This course is a continuation of NSC Paramedic 1 - 3. Care of the patient with special challenges and chronic illnesses will be discussed. Students will learn how to effectively manage a multiple casualty incident, gain Haz-Mat awareness, how to safely and effectively transport their patient, how to operate at a crime scene, and gain rescue awareness. Trauma and assessment based management will be discussed. Students will perform 150 hours of clinical time in the hospital and prehospital setting. Clinical emphasis will be devoted to the emergency department, intensive care unit, coronary care unit, pediatric department, labor and delivery department, and psychiatric department. Students will be expected to gain prehospital field experience on an ambulance or fire based EMS service.