This Concept of Operations outlines a plan for federal support of state Emergency Medical Services when demand exceeds availability in the New England region. It establishes guidelines for using federally contracted ambulances and paratransit vehicles to augment state resources during mass casualty events or evacuations. The process involves advisory, alert, and activation stages followed by check-in, deployment, command/control, and demobilization of assets. Command remains with the state while the contractor provides tactical management and logistics support for up to 72 hours before receiving assistance from FEMA. The goal is to maximize coordination between local, state, and federal partners.