there oh i'm sorry yes first order of business is public with matters they would like to raise which are not on the nobody ok but we will move the more general question is this is the time to get to it i was of the earlier being when you presented a lot of the the design concepts and so forth and i got the sense from the group it was a meeting that night there was a point you were talking there were some difficulties with the foundation and so forth and given the slope of the land behind the building where you could put something on the you know about under whatever one of the fights that came up at that time was what if in the general area of where your idea should is here in this picture you were to put in a modern foundation move the existing building onto it and then put the admission on the north side where it's not so visible from the traveling public void by preserving the historic character of the children museum has buildings there are similar ages stairways equally steve the public is going up and down these every day certainly you have to have the access for those that need it or for most ninety percent of the public the existing stairways perfectly fine into think about tearing this historic stairway out of this historic building it just doesn't seem to be a good option you know we've lost so much of our history already you know and again just a shame to  upstairs and the extra space because it does kind of separate the library from the public meetings face i think it's one of the least expensive options that you mention and i know you thought it might be overkill but i think if  we could look at maybe adding a back room up stairs that would give us a totally public second floor that would be segregated from the first part and you know it really it really does everything then to do it  that would you know keep more space in the existing library for library use it would make it accessible to people using the second floor the room the library might be worth  or the guy was going to die and you all homes were sort of in this business for a couple reasons they have the only vehicle in town you could lay down here and secondly they were service providers they took away gang violence and so you had to be available something's happened back in the sixty's they happened fairly abruptly as to do a madison put on a public white paper on injury calling it the neglect of disease of modern society and it was the first scientific  free halfway and really turn out to be that way murthy medicine was evolving his up as a physician specialty and if you go back to you know early seventy's there was this very more recently back in ninety six we better about this business of trying to improve v m s systems in this country for about thirty years and six we took a spot and said if we do thirty years started looking at very specific integration of here that was necessary for our stroke patient had a nice steady estie elevation myocardial infarction certain kind of heart attack those were is very time sensitive special we began to happen terrorist events and we started to have to recognize we've got to be ready to respond to those so this is a diagram i hate of how he slid off the road on a snowy day on the interstate nine one one might get eighteen or twenty calls on that car off the road why is everybody drive on a cell phone or they see the car on the road visible pick up on the dial nine does have a heart attack how long is that typical of a charlie have a heart attack wait from the onset of symptoms until they decide to do something about american heart association tells us about four hours right  typically do that through nine one one from i've got a rate nine one one system increasingly we're able to figure out from the hall where the where the emergency is they're given a new venue for ways to get in and they're going to start being able to they can do pretty much everything that ambulance can do for emergency care as soon as they get here in the back of their car the ambulance comes along all of our crews are capable of providing full basic and advanced life support for the only agency in the area that have the highest level paramedics or advanced life support and then the air transport faith in this area patien ninety nine point nine nine percent of our patients go to flatiron and the only hospital in town what are around is a specialty center for all of those various problems up there in other systems and other places you you all recall he got thrown off course had a very high cervical spine fracture was unable to breathe had a paralyzed diaphragm for the rest of life had beyond that only i would submit that you know bazillion dollars for spinal cord research all black and stuff we're very into prevention where we would much rather all wait be alert and see before it happens we do a lot of public education begin to do with this kind of presentation about what is the umask why do we have it and then inside the system are all of those other elements about communications human resources medical direction integration research money legislation all at other stop how does a local community support its young massive highly come to understand how they support it probably varies a lot by community because nine one one and it has to work we're sort of the last backstop where a network of resources programs where we try to keep people safe healthy has to be custom tailored to meet the needs given the resources patients and caregivers try not to get out of step with the community in terms of expectations about cost i would guess and the level of services spectrum all right so what are some of the successes and challenges for  i'm not a motion all or sentimental about quality here is that they're free they keep the cost of labor down the service is great and they keep the costs low we happen to benefit from a very knowledgeable board of directors and west for those guys help us with extra patient buyers oppression of motor vehicle crashes hazardous materials management we are part of a large mutual aid network for multi patient or larger ambulance service are largely fix we've got to have vehicle house insurance training radios medical