' or a 'paramedic', regardless of their training, or the lack of it. In some jurisdictions, both technicians and paramedics may be further defined by the environment in which they operate, including such designations as 'Wilderness', 'Tactical', and so on.


title: Emergency medical services

text: A unique aspect of EMS is that there are two hierarchies of authority, as the chain of command is separate to medical authority.


title: Emergency medical services

text: Certified first responders may be sent to provide first aid, sometimes to an advanced level. Their duties include the provision of immediate life-saving care in the event of a medical emergency; commonly advanced first aid, oxygen administration, cardio-pulmonary resuscitation (CPR), and automated external defibrillator (AED) usage. The first responder training is considered a bare minimum for emergency service workers who may be sent out in response to an emergency call. First responders are commonly dispatched by the ambulance service to arrive quickly and stabilize the patient before the ambulance arrives, and to then assist the ambulance crew.


title: Emergency medical services

text: Some EMS agencies have set up volunteer schemes, who can be dispatched to a medical emergency before the ambulance arrives. Examples of this include Community First Responder schemes run by ambulance services the UK and similar volunteer schemes operated by the fire services in France. In some countries such as the US, there may be autonomous groups of volunteer responders such as rescue squads. Police officers and firefighters who are on duty for another emergency service may also be deployed in this role, though some firefighters are trained to a more advanced medical level.


title: Emergency medical services

text: Besides first responders who are deployed to an emergency, there are others who may be stationed at public events. The International Red Cross and Red Crescent Movement and St John Ambulance both provide first aiders in these roles.


title: Emergency medical services

text: Some agencies separate the 'driver' and 'attendant' functions, employing ambulance driving staff with no medical qualification (or just a first aid and CPR certificates), whose job is to drive ambulances. While this approach persists in some countries, such as India, it is generally becoming increasingly rare. Ambulance drivers may be trained in radio communications, ambulance operations and emergency response driving skills.


title: Emergency medical services

text: Many countries employ ambulance staff who only carry out non-emergency patient transport duties (which can include stretcher or wheelchair cases). Dependent on the provider (and resources available), they may be trained in first aid or extended skills such as use of an AED, oxygen therapy, pain relief and other live-saving or palliative skills. In some services, they may also provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic. The role is known as an Ambulance Care Assistant in the United Kingdom.


title: Emergency medical services

text: Emergency medical technicians, also known as Ambulance Technicians in the UK and EMT in the United States. In the United States, EMT is usually made up of 3 levels. EMT-B, EMT-I (EMT-A in some states) and EMT-Paramedic. The National Registry of EMT New Educational Standards for EMS renamed the provider levels as follows: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic. EMTs are usually able to perform a wide range of emergency care skills, such as automated defibrillation, care of spinal injuries and oxygen therapy. In few jurisdictions, some EMTs are able to perform duties as IV and IO cannulation, administration of a limited number of drugs (including but not limited to Epinephrine, Narcan, Oxygen, Aspirin, Nitroglycerin - dependent on country, state, and medical direction), more advanced airway procedures, CPAP, and limited cardiac monitoring. Most advanced procedures and skills are not within the national scope of practice for an EMT. As such most states require additional training and certifications to perform above the national curriculum standards. In the US, an EMT certification requires intense courses and training in field skills. A certification expires after two years and holds a requirement of taking 48 CEUs (continuing education credits). 24 of these credits must be in refresher courses while the other 24 can be taken in a variety ways such as emergency driving training, pediatric, geriatric, or bariatric care, specific traumas, etc.


title: Emergency medical services

text: An emergency medical dispatcher is also called an EMD. An increasingly common addition to the EMS system is the use of highly trained dispatch personnel who can provide "pre-arrival" instructions to callers reporting medical emergencies. They use carefully structured questioning techniques and provide scripted instructions to allow callers or bystanders to begin definitive care for such critical problems as airway obstructions, bleeding, childbirth, and cardiac arrest. Even with a fast response time by a first responder measured in minutes, some medical emergencies evolve in seconds. Such a system provides, in essence, a "zero response time," and can have an enormous impact on positive patient outcomes.


title: Emergency medical services

text: A paramedic has a high level of pre-hospital medical training and usually involves key skills not performed by technicians, often including cannulation (and with it the ability to use a range of drugs to relieve pain, correct cardiac problems, and perform endotracheal intubation), cardiac monitoring, ultrasound, intubation, pericardiocentesis, cardioversion, thoracostomy, and other skills such as performing a surgical cricothyrotomy. The most important function of the paramedic is to identify and treat any life-threatening conditions and then to assess the patient carefully for other complaints or findings that may require emergency treatment. In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecution. In the United States, paramedics represent the highest licensure level of prehospital emergency care. In addition, several certifications exist for Paramedics such as Wilderness ALS Care, Flight Paramedic Certification (FP-C), and Critical Care Emergency Medical Transport Program certification.


