Mono County EMS operates under a physician medical director, and is authorized to perform state-of-the-art advanced medical procedures in the field through a comprehensive medical protocol system. The system was developed through cooperation with three other counties (forming ICEMA) and the base hospital staff. This allows quick and effective intervention when only minutes can mean the difference between life and death.  The Inland Counties Emergency Medical Agency  (ICEMA) is continuously updating protocols to keep abreast of the most recent medical advances. Their website is: http://www.sbcounty.gov/icema/ [1].