EMS is not only response, treatment and transport-the back office and support functions are the “power behind the punch” of service delivery. The creation of lean, efficient and measurable systems is the key to success. An example of this is a high functioning fleet service. If your vehicles fail on the way to calls, then so does the mission. Keeping your organization well serviced and maintained is an arterial function and performance could hemorrhage if you can’t get to where you need to go. The swift conversion of treatment, to bill, to income is also an essential function. Remembering the economic requirement that we turn the amount of available funds into quality healthcare requires the generation of said funds to keep the EMS circle of life turning. While those in support functions are not delivering lifesaving and patient care, they keep the organization alive and healthy.