title: Emergency medical services

text: A critical care paramedic, also known as an advanced practice paramedic or specialist paramedic, is a paramedic with additional training to deal with critically ill patients. Critical care paramedics often work on air ambulances, which are more likely to be dispatched to emergencies requiring advanced care skills. They may also work on land ambulances. The training, permitted skills, and certification requirements vary from one jurisdiction to the next. It also varies to whether they are trained externally by a university or professional body or 'in house' by their EMS agency.


title: Emergency medical services

text: These providers have a vast array of and medications to handle complex medical and trauma patients. Examples of medication are dopamine, dobutamine, propofol, blood and blood products to name just a few. Some examples of skills include, but not limited to, life support systems normally restricted to the ICU or critical care hospital setting such as mechanical ventilators, Intra-aortic balloon pump (IABP) and external pacemaker monitoring. Depending on the service medical direction, these providers are trained on placement and use of UVCs (Umbilical Venous Catheter), UACs (Umbilical Arterial Catheter), surgical airways, central lines, arterial lines and chest tubes.


title: Emergency medical services

text: In the United Kingdom and South Africa, some serving paramedics receive additional university education to become practitioners in their own right, which gives them absolute responsibility for their clinical judgement, including the ability to autonomously prescribe medications, including drugs usually reserved for doctors, such as courses of antibiotics. An emergency care practitioner is a position that is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are university graduates in Emergency Medical Care or qualified paramedics who have undergone further training, and are authorized to perform specialized techniques. Additionally some may prescribe medicines (from a limited list) for longer-term care, such as antibiotics. With respect to a Primary Health Care setting, they are also educated in a range of Diagnostic techniques.


title: Emergency medical services

text: The use of registered nurses (RNs) in the pre-hospital setting is common in many countries in absence of paramedics. In some regions of the world nurses are the primary healthcare worker that provides emergency medical services. In European countries such as France or Italy, also use nurses as a means of providing ALS services. These nurses may work under the direct supervision of a physician, or, in rarer cases, independently. In some places in Europe, notably Norway, paramedics do exist, but the role of the 'ambulance nurse' continues to be developed, as it is felt that nurses may bring unique skills to some situations encountered by ambulance crews.


title: Emergency medical services

text: In North America, and to a lesser extent elsewhere in the English-speaking world, some jurisdictions use specially trained nurses for medical transport work. These are mostly air-medical personnel or critical care transport providers, often working in conjunction with a technician, paramedic or physician on emergency interfacility transports. In the United States, the most common uses of ambulance-based registered nurses is in the Critical Care/Mobile Intensive Care transport, and in Aeromedical EMS. Such nurses are normally required by their employers (in the US) to seek additional certifications beyond the primary nursing licensure. Four individual states have an Intensive Care or Prehospital Nurse licensure. Many states allow registered nurses to also become registered paramedics according to their role in the emergency medical services team. In Estonia 60% of ambulance teams are led by nurse. Ambulance nurses can do almost all emergency procedures and administer medicines pre-hospital such as physicians in Estonia. In the Netherlands, all ambulances are staffed by a registered nurse with additional training in emergency nursing, anaesthesia or critical care, and a driver-EMT. In Sweden, since 2005, all emergency ambulances should be staffed by at least one registered nurse since only nurses are allowed to administer drugs. And all Advanced Life Support Ambulances are staffed at least by a registered nurse in Spain. In France, since 1986, fire department-based rescue ambulances have had the option of providing resuscitation service (reanimation) using specially trained nurses, operating on protocols, while SAMU-SMUR units are staffed by physicians and nurses


title: Emergency medical services

text: In countries with a physician-led EMS model, such as France, Italy, the German-speaking countries (Germany, Switzerland, Austria), and Spain, physicians respond to all cases that require more than basic first aid. In some versions of this model (such as France, Italy, and Spain), there is no direct equivalent to a paramedic, as ALS is performed by physicians. In the German-speaking countries, paramedics are assistants to ambulance physicians (called Notarzt). In these countries, if a physician is present, paramedics require permission from the physician to administer treatments such as defibrillation and drugs. If there is no physician on scene and a life-threatening condition is present, they may administer treatments that follow the physician's instructions.


title: Emergency medical services

text: In countries where EMS is led by paramedics, the ambulance service may still employ physicians. They may serve on specialist response vehicles, such as the air ambulances in the UK. They may also provide advice and devise protocols for treatment, with a medical director acting as the most senior medical adviser to the ambulance service. In the United States, EMS became an officially recognized subspecialty by the American Board of Emergency Medicine in 2010, and the first examinations were held in 2013. Many states now recommend EMS board certifiction for newly hired Medical Directors of EMS agencies.


title: Emergency medical services

text: Air ambulances often complement a land ambulance service. In some remote areas, they may even form the primary ambulance service. Like many innovations in EMS, medical aircraft were first used in the military. One of the first recorded aircraft rescues of a casualty was in 1917 in Turkey, when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a de Havilland DH9. In 1928, the first civilian air medical service was founded in Australia to provide healthcare to people living in remote parts of the Outback. This service became the Royal Flying Doctor Service. The use of helicopters was pioneered in the Korean War, when time to reach a medical facility was reduced from 8 hours to 3 hours in World War II, and again to 2 hours by the Vietnam War.


