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Welcome to the November edition of the Los Santos Fire Department's Monthly Bulletin!


The Public Affairs team are glad to welcome it's new members to the division this month who have aided in making this last monthly bulletin of the year as always unique and informative. Why the last of the year? Well the next release by the Public Affairs Division will be a yearly bulletin, rounding up on all the years events in the Los Santos Fire Department. We hope you have a pleasant read!

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Written by Commissioner Jenny Russ

I honestly can't believe that this will be the last time I write something for our monthly bulletin in the year of 2012. It has been an amazing year so far and I'm sure we'll make sure to end it as a year of celebration. Speaking of celebrations, it looks like December is upon us, the winter nights are hear and the time for being with family is more important than ever.

Before we look onto the month ahead however let me speak about the month just passed. November saw a Halloween carnival in town, a unique airshow hosted by the San Andreas Sherrifs Department and a new mayor in Allegra Nixon. These are moments throughout the month that most citizens of Los Santos would have seen first hand, however this isn't everything that has happened this month.

Citizens don't always see what the men and women of the Los Santos Fire Department have been doing and I'm proud to say I get to see this each and everyday. Every member of the department has done the LSFD proud this month with their continuous efforts in ensuring lives are saved and preserved even when there own lives may be threatened. Throughout the month more on duty injuries than in any month have occurred to the EMT's and Doctors of the department while performing their daily tasks. Why is this? We will never know but I praise each and every member of the LSFD who did not let the increase in crime phase them and continued to aid citizens in whatever way they could.

Now we look to the month ahead, the time for celebration in time for Christmas and the New Year. As winter arrives we I urge each and every citizen to wrap up warm and take extra care when on the streets and roads of Los Santos. Yes winter is a time when most smile but it's also a time when more accidents are prone to happen.

Keep Safe Los Santos!

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LSFD Internal Awards 2012
Written by Jenny Russ

As mentioned in last months bulletin this year to celebrate the year that has passed the department will be holding the Los Santos Fire Department Internal Awards for the year 2012. Nominations started at the beginning of November for several categories that we're choosen by the Public Affairs division. These categories are:


    - LSFD Member of the Year
    - Firefighter of the Year
    - Physician of the Year
    - Deputy (SASD) of the Year
    - Officer (LSPD) of the Year
    - Guard (SaDoC) of the Year
    - Sub Department/Clinical Team of the Year
    - Funniest LSFD Member
    - Best Command/High Command Member
    - Most Active On-duty Member
    - Most Helpful Member
    - Most Respected Firefighter/Physician
    - Scariest LSFD Member
    - Worst Emergency Response Driver
    - Best Emergency Response Driver
    - Most Remembered Member
    - Greatest Changes to LSFD
    - Best Moment in LSFD


Voting has now opened for each of the categories, if you wish to cast your vote please visit the voting box situation with ASGH. ((If not a member of the the LSFD forums you will be required to register and request visitor status before voting. Awards section can be found at: http://www.ems.lsgov.us/viewforum.php?f=549))

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SASD Air Show
Written by Arun Harris

On the 25th of November 2012, hundreds of civilians headed towards San Fierro to watch an Air Show put on by the Sheriff's Department. It was a great success with the Police Department, Fire Department, Sheriff's Department and the National Guard all putting on little performances for the crowd.

From our department, Commissioner Russ, Bureau Chief Harris, Lieutenant Lambe, Lieutenant Donnell and Firefighter Second Class Foster all took part in two LifeFlights, a SeaKing and a FireHawk. The helicopters hovered around the crowd as information regarding the choppers was relayed to everyone using a megaphone. The FireHawk then released a large amount of water from their undercarriage and the SeaKing landed in the water and performed a water rescue.

Overall, it was a great event and the team would like the thank Lieutenant Russ from the Sheriff's Department for planning everything and making it run very smoothly. We had some great feedback from the civilians and this will hopefully bring attention to our Air Operations Division.

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Field Training Exercises
Written by Eleonora Tjader

Over the past month the LSFD have been further developing the use of Field Training Exercises mentioned in last months bulletin. Field training exercises provide experience and extra training to new and old firefighters ensuring they are ready and able for any call they may get.

One main goal for LSFD using these drills is to reduce response times without increasing any hazards to pedestrians or road users. The second is to assess where a firefighter may need extra training and support so advise and additional training may be provided.

