Pointe Claire QC–I’m driving out towards Stanstead on Highway 10 in Quebec when I realize the flat end of the EMS line is where we really need Advanced Life Support [ALS]. The number of ambulances per capita drops off radically as you cross the Champlain Bridge off the island of Montreal. Half an hour later and you’ve left the territory belonging to the South Shore’s ambulance service [CETAM] behind, too. Within 45 minutes you’re cruising past the shrouded-in-snow-being-blown-out-of-machines slopes of Bromont. There are a couple of ambulances in the area. Maybe. If no one has skied out of their depth and slammed into a mogul femur first. An hour later and you’re almost at the end of the line on Highway 55 and there’s one ambulance out there and no fire department first response. And no real Advanced Life Support. What’s up with that? Why is it that the test cohort for true ALS paramedics is in the City of Montreal where transport times to hospitals can be averaged in the less than 15 minutes range? It’s at the flat end of the EMS line where we need ALS.