title: Emergency medical services

text: Aircraft can travel faster and operate in a wider coverage area than a land ambulance. They have a particular advantage for major trauma injuries. The well-established theory of the golden hour suggests that major trauma patients should be transported as quickly as possible to a specialist trauma center. Therefore, medical responders in a helicopter can provide both a higher level of care at the scene, faster transport to a specialist hospital and critical care during the journey. A disadvantage is that it can be dangerous and potentially not possible for them to fly at night or in bad weather.


title: Emergency medical services

text: Some EMS agencies have set up specialist teams to help those injured in a major incident or a dangerous situation. These include tactical police operations, active shooters, bombings, hazmat situations, building collapses, fires and natural disasters. In the US, these are often known as Tactical EMS teams and are often deployed alongside police SWAT teams. The equivalent in UK ambulance services is a Hazardous Area Response Team (HART).


title: Emergency medical services

text: Wilderness EMS-like systems (WEMS) have been developed to provide medical responses in remote areas, which may have significantly different needs to an urban area. Examples include the National Ski Patrol or the regional-responding Appalachian Search and Rescue Conference (USA based). Like traditional EMS providers, all wilderness emergency medical (WEM) providers must still operate under on-line or off-line medical oversight. To assist physicians in the skills necessary to provide this oversight, the Wilderness Medical Society and the National Association of EMS Physicians jointly supported the development in 2011 of a unique "Wilderness EMS Medical Director" certification course, which was cited by the Journal of EMS as one of the Top 10 EMS Innovations of 2011. Skills taught in WEMT courses exceeding the EMT-Basic scope of practice include catheterization, antibiotic administration, use of intermediate Blind Insertion Airway Devices (i.e. King Laryngeal Tube), Nasogastric Intubation, and simple suturing; however, the scope of practice for the WEMT still falls under BLS level care. A multitude of organizations provide WEM training, including private schools, non-profit organizations such as the Appalachian Center for Wilderness Medicine and the Wilderness EMS Institute, military branches, community colleges and universities, EMS-college-hospital collaborations, and others.


title: Vero Beach, Florida

text: Vero Beach is a city in and the seat of Indian River County, Florida, United States. Vero Beach is the second most populous city in Indian River County. Abundant in beaches and wildlife, Vero Beach is located on Florida's Treasure Coast. It is thirty-four miles south of Melbourne, Florida. According to the U.S. Census Bureau's 2010 data, the city had a population of 15,220.


title: Vero Beach, Florida

text: Parts of a human skeleton were found north of Vero in association with the remains of Pleistocene animals in 1915. The find was controversial, and the view that the human remains dated from much later than the Pleistocene prevailed for many years. In 2006, an image of a mastodon or mammoth carved on a bone was found in vicinity of the Vero man discovery. A scientific forensic examination of the bone found the carving had probably been done in the Pleistocene. Archaeologists from Mercyhurst University, in conjunction with the Old Vero Ice Age Sites Committee (OVIASC), conducted excavations at the Old Vero Man site in Vero Beach in 2014–2015. Starting in 2016, archaeologists from Florida Atlantic University joined the Old Vero Man site excavations.


title: Vero Beach, Florida

text: In 1715, a Spanish treasure fleet wrecked off the coast of Vero. Eleven out of twelve Spanish ships carrying tonnes of silver foundered in a hurricane. The remains of the silver attracted pirates. A group of 300 unemployed English privateers led by Henry Jennings stole about £87,500 in gold and silver in their first acts of piracy. The coins still wash to the shore to this day.


title: Vero Beach, Florida

text: In 1872 Captain Allen W. Estes officially established the first land patent between the Atlantic Ocean and the Indian River Lagoon, after settling in the area in 1870.


title: Vero Beach, Florida

text: Vero was officially renamed "Vero Beach" and was switched from being part of St. Lucie County to become the county seat of Indian River County when it was formed in June, 1925. There are many theories on possible origin of the city name, but there's no consensus. Early residential construction in the area often utilized Florida cracker architecture style.


title: Vero Beach, Florida

text: During the war year of 1942 the U.S. Navy selected surrounding the Vero Beach Municipal Airport as the site of Fort Pierce Naval Amphibious Training Base, a Naval Air Station. Due to the bombing practices conducted during the WWII, there are many buried explosives and the Army Corps officials have conducted ongoing search & clearing exercises for the potentially dangerous items since 2014.


title: Vero Beach, Florida

text: In 1951 Barber Bridge was built from mainland to barrier islands. It was later demolished and replaced in 1995 with the Merrill P. Barber Bridge. It is named after Merrill P. Barber who was the mayor of Vero beach in 1947.


title: Vero Beach, Florida

text: In 1957 Piper Aircraft began research and development in Vero Beach. In 1961 Piper Aircraft moved administrative and manufacturing operations to Vero after completing building additions.