Field training exercises provide drills for the following but are not limited to:

    - Fire Rescue
    - Search and Rescue
    - Vehicle Rescue/Extrication
    - Hazardous Materials Mitigation


So far these training exercises have been successful and continue to be received well by all employees

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Special Hazards Unit
Written by Matthew Primiano

Over the past few weeks, the commanders of the two Los Santos Fire Department advanced firefighting divisions have been communicating together about combining the divisions to form a joint sub-department charged with fulfilling the duties of both divisions. Just recently, on November 25, the Hazardous Materials Response Team (under Arturo Fontana) and the Advanced Technical Rescue (under Matthew Primiano) received approval from the command and high command staff of the Fire Department to create the Special Hazards Unit. The Special Hazards Unit has been approved to be commanded by the recently promoted Lieutenant Matthew Primiano with deputy commanders, Lieutenant Ted Lambe and Engineer Nick Apps, to assist in carrying out the duties of the new division.

Now, the Special Hazards Unit will be performing more advanced motor vehicle accident extrication's, swift water rescues, rope rescues, ladder operations, roof ventilation, hazardous materials decontamination and transports, confined space rescue, and much more. Additionally, the Los Santos Fire Department has recently purchased a new emergency apparatus to add to their fleet, Special Hazards Rescue 1 which is due to come in within the next few days. This piece of apparatus will be red and white (Enforcer) and will have fully functioning rear doors that store equipment and personnel when responding to and from calls. Commander Matthew Primiano ensures that this new piece of apparatus will enhance special hazards operations and accompany everything the unit encompasses.

The Special Hazards Unit will be fully up and running by December 5th, after all current personnel are inter-department trained in all operations and procedures. Recruitment for the division will be opened on December 7th for all personnel ranked Firefighter I and above. The handbook has been fully re-developed with the combination of the recent HAZMAT and ATR handbooks with some additional information. Members of the division are excited to get started on day-to-day operations that require special hazards units to respond; more information should be introduced in next months newsletter.

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New In-Service Training!
Written by Arturo Fontana

Over the last few weeks, your Training Division High Command and Command Team members have discussed the need for additional training throughout the department. We understand that no everyone enjoys training, so we have decided to resurrect the voluntary LSFD In-Service Training program. This program was de-commissioned about eight months ago because of lack of trainers and interest overall within the department. The TD is going to give this program a face-lift and re-institute some new courses within December. Understanding that many of our firefighters are told to read and understand their new medical guides once promoted to the rank of Firefighter First Class and Engineer, there are a lot of new intermittent and advanced medical procedures and protocols to understand. Most of us have just memorized the new guides and applied and learned the new procedures while on the job. Well, our first two in-service training sessions provided during December will be voluntary classes on EMT-I and EMT-P medical procedures and protocols. Similar to our EMT-B training program, our qualified trainers will demonstrate the EMT-I and EMT-P procedures and protocols to our Firefighter First Class, Firefighter Second Class, and Engineers or any hospital personnel that may be interested in "sharpening the saw." Some of the next in-training classes to be offered will be situation awareness, basic radio protocols and Operation Command Dispatch (OCD). If you have any suggestions or desires for upcoming in-service training sessions, please feel free to contact any member of the TD. Keep your eyes open for future classes and sign up today!

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High Risk Liver Transplant
Written by Dr. Logan Thornton

Good news, City of Los Santos, because the will power of humanity has once again overcome all odds in the fight for life against the infamous malfunctioning of organs, that has brought down the lives of millions to the ground and is still successfully making the life of thousands miserable. Recently the Mr.Alexander Eisenberg underwent a high risk liver transplantation and even though his life hasn’t been much of a fairy tale, has successfully beget a fairy tale ending.

Hepatic Cirrhosis

   On November 12, 2012, Mr. Alexander Eisenberg, who was a victim of a brutal vehicle accident was brought into the All Saints General Hospital by one of the senior firefighter Eleonora Tjader.

   Even though the condition of the victim of the accident, Mr. Eisengberg, seemed to have suffered a fracture due to the accident, the CT-Scan revealed a more brutal truth hidden inside his body. Mr. Alexander Eisenberg, an alcoholic, was diagnosed of the Hepatic Cirrhosis , one of the lesser known long term effect of alcoholism.

