**Exhibit 4.10**

SUPPLEMENTALINDENTURE NO. 4

THIS SUPPLEMENTALINDENTURE NO. 4 (this “Supplemental Indenture”), dated as of August 7,2006, is among the Issuers (as defined in the Indenture), the Guarantors (asdefined in the Indenture) and U.S. Bank Trust National Association, a nationalbanking association organized under the laws of the United States of America,as trustee (the “Trustee”).

W I T N E S S E TH

WHEREAS, theIssuers and the Guarantors have heretofore executed and delivered to theTrustee an indenture (the “Indenture”), dated as of February 10, 2005,providing for the issuance of the Issuers’ 10% Senior Subordinated Notes due2015 (the “Notes”);

WHEREAS, theIndenture was amended by the Supplemental Indenture, dated April 15, 2005,among the Issuers, AMR Brockton L.L.C., the Guarantors and the Trustee (the “FirstSupplemental Indenture”), Supplemental Indenture No. 2, dated September 30,2005, among the Issuers, Global Medical Response, Inc., the Guarantors and theTrustee (the “Second Supplemental Indenture”), and SupplementalIndenture No. 3, dated February 23, 2006, among the Issuers, Emergency MedicalServices Corporation, the Guarantors and the Trustee (the “ThirdSupplemental Indenture”);

WHEREAS, theIndenture provides that the Issuers and the Trustee may amend the Indenture tocure any ambiguity, defect or inconsistency; and

WHEREAS, pursuantto Section 9.01 of the Indenture, the Trustee is authorized to execute anddeliver this Supplemental Indenture.

NOW THEREFORE, inconsideration of the foregoing and for other good and valuable consideration,the receipt of which is hereby acknowledged, the Issuers, the Guarantors andthe Trustee mutually covenant and agree for the equal and ratable benefit ofthe Holders of the Notes as follows:

1.             Capitalized Terms.  Capitalized terms used herein withoutdefinition shall have the meanings assigned to them in the Indenture.

2.             Correction of Incorrect Cross-Reference in Exhibit Fof Indenture.  The references to “Section10.02” and “Article 10” in Section 2(e) of Exhibit F to the Indenture shall bereplaced with references to “Section 11.03” and “Article 11”, respectively.

3.             Correction of Incorrect Cross-Reference in the FirstSupplemental Indenture.  Thereferences to “Section 10.02” and “Article 10” in Section 2(i) of the FirstSupplemental Indenture shall be replaced with references to “Section 11.03” and“Article 11”, respectively.

4.             Correction of Incorrect Cross-Reference in the SecondSupplemental Indenture.  Thereferences to “Section 10.02” and “Article 10” in Section 2(i) of the SecondSupplemental Indenture shall be replaced with references to “Section 11.03” and“Article 11”, respectively.

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5.             Correction of Incorrect Cross-Reference in the ThirdSupplemental Indenture.  Thereferences to “Section 10.02” and “Article 10” in Section 2(e) of the ThirdSupplemental Indenture shall be replaced with references to “Section 11.03” and“Article 11”, respectively.

6.             NEW YORK LAW TO GOVERN.  THE INTERNAL LAW OF THE STATE OF NEW YORKSHALL GOVERN AND BE USED TO CONSTRUE THIS SUPPLEMENTAL INDENTURE BUT WITHOUTGIVING EFFECT TO APPLICABLE PRINCIPLES OF CONFLICTS OF LAW TO THE EXTENT THATTHE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY.

7.             Counterparts. The parties may sign any number of copies of this SupplementalIndenture.  Each signed copy shall be anoriginal, but all of them together represent the same agreement.

8.             Effect of Headings.  The Section headings herein are forconvenience only and shall not affect the construction hereof.

9.             The Trustee. The Trustee shall not be responsible in any manner whatsoever for or inrespect of the validity or sufficiency of this Supplemental Indenture or for orin respect of the recitals contained herein, all of which recitals are made solelyby the Issuers and the Guarantors.

[*Remainder of Page Left Intentionally Blank*]

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IN WITNESSWHEREOF, the parties hereto have caused this Supplemental Indenture to be dulyexecuted and attested, all as of the date first above written.
| AMR  HOLDCO, INC. n/k/a EMSC MANAGEMENT, INC.                    |   |                    |
|------------------------------------------------------------------|--------|-------------------------|
|                                                             |   |                    |   |   |
| By:                                                              |   | /s/ WILLIAM A. SANGER   |   |   |
| Name:                                                            |   | William A. Sanger       |   |   |
| Title:                                                           |   | Chief Executive Officer |   |   |
|                                                             |   |                    |   |   |
|                                                             |   |                    |   |   |
| EMCARE HOLDCO, INC.                                              |   |                    |
|                                                             |   |                    |   |   |
| By:                                                              |   | /s/ WILLIAM A. SANGER   |   |   |
| Name:                                                            |   | William A. Sanger       |   |   |
| Title:                                                           |   | Chief Executive Officer |   |   |
|                                                             |   |                    |   |   |
|                                                             |   |                    |   |   |
| EMERGENCY MEDICAL SERVICES L.P.                                  |   |                    |
| By: Emergency Medical Services Corporation, its  general partner |   |                    |
|                                                             |   |                    |   |   |
| By:                                                              |   | /s/ WILLIAM A. SANGER   |   |   |
| Name:                                                            |   | William A. Sanger       |   |   |
| Title:                                                           |   | Chief Executive Officer |   |   |
|                                                                  |        |                         |  |  |  |  |