title: Vero Beach, Florida

text: In 1965 the A1A bridge over the Sebastian Inlet connected the two barrier islands. In 1979, the 17th Street Bridge was completed, allowing a second point of access from Vero Beach mainland to the barrier islands.


title: Vero Beach, Florida

text: As of the 2010 census, there were 15,220 people, 7,505 households, and 3,946 families residing in the city. There were 10,258 housing units. The racial makeup of the city was 87.5% White, 4.8% Black, 0.30% Native American, 1.8% Asian, 0.00% Pacific Islander, 3.7% from other races, and 1.8% from two or more races. Hispanic or Latino of any race were 10.7% of the population.


title: Vero Beach, Florida

text: There were 7,505 households, out of which 16.5% had children under the age of 18 living with them, 39.2% were married couples living together, 9.3% had a female householder with no husband present, and 47.4% were non-families. 19.6% had someone living alone who was 65 years of age or older, with 4.8% being 85 years and older. The average household size was 2.01 and the average family size was 2.65.


title: Vero Beach, Florida

text: In the city the population was spread out, with 14.1% under the age of 16, 84.1% over 18, 4.3% from 15 to 19, 4.9% from 20 to 24, 5.5% from 20 to 25 and 29.4% who were 65 years of age or older. The median age was 50.9 years.


title: Vero Beach, Florida

text: For every 100 females, there were 92.8 males. The population consists of 51.3% female and 48.7% male.


title: Vero Beach, Florida

text: Vero Beach is home to general aviation manufacturer Piper Aircraft, which is the largest private employer in Indian River County. As of July 2015, Piper employed approximately 750 people. Aside from Piper, the bulk of commercial activity in Vero Beach centers around tourism, the citrus industry and service activities.


title: Vero Beach, Florida

text: There are two shopping malls: the Indian River Mall, and the Vero Beach Outlets just west of I-95 on State Road 60.


title: Vero Beach, Florida

text: There are small specialty shops along Ocean Drive on the barrier island. There are also a set of shops directly inland in what is called "Miracle Mile." The Historic Downtown is a newly revitalized area of shopping, dining, antique stores, and art galleries.


title: Vero Beach, Florida

text: The beaches in Vero Beach are part of Florida's Treasure Coast. Vero's three main public beaches are South Beach, accessible at the eastern end of Florida State Road 656 at the eastern end of 17th Street; Humiston Park, in Vero's Central Beach Business District on Ocean Drive and Jaycee Park which is adjacent to Conn Beach.


title: Vero Beach, Florida

text: Vero Beach also has other free public access trails and walkways with beach access, such as Riomar Beach, Sea Cove, Sea Grape Trail, Sexton Plaza, and Turtle Trail.


title: Vero Beach, Florida

text: The Indian River Lagoon, passing through Vero Beach, forms a significant portion of the Intracoastal Waterway, and is a hub for boating, fishing, water skiing, diving, kayaking and other small-craft waterborne activities.


title: Vero Beach, Florida

text: Disney's Vero Beach Resort is officially located in Wabasso, a small town north of Vero Beach. , the city hosts 14 private golf clubs.


title: Vero Beach, Florida

text: Vero Beach is home to Historic Dodgertown, which initially started operations during World War II as a U.S. Naval Air Station, and later served as the Spring Training facility of the Los Angeles Dodgers baseball team, until 2008. After the team's departure for a new Spring home in Arizona in 2008, it has served as a year-round multi-purpose facility for athletes of all ages. As of January 2, 2019, MLB has assumed control of the historic facilities with plans to expand the complex and rename it The Jackie Robinson Training Complex. This is to honor both the late Jackie Robinson and the site's history as the first racially integrated spring-training center in the American South.


title: Vero Beach, Florida

text: Vero Beach Regional Airport is a public airport one mile northwest of Vero Beach, offering commercial jet service by Elite Airways. It will begin flying Breeze Airways on February 2, 2023.


title: Vero Beach, Florida

text: The Florida East Coast Railway (FEC) mainline bisects Vero Beach, with an active team track in town serving two off-line lumber/building products customers, who receive boxcars, flatcars and gondolas, . The Vero Railroad Station served the transportation needs of the community and its surrounding agricultural area for almost 65 years from 1903 to 1968. It now serves as a county historical exhibit center.


title: Syrian opposition

text: The Syrian opposition ( "", ) is the political structure represented by the Syrian National Coalition and associated Syrian anti-Assad groups with certain territorial control as an alternative Syrian government.


title: Syrian opposition

text: The Syrian opposition evolved since the beginning of the Syrian conflict from groups calling for the overthrow of the Assad government in Syria and who have opposed its Ba'athist government. Prior to the Syrian Civil War, the term "opposition" () had been used to refer to traditional political actors, for example the National Coordination Committee for Democratic Change; that is, groups and individuals who have had a history of dissidence against the Syrian state.


title: Syrian opposition

text: The first opposition structures to form in the Syrian uprising were local protest-organizing committees. These formed in April 2011, as protesters graduated from spontaneous protests to protests organized by meetings beforehand.