About Hepatic Cirrhosis

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   Hepatic Cirrhosis, usually caused due to alcohol, Hepatitis B, Hepatitis C etc, is a life threatening liver disease that is characterized by the replacement of the much needed liver tissue by fibrosis, scar tissue and lumps that occur as a result of a process in which damaged tissue is regenerated (nodules ).
   Cirrhosis is an irreversible disease. In other words, the only solution to the disease is a liver transplantation which does not guarantee that the body will accept the new transplanted liver and there is a huge percent of the subject undergoing coma and finally death.

Symptoms of Hepatic Cirrhosis
   Like all other diseases, Hepatic Cirrhosis also contain some visible symptoms. They are as follows;

Spider angiomata or spider nevi. Vascular lesions consisting of a central arteriole surrounded by many smaller vessels because of an increase in estradiol. These occur in about 1/3 of cases.[5]

•   Palmar erythema. Exaggerations of normal speckled mottling of the palm, because of altered sex hormone metabolism.
•   Nail changes.
•   Muehrcke's lines - paired horizontal bands separated by normal color resulting from hypoalbuminemia (inadequate production of albumin).
•   Terry's nails - proximal two-thirds of the nail plate appears white with distal one-third red, also due to hypoalbuminemia
•   Clubbing - angle between the nail plate and proximal nail fold > 180 degrees
•   Hypertrophic osteoarthropathy. Chronic proliferative periostitis of the long bones that can cause considerable pain.
•   Dupuytren's contracture. Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers. Thought to be caused by fibroblastic proliferation and disorderly collagen deposition. It is relatively common (33% of patients).
•   Gynecomastia. Benign proliferation of glandular tissue of male breasts presenting with a rubbery or firm mass extending concentrically from the nipples. This is caused by increased estradiol and can occur in up to 66% of patients.
•   Hypogonadism. Manifested as impotence, infertility, loss of sexual drive, and testicular atrophy because of primary gonadal injury or suppression of hypothalamic or pituitary function.
•   Liver size. Can be enlarged, normal, or shrunken.
•   Splenomegaly (increase in size of the spleen). Caused by congestion of the red pulp as a result of portal hypertension.
•   Ascites. Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs about 1500 mL to detect flank dullness).
•   Caput medusa. In portal hypertension, periumbilical collateral veins may dilate. Blood from the portal venous system may be shunted through the periumbilical veins and ultimately to the abdominal wall veins, manifesting as caput medusa.
•   Cruveilhier-Baumgarten murmur. Venous hum heard in epigastric region (on examination by stethoscope) because of collateral connections between portal system and the periumbilical veins in portal hypertension.
•   Fetor hepaticus. Musty odor in breath as a result of increased dimethyl sulfide.
•   Jaundice. Yellow discoloring of the skin, eye, and mucus membranes because of increased bilirubin (at least 2–3 mg/dL or 30 mmol/L). Urine may also appear dark.

The above listed symptoms are more commonly occurring and if observed it is highly recommended to contact  your doctor immediately.

Liver Transplantation

   As Mr.Eisenberg, the unfortunate victim of the life threatening disease, looked forward for to begin the transplantation, the medic team at the All Saints General Hospital were on their toes searching for the liver that would supposedly match the victim.
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   Liver is a unique organ present in the human body that performs several major functionalities such as metabolism, decomposition of RBC, Glycogen storage etc. It is located by the diaphragm in the abdominal-pelvic region of the abdomen. Liver is the only organ in the body that is capable of reproducing itself. Hence while performing a liver transplantation, several times, a part of the liver from a healthy human being is removed and transplanted into the subject. The liver takes about 10-15 days and both the donating party and the subject must be kept under strict observation during these days.

Pre-surgical procedures

   The subject will be made to undergo some of the procedures prior to the surgery. These procedures have been listed below;
•   Psychological and social evaluation. Psychological and social issues involved in organ transplantation, such as stress, financial issues, and support by family and/or significant others are assessed. These issues can significantly impact the outcome of a transplant.
•   Blood tests. Blood tests are performed to help determine a good donor match, to assess your priority on the donor list, and to help improve the chances that the donor organ will not be rejected.
•   Diagnostic tests. Diagnostic tests may be performed to assess your liver as well as your overall health status. These tests may include X-rays, ultrasound procedures, liver biopsy, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.
Other than the procedures listed above, the doctor will also perform the following;
•   Your doctor will explain the procedure to you and offer you the opportunity to ask any questions about the procedure.
•   You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.
•   For a planned living transplant, you should fast for eight hours before the operation, generally after midnight. In the case of a cadaver organ transplant, you should begin to fast once you are notified that a liver has become available.
•   You may receive a sedative prior to the procedure to help you relax.
•   Based on your medical condition, your doctor may request other specific preparation.
Once Mr. Eisenberg had gone through the procedure, he was all set for the major surgical process that lasted upto two hours. Thanks to the hardwork of the  Los Santos Fire Department and the Hospital Department in the ultimate fight  for survival, the surgery was a complete success.

