The Crag Rats, Pacific Northwest Search And Rescue, and Portland Mountain Rescue have formed Search and Rescue Advance Life Support teams.  This skilled group of volunteer paramedics, nurses, nurse practitioners, physician associates, and doctors provide advanced medical care in remote locations where conventional services cannot easily reach.  The Hood River County Health Department say sthe SAR ALS program was started because the American Medical Response Reach and Treat Team, which served the region for 40 years with backcountry paramedics, ceased operation on April 30.  Hood River County Health Officer and SAR Emergency Medical Services Medical Director Dr. Christopher Van Tilburg worked with regional SAR organizations to fill the gap.  Hood River County Sheriff Matt English says the new capabilities are a game changer.  He says the ability to provide advanced medical care in remote locations, not readily accessible by Fire and EMS crews, greatly increases the likelihood of positive outcomes.