title: Syrian opposition

text: The Syrian uprising phase, from March 2011 until the start of August 2011, was characterized by a consensus for nonviolent struggle among the uprising's participants. Thus the conflict could not have been yet characterized as a "civil war", until army units defected in response to government reprisals against the protest movement. This occurred 2012, allowing the conflict to meet the definition of "civil war."


title: Syrian opposition

text: Opposition groups in Syria took a new turn in late 2011, during the Syrian Civil War, as they united to form the Syrian National Council (SNC), which has received significant international support and recognition as a partner for dialogue. The Syrian National Council was recognized or supported in some capacity by at least 17 member states of the United Nations, with three of those (France, United Kingdom and the United States) being permanent members of the Security Council.


title: Syrian opposition

text: A broader opposition umbrella group, the National Coalition for Syrian Revolutionary and Opposition Forces, was formed in November 2012 and has gained recognition as the "legitimate representative of the Syrian people" by the Cooperation Council for the Arab States of the Gulf (CCASG) and as a "representative of aspirations of Syrian people" by the Arab League. The Syrian National Coalition was subsequently considered to take the seat of Syria in the Arab League, with the representative of Bashar Al-Assad's government suspended that year. The Syrian National Council, initially a part of the Syrian National Coalition, withdrew on 20 January 2014 in protest at the decision of the coalition to attend the Geneva talks. Despite tensions, the Syrian National Council retained a degree of ties with the National Coalition for Syrian Revolutionary and Opposition Forces. Syrian opposition groups held reconciliation talks in Astana, Kazakhstan in October 2015. In late 2015, the Syrian Interim Government relocated its headquarters to the city of Azaz in North Syria and began to execute some authority in the area. In 2017, the opposition government in the Idlib Governorate was challenged by the rival Syrian Salvation Government, backed by the Islamist faction Hayat Tahrir al-Sham (HTS).


title: Syrian opposition

text: A July 2015 ORB International poll of 1,365 adults across all of Syria's 14 governorates found that about 26 percent of the population supported the Syrian opposition (41 percent in the areas it controlled), compared to 47 percent who supported the Syrian Arab Republic's government (73 percent in the areas it controlled), 35 percent who supported the Al-Nusra Front (58 percent in the areas it controlled), and 22 percent who supported the Islamic State (71 percent in the areas it controlled). A March 2018 ORB International Poll with a similar method and sample size found that support had changed to 40% Syrian government, 40% Syrian opposition (in general), 15% Syrian Democratic Forces, 10% al-Nusra Front, and 4% Islamic State (crossover may exist between supporters of factions).


title: Syrian opposition

text: Syria has been an independent republic since 1946 after the expulsion of the French forces. For decades, the country was partially stable with a series of coups until the Ba'ath Party seized power in Syria in 1963 after a "coup d'état". The head of state since 1971 has been a member of the Assad dynasty, beginning with Hafez al-Assad (19712000). Syria was under emergency law from the time of the 1963 Syrian coup d'état until 21 April 2011, when it was rescinded by Bashar al-Assad, Hafez's eldest surviving son and the current President of Syria.


title: Syrian opposition

text: The rule of Assad dynasty was marked by heavy repression of secular alternatives such as the Arab nationalist Nasserists and liberal democrats. The biggest organised resistance to the Ba’athist rule has been the Syrian Muslim Brotherhood; which successfully capitalised on the widespread Sunni resentment against the Alawite hegemony. Syrian "Ikhwan" was inspired by the Syrian Salafiyya movement led by Muhammad Rashid Rida, an influential Sunni Islamic theologian who is respected as their "Imam". In line with the teachings of Rashid Rida, the Muslim Brotherhood advocates the replacement of the Ba’ath party rule with an Islamic state led by an Emir elected by qualified Muslim delegates known as "Ahl al-Hall wa-al-‘Aqd". The Islamic government should implement laws based on "sharia" (Islamic law) with the assistance of "ulema" who are to be consulted on solving contemporary challenges. The power of the ruler is also to be checked by the provisions laid out in an Islamic constitution through "shura" (consultation) with the "Ahl al-Hall wa-al-‘Aqd". Assad regime introduced Law No. 49 in 1980 which criminalised the movement and legalised executions of anyone accused of membership with the Brotherhood. In response, the Syrian Islamic Front was established the same year to topple the Assadist military dictatorship through an armed revolution. The Front got widespread support from the traditional Sunni "ulema" and the conservative population; enabling the Syrian "Ikhwan al-Muslimeen" to rise as the most powerful opposition force by the 1980s.


title: Syrian opposition

text: As the revolutionary wave commonly referred to as the Arab Spring began to take shape in early 2011, Syrian protesters began consolidating opposition councils.


title: Syrian opposition

text: The Istanbul Meeting for Syria, the first convention of the Syrian opposition, took place on 26 April 2011, during the Syrian civil uprising. There followed the Antalya Conference for Change in Syria or "Antalya Opposition Conference", a three-day conference of representatives of the Syrian opposition held from 31 May until 3 June 2011 in Antalya, Turkey.