Post surgical guidelines

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   The surgery might be successful but this does not mean that the subject Is out of danger yet. After the surgery, Mister Eisenberg was subjected to several post surgical procedures listed below;

•   The subject  was connected to monitors that will constantly display the EKG tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Liver transplant surgery requires an in-hospital stay of seven to 14 days, or longer.
•   The subject will be intubated during these days.
•   Special IV drips will be provided to make sure that the body is stable during the days at the hospital. These tubes will be removed only when the body starts accepting the new lever and acts accordingly.
•   Later the subject is moved to the hospital Rest Room, where he will be rested for few more days.
•   Once the patient has been moved to his house, he is made to be on a liquid diet for about a week and his conditions are closely monitored. Care should be taken that the person is not suffering from signs of rejections such as fever, vomiting, jaundice etc. If found, he should be immediately moved to the hospital for further treatments.
Luckily, Mister Eisenberg, made a good progress and showed no signs of rejections. Now he is a normal civilian of Los Santos again, who is living his life after  winning the battle against time at his home.

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Sub-Department Changes
Written by Arturo Fontana

Due to organizational restructuring within the Los Santos Fire Department there have been changes made to the sub-department leaders this month. The changes are listed below:

    - Dr. Elena Armero is the Commander of Child Protection Services again. We trust that Dr. Armero will do a wonderful job ensuring the safety and welfare of the youth as she has done in the past.
    - Lieutenant Matthew Primiano is now the Commander of the new Special Hazards Unit. The new Special Hazards Unit was formed through a merger of the Advanced Technical Rescue and HAZMAT divisions. Lieutenant Primiano has already made significant strides within this new unit, and we expect great things from this highly skilled group in the future!


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Recruitment & Training Review
Written by Shawn Donnell

The Recruitment and Training Programs saw another successful month! The following data are statistics from Recruitment Drive #20:

Total applications: 36
Accepted applications: 15 (42%)
Denied applications: 21 (58%)
Successful EMT applicants: 15
Average Exam Score: 86%
Successful Physician applicants: 3

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Written by Arun Harris

Total members in the Los Santos Fire Department: 50

High Command - 8.0%
Commissioner
1 - 2.0%
Bureau Chief
1 - 2.0%
Battalion Chief
2 - 4.0%

Command - 14.0%
Captain
2 - 4.0%
Lieutenant
4 - 8.0%
Chief of Surgery
1 - 2.0%

Non-Commissioned - 78.0%
Attending Physician
1 - 2.0%
Senior Resident
2- 4.0%
Resident
2 - 4.0%
Intern
3 - 6.0%

Engineer
4 - 8.0%
Firefighter II
3 - 6.0%
Firefighter I
10 - 20.0%
Probationary Firefighter
14 - 28.0%

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Written by Arun Harris

We would like to wish everyone who has resigned from the Los Santos Fire Department the best of luck with the rest of their lives.
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    - Melissa Smart
    Engineer

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    - Robert Fullman
    Firefighter Second Class

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    - Felix Racicot
    Firefighter First Class

______________________________________________________________________

    - Paulo Caetano
    Probationary Firefighter

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    - Zach Rayne
    Probationary Firefighter

______________________________________________________________________

    - Johnny Tomson
    Resident

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Written by Adam Foster

Individual promotions are handed out during the month, so here are the individuals that were promoted throughout the month of October:

Probationary Firefighter -> Firefighter I
    - Derek Hird
    - Amelia Evans
    - Michelle Lonsdale
    - Paulie Mazzone
    - Mason Verdone
    - Juozas Venta


Firefighter I -> Firefighter II
    - Alexis Finnessey
    - Adam Foster
    - Mariza Aparicio


Firefighter II -> Engineer
    - Eleonora Tjader
    - Nick Apps


Engineer -> Lieutenant
    - Matthew Primiano


Intern -> Resident
    - Logan Thornton
    - Peter Patel
    - Jimmy Ventura


Resident -> Senior Resident
    - Logan Thornton


Congratulations to all who have been promoted this month.  Please understand that if you were not promoted this month, you still have many opportunities throughout the month of November to prove yourself meritorious of an increase in rank.