 

 

AMERICAN MEDICAL RESPONSE, INC.

HANK’S ACQUISITION CORP.

FOUNTAIN AMBULANCE SERVICE, INC.

MEDLIFE EMERGENCY MEDICAL SERVICE, INC.

AMERICAN MEDICAL RESPONSE NORTHWEST, INC.

AMERICAN MEDICAL RESPONSE WEST

METROPOLITAN AMBULANCE SERVICE

AMERICAN MEDICAL RESPONSE OF INLAND EMPIRE

DESERT VALLEY MEDICAL TRANSPORT, INC.

SPRINGS AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE OF COLORADO, INC.

INTERNATIONAL LIFE SUPPORT, INC.

[Signature Page toSupplemental Indenture Correcting Cross-References]

 

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MEDEVAC MIDAMERICA, INC.

MEDEVAC MEDICAL RESPONSE, INC.

AMERICAN MEDICAL RESPONSE OF OKLAHOMA, INC.

AMERICAN MEDICAL RESPONSE OF TEXAS, INC.

KUTZ AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE HOLDINGS, INC.

AMERICAN MEDICAL RESPONSE MANAGEMENT, INC.

A1 LEASING, INC.

FLORIDA EMERGENCY PARTNERS, INC.

MOBILE MEDIC AMBULANCE SERVICE, INC.

METRO AMBULANCE SERVICE, INC.

METRO AMBULANCE SERVICE (RURAL), INC.

MEDIC ONE AMBULANCE SERVICES, INC.

AMERICAN MEDICAL RESPONSE OF SOUTH CAROLINA, INC.

AMERICAN MEDICAL RESPONSE OF NORTH CAROLINA, INC.

AMERICAN MEDICAL RESPONSE OF GEORGIA, INC.

TROUP COUNTY EMERGENCY MEDICAL SERVICES, INC.

RANDLE EASTERN AMBULANCE SERVICE, INC.

MEDI-CAR SYSTEMS, INC.

MEDI-CAR AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE OF TENNESSEE, INC.

PHYSICIANS & SURGEONS AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE OF ILLINOIS, INC.

MIDWEST AMBULANCE MANAGEMENT COMPANY

PARAMED, INC.

MERCY AMBULANCE OF EVANSVILLE, INC.

TIDEWATER AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE OF CONNECTICUT, INCORPORATED

AMERICAN MEDICAL RESPONSE OF MASSACHUSETTS, INC.

AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC.

AMBULANCE ACQUISITION, INC.

METRO AMBULANCE SERVICES, INC.

BROWARD AMBULANCE, INC.

ATLANTIC AMBULANCE SERVICES ACQUISITION, INC.

ATLANTIC/KEY WEST AMBULANCE, INC.

ATLANTIC/PALM BEACH AMBULANCE, INC.

SEMINOLE COUNTY AMBULANCE, INC.

LIFEFLEET SOUTHEAST, INC.

AMERICAN MEDICAL PATHWAYS, INC.

ADAM TRANSPORTATION SERVICE, INC.

ASSOCIATED AMBULANCE SERVICE, INC.

PARK AMBULANCE SERVICE INC.

FIVE COUNTIES AMBULANCE SERVICE, INC.

SUNRISE HANDICAP TRANSPORT CORP.

[Signature Page toSupplemental Indenture Correcting Cross-References]

 

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STAT HEALTHCARE, INC.

LAIDLAW MEDICAL TRANSPORTATION, INC.

MERCY, INC.

AMERICAN INVESTMENT ENTERPRISES, INC.

LIFECARE AMBULANCE SERVICE, INC.

TEK, INC.

MERCY LIFE CARE

HEMET VALLEY AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA

MEDIC ONE OF COBB, INC.

PUCKETT AMBULANCE SERVICE, INC.

AMERICAN MEDICAL RESPONSE DELAWARE VALLEY, LLC

By: American Medical Response Mid-Atlantic, Inc., its sole member

REGIONAL EMERGENCY SERVICES, LP

By: Florida Emergency Partners, Inc., its general partner

PROVIDACARE, L.L.C.

By: American Medical Pathways, Inc., its sole member

AMR BROCKTON, L.L.C.