title: Syrian opposition

text: Organized by Ammar al-Qurabi's "National Organization for Human Rights in Syria" and financed by the wealthy Damascene Sanqar family, it led to a final statement refusing compromise or reform solutions, and to the election of a 31-member leadership.


title: Syrian opposition

text: After the Antalya conference, a follow-up meeting took place two days later in Brussels, then another gathering in Paris that was addressed by Bernard Henri Levy. It took a number of further meetings in Istanbul and Doha before yet another meeting on 23 August 2011 in Istanbul set up a permanent transitional council in form of the Syrian National Council.


title: Syrian opposition

text: The Syrian opposition does not have a definitive political structure. In December 2015, members of the Syrian opposition convened in Riyadh, Saudi Arabia: 34 groups attended the convention, which aimed to produce a unified delegation for negotiations with the Syrian government. Notable groups present included:


title: Syrian opposition

text: The National Coalition for Syrian Revolutionary and Opposition Forces is a coalition of opposition groups and individuals, mostly exilic, who support the Syrian revolution side and oppose the Assad government ruling Syria. It formed on 11 November 2012 at a conference of opposition groups and individuals held in Doha, Qatar. It has relations with other opposition organizations such as the Syrian National Council, the previous iteration of an exilic political body attempting to represent the grassroots movement; the union of the two was planned, but has failed to realize. Moderate Islamic preacher Moaz al-Khatib, who had protested on the Syrian street in the early nonviolent phase of the uprising, served a term as the president of the coalition, but soon resigned his post, frustrated with the gap between the body and the grassroots of the uprising inside Syria. Riad Seif and Suheir Atassi, both of whom had also protested on the street in Syria early in the uprising, were elected as vice presidents. Mustafa Sabbagh is the coalition's secretary-general.


title: Syrian opposition

text: The Syrian National Council ("al-Majlis al-Waṭanī as-Sūri") sometimes known as "SNC", the "Syrian National Transitional Council" or the "National Council of Syria", is a Syrian opposition coalition, based in Istanbul (Turkey), formed in August 2011 during the Syrian civil uprising against the government of Bashar al-Assad.


title: Syrian opposition

text: Initially, the council denied seeking to play the role of a government in exile, but this changed a few months later when violence in Syria intensified. The Syrian National Council seeks the end of Bashar al-Assad's rule and the establishment of a modern, civil, democratic state. The SNC National Charter lists human rights, judicial independence, press freedom, democracy and political pluralism as its guiding principles.


title: Syrian opposition

text: In November 2012 the Council agreed to unite with several other opposition groups to form the National Coalition for Syrian Revolutionary and Opposition Forces, with the SNC having 22 out of 60 seats. The Council withdrew from the Coalition on 20 January 2014 in protest at the decision of the Coalition to attend talks in Geneva.


title: Syrian opposition

text: The National Coordination Committee for Democratic Change ("NCC"), or "National Coordination Body for Democratic Change" ("NCB"), is a Syrian bloc chaired by Hassan Abdel Azim and consisting of 13 left-wing political parties and "independent political and youth activists". Reuters has defined the committee as the internal opposition's main umbrella group. The NCC initially had several Kurdish political parties as members, but all except for the Democratic Union Party left in October 2011 to join the Kurdish National Council. Some opposition activists have accused the NCC of being a "front organization" for Bashar al-Assad's government and have denounced some of its members as ex-government insiders.


title: Syrian opposition

text: The NCC generally has poor relationships with other Syrian political opposition groups. The Syrian Revolution General Commission, the Local Coordination Committees of Syria, and the Supreme Council of the Syrian Revolution oppose the NCC calls to dialogue with the Syrian government. In September 2012 the Syrian National Council (SNC) reaffirmed that despite broadening its membership, it would not join with "currents close to [the] NCC". Despite the NCC recognizing the Free Syrian Army (FSA) on 23 September 2012, the FSA has dismissed the NCC as an extension of the government, stating that "this opposition is just the other face of the same coin".


title: Syrian opposition

text: The Syrian Democratic Council was established on 10 December 2015 in al-Malikiyah. It was co-founded by prominent human rights activist Haytham Manna and was intended as the political wing of the Syrian Democratic Forces. The council includes more than a dozen blocs and coalitions that support federalism in Syria, including the Movement for a Democratic Society, the Kurdish National Alliance in Syria, the Law–Citizenship–Rights Movement, and since September 2016 the Syria's Tomorrow Movement. The last group is led by former National Coalition president and Syrian National Council Ahmad Jarba. In August 2016 the SDC opened a public office in al-Hasakah.


title: Syrian opposition

text: The Syrian Democratic Council is considered an "alternative opposition" bloc. Its leaders included former NCC members such as Riad Darar, a "key figure" in the Syrian opposition, and Haytham Manna, who resigned from the SDC in March 2016 in protest of its announcement of the Northern Syria Federation. The SDC was rejected by some other opposition groups due to its system of federalism.