oversight all that stuff before you turn earth we're the next cog it's pretty cheap is in pretty good shape we have a reasonable facility i would suggest we have a pretty good management intermodal command structure that makes it a comfortable place for folks to serve we have career staff shoulder a lot of acquittal duties but also provide our shoulder mostly administrative duties but also cover some clerical work we are not you that we don't have any debt on we're paramedic level agency benefit from a community advisory board which keeps us connected with the community we have a well established first response network lots of partnerships in the community and we have a very strong program of the house training what are some of our challenges and opportunities going forward i think the sixty four million dollar question is are we going to be able to sustain the level of violence here in the joint the day we provide the service we do today  forty years ago and cassie's junction assets under real geo westford the demographics of the population you know layout is was different then than it is today and i think that's a question we need to be looking at going forward we're in a great era of uncertainty about health care reimbursement whole idea of moving the single payer health here and how all of that works stands to make a huge difference in the amount of money we are able to recover from the patients served we are looking at our existing funding model and we're asking ourselves are we really covering all of our costs we're certainly doing long term need for civilities and other capital costs we work in conjunction with mining community and so how do we best mandy decisions on the part of one community that might very happily and all kinds of things around terrorism preparedness not a big part of our response but it's become a much bigger part of what we are asked to do with raster ready for so what can in different direction in terms of ambulance service we don't think that would be great for any of the unity we also think it would be an adverse decision to the other kalm who currently share this operation w about how what's the real indication of a conditional use within a within district because the high school is a conditional use within the world residential district when do they need permits and since they are conditional error and thinking that because they're exempt from going through the business of filling out a piece of paper that they are there for exemption from the rules of the cell that i think is your argument and  what's also interesting to listen to somebody well who's really rather a great i was going to say certainly done your homework it's obviously an issue that you are not just studying but you seem pretty open minded and that you've looked at then there are a lot of people that come in during april and they just you know miss the deadline but they do pay four dollars late fee on top of the registration when they come in after one and then at thirtieth we one hundred ninety nine notices out and prior to that we actually there's four vets in the area that allow us to send them the list and they go through and let us know  of the dogs have passed away or they may know that they've got out of town so we're able to cull those out before we send out the hundred ninety nine dollars to you know contact the owner or that person just him and then when we send the hundred ninety nine out so we send it return receipt or rich it comes back to us if it can't be delivered so that way we might find docs that moved out of town or at least their mails going so the twenty first and there were seventy eight on that list but i'm just sitting here tonight and went through only eighteen of those dogs on this list tonight of the eighty eight so yeah there are some people that are continually on the list and there are some people that are kind of against the idea of having their dog either vaccinated or registered they just don't agree with you know the state so they're i don't know what you do with those people have a vaccination you have to have the vaccination to be registered you have to have the vaccination or there's a form that of that can fill out where you do need that signature saying that they examine the animal and because of attempt to get license hundred twenty six there was a high in two thousand and eight of nine hundred sixty gods which was here because that was the year that we were over in the church right and we thought doug registration was going to be hard but  through the website now so it's easy it's less time intensive for us because we just get our life people signed up on the website so we're not having to manage the email list time that we've made s because you'll hear a lot of people think oh it's april fifteenth you know because they associate it with the taxpayer centric but some people don't think that they can license before april one you know so they're sometimes it's just an education thing which we try to do in the town agreement i think two thousand and ten is when i stop making phone calls to delinquent dogs and because it used to be that we had no delinquent dogs at the end of the year because we knew what had happened to them or they had come in where now we have to roll over that or you know better not license during the year they don't get any additional fine  but then they're encouraged to license the following year so i think following up on that you know after the second letter goes out if there was some follow up like in august or far for the placement of my concerns are still with the parking situation across from the store and that may be but i still see a very dangerous situation that we because when they were there you know what i mean is that the painted crosswalks coming across you know you don't really see and the idea of moving the one cost one more toward the middle  couple quick questions for other business are we going to apply for the female money for the store since they were declared disaster area more input from the public again because that's been done we've signed off on it that is are we putting ourselves in a position if we postpone certain parts of this