By: American Medical Response of Massachusetts, Inc., its manager

 
| By:    |   | /s/ RANDEL G. OWEN |   |   |
|--------|--------|--------------------|--------|--------|
| Name:  |   | Randel G. Owen     |   |   |
| Title: |   | Vice President     |   |   |

 

 

EMCARE HOLDINGS INC.

EMCARE, INC.

EMCARE OF ALABAMA, INC.

EMCARE CONTRACT OF ARKANSAS, INC.

EMCARE OF ARIZONA, INC.

EMCARE OF CALIFORNIA, INC.

EMCARE OF COLORADO, INC.

EMCARE OF CONNECTICUT, INC.

EMCARE OF FLORIDA, INC.

EMCARE OF GEORGIA, INC.

EMCARE OF HAWAII, INC.

EMCARE OF INDIANA, INC.

EMCARE OF IOWA, INC.

EMCARE OF KENTUCKY, INC.

EMCARE OF LOUISIANA, INC.

EMCARE OF MAINE, INC.

EMCARE OF MICHIGAN, INC.

[Signature Page toSupplemental Indenture Correcting Cross-References]

 

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EMCARE OF MINNESOTA, INC.

EMCARE OF MISSISSIPPI, INC.

EMCARE OF MISSOURI, INC.

EMCARE OF NEVADA, INC.

EMCARE OF NEW HAMPSHIRE, INC.

EMCARE OF NEW JERSEY, INC.

EMCARE OF NEW MEXICO, INC.

EMCARE OF NEW YORK, INC.

EMCARE OF NORTH CAROLINA, INC.

EMCARE OF NORTH DAKOTA, INC.

EMCARE OF OHIO, INC.

EMCARE OF OKLAHOMA, INC.

EMCARE OF OREGON, INC.

EMCARE OF PENNSYLVANIA, INC.

EMCARE OF RHODE ISLAND, INC.

EMCARE OF SOUTH CAROLINA, INC.

EMCARE OF TENNESSEE, INC.

EMCARE OF TEXAS, INC.

EMCARE OF VERMONT, INC.

EMCARE OF VIRGINIA, INC.

EMCARE OF WASHINGTON, INC.

EMCARE OF WEST VIRGINIA, INC.

EMCARE OF WISCONSIN, INC.

EMCARE PHYSICIAN PROVIDERS, INC.

EMCARE PHYSICIAN SERVICES, INC.

EMCARE SERVICES OF ILLINOIS, INC.

EMCARE SERVICES OF MASSACHUSETTS, INC.

EMCARE ANESTHESIA SERVICES, INC.

ECEP, INC.

COORDINATED HEALTH SERVICES, INC.

EM-CODE REIMBURSEMENT SOLUTIONS, INC.

EMERGENCY MEDICINE EDUCATION SYSTEMS, INC.

EMERGENCY SPECIALISTS OF ARKANSAS, INC. II

FIRST MEDICAL/EMCARE, INC.

HEALTHCARE ADMINISTRATIVE SERVICES, INC.

OLD STAT, INC.

REIMBURSEMENT TECHNOLOGIES, INC.

STAT PHYSICIANS, INC.

THE GOULD GROUP, INC.

TIFTON MANAGEMENT SERVICES, INC.

TUCKER EMERGENCY SERVICES, INC.

HELIX PHYSICIANS MANAGEMENT, INC.

NORMAN BRUCE JETTON, INC.

PACIFIC EMERGENCY SPECIALISTS MANAGEMENT,INC.

AMERICAN EMERGENCY PHYSICIANS MANAGEMENT,INC.

EMERGENCY MEDICAL SERVICES CORPORATION

EMS MANAGEMENT LLC

By: EMSC Management, Inc. and EmCare HoldCo,Inc., its members

[Signature Page toSupplemental Indenture Correcting Cross-References]

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PHYSICIAN ACCOUNT MANAGEMENT, INC.

PROVIDER ACCOUNT MANAGEMENT, INC.

CHARLES T. MITCHELL, M.D., INC.

GLOBAL MEDICAL RESPONSE, INC.

EMCARE OF MARYLAND LLC,

By: EmCare Holdings Inc. and EmCare, Inc., its members

 
| By:    |   | /s/ WILLIAM A. SANGER   |   |   |
|--------|--------|-------------------------|--------|--------|
| Name:  |   | William A. Sanger       |   |   |
| Title: |   | Chief Executive Officer |   |   |

 

 

U.S. BANK TRUST NATIONAL ASSOCIATION, as Trustee

 
| By:    |   | /s/ PAUL SCHMALZEL |   |   |
|--------|--------|--------------------|--------|--------|
| Name:  |   | Paul Schmalzel     |   |   |
| Title: |   | Vice President     |   |   |

[Signature Page toSupplemental Indenture Correcting Cross-References]

 

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