The primary responsibility of the Denver Health Paramedic Division is to provide 911-ambulance service to the City of Denver. At peak times there are 21 Advanced Life Support (ALS) ambulances available to serve the city. Each of these ambulances has a 10-hour day shift and a 10-hour night shift, with the shifts staggered throughout the day to provide continuous 24-hour coverage. Real-time medical control is available from the physicians of Denver Health’s emergency department, who provide instruction and advice to providers in the field. More than 46,000 patients a year are transported by Denver Health ambulance. These patients are transported to one of twelve 911-participating emergency departments in the Denver metropolitan area, based on the patient’s need for specialty services and proximity.