title: Syrian opposition

text: The Syrian Democratic Council was invited to participate in the international Geneva III peace talks on Syria in March 2016. However, it rejected the invitations because no representatives of the Movement for a Democratic Society, led by the Democratic Union Party, were invited.


title: Syrian opposition

text: At a conference held in Istanbul on 19 March 2013 members of the National Coalition elected Ghassan Hitto as prime minister of an interim government for Syria, the Syrian Interim Government (SIG). Hitto has announced that a technical government will be formed which will be led by between 10 and 12 ministers, with the Free Syrian Army choosing the Minister of Defense. The SIG is based in Turkey. It has been the primary civilian authority throughout most of opposition-held Syria. Its system of administrative local councils operate services such as schools and hospitals in these areas, as well as the Free Aleppo University. By late 2017, it presided over 12 provincial councils and over 400 elected local councils. It also operates a major border crossing between Syria and Turkey, which generates an estimated $1 million revenue each month. It is internationally recognized by the European Union and the United States, among others. It maintains diplomatic ties with some non-FSA rebel groups, such as Ahrar al-Sham, but is in conflict with the more extreme Tahrir al-Sham, which is one of the largest armed groups in Idlib Governorate.


title: Syrian opposition

text: The Syrian Salvation Government is an alternative government of the Syrian opposition seated within Idlib Governorate, which was formed by the General Syrian Conference in September 2017. The domestic group has appointed Mohammed al-Sheikh as head of the Government with 11 more ministers for Interior, Justice, Endowment, Higher Education, Education, Health, Agriculture, Economy, Social Affairs and Displaced, Housing and Reconstruction and Local Administration and Services. Al-Sheikh, in a press conference held at the Bab al-Hawa Border Crossing has also announced the formation of four commissions: Inspection Authority, Prisoners and missing Affairs, Planning and Statistics Authority, and the Union of Trade Unions. The founder of the Free Syrian Army, Col. Riad al-Asaad, was appointed as deputy prime minister for military affairs. The SSG is associated with Hay'at Tahrir al-Sham (HTS) and not recognised by the rest of the opposition, which is in conflict with HTS.


title: Syrian opposition

text: There is a sharp ideological divide between the two competing opposition civil authorities: The SIG espouses secular, moderate values and regularly participates in international peace talks; the SSG enforces a strict interpretation of Islamic law and stringently rejects talks with the Syrian regime.


title: Syrian opposition

text: Various Syrian opposition groups have at least some presence in seven Syrian governorates, though none is fully under the control of the entity. Governorates with partial opposition control include:


title: Syrian opposition

text: In April 2015, after the Second Battle of Idlib, the interim seat of the Syrian Interim Government was proposed to be Idlib, in the Idlib Governorate. However, this move was rejected by the al-Nusra Front and Ahrar al-Sham-led Army of Conquest, which between them controlled Idlib. According to the Syrian National Coalition, in 2017 there were 404 opposition-aligned local councils operating in villages, towns, and cities controlled by rebel forces. In 2016, the Syrian Interim Government became established within the Turkish Controlled areas.


title: Syrian opposition

text: The Syrian Free Army maintains the al-Tanf Garrison. Due to this garrison being inside an American De-Escalation zone, the garrison is not often attacked, nor does it often attempt to expand its territory.


title: Syrian opposition

text: The foreign relations of the Syrian Opposition refers to the external relations of the self-proclaimed oppositional Syrian Arab Republic, which sees itself as the genuine Syria. The region of control of Syrian opposition affiliated groups is not well defined. The Turkish government recognizes Syrian opposition as the genuine Syrian Arab Republic and hosts several of its institutions on its territory. The seat of Syria in the Arab League is reserved for the Syrian opposition since 2014, but not populated.


title: Syrian opposition

text: Initially, the Free Syrian Army was perceived as the ultimate military force of the Syrian Opposition, but with the collapse of many FSA factions and emergence of powerful Islamist groups, it became clear to the opposition that only a cooperation of secular military forces and moderate Islamists could form a sufficient coalition to battle both the Syrian Government forces and radical Jihadists such as ISIL and in some cases al-Nusra Front.


title: Syrian opposition

text: In 2014, the military forces associated with the Syrian Opposition were defined by the Syrian Revolutionary Command Council, which in turn was mainly relying on the Free Syrian Army (with links to Syrian National Coalition) and the Islamic Front (Syria). Members of the Syrian Revolutionary Command Council:


title: Richard Tice

text: Richard James Sunley Tice (born 13 September 1964) is a British businessman and right wing politician who has been Leader of Reform UK since 6 March 2021.


title: Richard Tice

text: Tice was CEO of the real estate group CLS Holdings from 2010 to 2014, after which he became CEO of the property asset management group Quidnet Capital LLP. He was a founder and co-chairman of the pro-Brexit campaign groups Leave.EU and Leave Means Leave.


title: Richard Tice

text: Tice helped found the Brexit Party, later rebranded as Reform UK, and was elected as a Member of the European Parliament (MEP) for the East of England constituency at the 2019 European Parliament election. He held this role until the United Kingdom's withdrawal from the EU in January 2020. However, he continued to serve as chairman of the party under Nigel Farage and took office as leader in March 2021.