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Written by Adam Foster

Every month, we recognize our firefighters and doctors within the Los Santos Fire Department and All Saints General Hospital who have received commendations for their tireless dedication, bravery and professionalism.  We praise these wonderful achievements with awards.  Let's take a moment and reflect on who was honored during the month of October:

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Service Award II
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We would like to thank Engineer Nick Apps for their wonderful dedication and enthusiasm within the LSFD for the last 6 months.  Keep up the great energy and professionalism!

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Service Award I
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We would like to thank Engineer Eleonora Tjader for their continued dedication and service to the LSFD for the last three months.

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EMT-B Certification Award
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These are our newest members of the department who have successfully passed our basic medical training program and have been certified as Probationary Firefighters.

Recipients:
Lisa Bower
Luke Michaels
Amber Madox
Alexa Johnson
Ronald Costa
Connor McNally
Claudia Winstan
Raymond Ramirez
Gabriela Rivera
Kevin Simon
Sookie Jones
Anna Sokolova
Sofia Sanna

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EMT-I Certification Award
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These individuals have completed their firefighter training program and have been employed with the LSFD for at least two months ((two weeks)); therefore, these men/women have achieved the rank of Firefighter I allowing them to respond to fire events and practice intermediate medical procedures and protocols.

Recipients:
Juozas Venta
Amelia Evans
Mitchelle Cooper
Paulie Mazzone
Mason Verdone
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EMT-P Certification Award
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These members have continued to exceed expectations in the field of emergency medical care and are now certified to administer advanced emergency medical care as certified paramedics:

Recipients:
Eleonora Tjader
Nick Apps
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Firefighter Certification
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The department’s medics not only provide outstanding emergency medical care, but they are also expected to fight fires in Los Santos.  The following individuals have traversed the department’s firefighter training program to receive their firefighter certifications, which also makes them eligible for promotion to the rank of Firefighter I:

Recipients:
Juozas Venta
Amelia Evans
Mitchelle Cooper
Paulie Mazzone
Mason Verdone

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Command Team Award
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Mr. Matthew Primiano has achieved the rank of Lieutenant in the LSFD.  This position is part of the LSFD Command Team and with it, comes great responsibility.  We know Mr. Matthew Primiano is  up for the challenges and we look forward to their leadership.

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Medical Internship & Residency
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The LSFD is not only comprised of pre-hospital personnel that provide emergency medical services in the field, but the ASGH maintains an amazing staff of highly trained doctors to administer surgical procedures and tend to our many drug addicted citizens of Los Santos; however, every doctor has to start somewhere.  So, we would like to recognize the newest interns and residents that have joined the elite team of doctors at the ASGH:

Recipients:
Jimmy Ventura
Lilian Johnson
Emmanuel Walcott
Nick Hampton


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Every month, High Command recognizes two individuals from the hospital and pre-hospital sides of the department for their outstanding and consistent efforts to advance emergency medical care and the Hippocratic Oath within the field and administratively within the office.  We recognize the exemplary efforts of these individuals with the Physician of the Month and Firefighter of the Month awards.  So, without further delay: 

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The title of Firefighter of the Month goes to Engineer Eleonora Tjader for her continuous dedication shown to the department and expertise show in all elements of her work in the field and in the office.  Her interests within the Training Division and contributions to the Rapid Response Division have been appreciated.

We would also like to present Dr. Logan Thornton with the title of Physician of the Month for his admirable work ethics shown towards his many duties as a physician and continuous dedication throughout the department.  Dr. Thornton's amazing one hour marathon liver transplant this month was just breath taking!


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Written Jenny Russ

That concludes our last monthly bulletin of the year for 2012 and we apprecaite any feedback you may have on this months release. Keep your eye out for the next bulletin released by the Los Santos Fire Department Public Affairs team which will be the 2012 yearly bulletin as well as the results from the LSFD Internal Awards 2012.

Remember, it's winter so be extra careful out there. We here at the Los Santos Fire Department wish you all a safe and merry Christmas and a Happy new year!

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Produced by the Public Affairs Department
Edited for release by Battalion Chief Arturo Fontana
Approved for release by Commissioner Jenny Russ