title: Richard Tice

text: Richard James Sunley Tice was born on 13 September 1964 in Farnham, the third child of James S. Tice and the horse trainer and philanthropist Joan Mary Tice DL OBE, who died on 26 April 2019. He is a maternal grandson of the property developer Bernard Sunley.


title: Richard Tice

text: Tice was educated at the independent Uppingham School. He subsequently received a bachelor's degree in construction economics and quantity surveying from the University of Salford.


title: Richard Tice

text: After graduation in 1987, Tice's first job was at the housing developer London and Metropolitan. This included time at its Paris office where he learnt French. He then started working for the housebuilding and commercial property company founded by his grandfather called The Sunley Group in 1991. Tice was its joint chief executive officer (CEO) for 14 years before leaving the company in 2006.


title: Richard Tice

text: Tice then ran his own debt advisory consultancy before joining the property investment group CLS Holdings in 2010. He led major planning property applications in Vauxhall, London. He was its CEO until 2014. He left the company to become the CEO of the property investment firm, Quidnet Capital Partners LLP, having been removed from CLS' board as a result of a potential conflict of interest.


title: Richard Tice

text: Tice wrote a 2008 report for the think tank Reform called "Academies: A model education?". In 2017, he co-wrote a pamphlet for the think tank UK 2020, "Timebomb: how the university cartel is failing Britain's students", which included recommendations on how to expand two-year degrees. He produced a follow-up report on student finances called "Defusing the debt timebomb" which he sent to the then Chancellor of the Exchequer, Philip Hammond.


title: Richard Tice

text: In a May 2018 article on the "Conservative Home" website, Tice argued for the importance of expanding the availability of homes for people on lower incomes and how this could be achieved more effectively. He felt that crime could also be reduced if housing was better managed.


title: Richard Tice

text: Tice is a Eurosceptic. He was a director of the campaign group, Business for Sterling, which campaigned for the United Kingdom not to join the Euro currency in the late 1990s. Tice donated £1,750 to the Eurosceptic MP David Davis' candidacy in the 2001 Conservative Party leadership election.


title: Richard Tice

text: In July 2015, Tice co-founded, with the businessman Arron Banks, the pro-Brexit Leave.EU campaign group. It was originally known as The Know.EU before being rebranded in September of that year as Leave.EU. He also donated £38,000 to the pro-Brexit campaign group Grassroots Out. Shortly after the United Kingdom voted to leave the European Union in the June 2016 referendum, he left Leave.EU, and co-founded the pressure group Leave Means Leave. He co-chairs it with the businessman John Longworth. In October 2017, they were placed jointly at Number 90 on Iain Dale's list of the "Top 100 Most Influential People on the Right".


title: Richard Tice

text: Tice, Banks, Andy Wigmore and Nigel Farage are sometimes referred to by sections of the media as the "Bad Boys of Brexit", a group who facilitated Brexit. He has written a number of articles advocating a no-deal Brexit. He was the first to use the phrase, "no deal is better than a bad deal" in relation to Brexit in July 2016 which was later used in the then prime minister Theresa May's Lancaster House speech outlining the government's approach to negotiations in January 2017.


title: Richard Tice

text: The Brexit Party, a conservative, Eurosceptic political party, was formed as an incorporated limited company on 23 November 2018, and Tice was appointed a director of it on 8 May 2019. In his role as the chairman of The Brexit Party he regularly represented it, with appearances in the media including BBC Radio 4's "Any Questions?". He was the chairman when the party participated in the 2019 European Parliament election, under Nigel Farage's leadership. In that election, it won 29 seats in the European Parliament.


title: Richard Tice

text: Tice stood as a candidate at the 2019 European Parliament election. He was first on his party's list in the East of England constituency, and was elected as one of three of its MEPs for there. In the European Parliament, he was a member of the Committee on Economic and Monetary Affairs and was part of the delegation for relations with Canada.


title: Richard Tice

text: In November 2019, it was announced that Tice would be standing as the Brexit Party candidate for the Hartlepool constituency at the 2019 general election. He finished in third place in Hartlepool with 25.8% of the vote.


title: Richard Tice

text: On 30 October 2020, Farage applied to the Electoral Commission to change the Brexit Party's name to Reform UK. On 6 March 2021, it was announced that Tice would become Leader of Reform UK following Farage's resignation.


title: Richard Tice

text: In March 2021, Tice announced he would be the Reform UK candidate for the Havering and Redbridge constituency in the 2021 London Assembly election. He came fifth.


title: Richard Tice

text: In December 2021, Tice stood in the by-election for the Old Bexley and Sidcup constituency following the death of the sitting MP, James Brokenshire. He received 1,432 votes, a 6.6% vote share, and therefore retained his deposit.


title: Richard Tice

text: Tice is married and has three children. He began a relationship with the journalist Isabel Oakeshott in 2018 and separated from his wife in March 2019.