HFD EMS Assistant Chief David Almaguer discusses how he became a paramedic, the impact of Life Flight on Houston medicine, his memories of Red Duke, and the role Houston EMS has played in its 45-year history. Almaguer’s first fire-safety experience was in an elementary school demonstration and was followed by a Southwest Houston church fire in his community one week later. Working throughout his college years at the fire department, he was initially an EMT and had no plans to become a paramedic until he was instructed to become one by superiors. A portion of the interview centers on his knowledge of Dr. Red Duke, who started Houston’s helicopter ambulance Life Flight, and cared for Gov. .John Connally who was shot along with President Kennedy in 1963. . The bulk of the interview, however, is devoted to the history of Houston EMS, which began service April 10, 1971. He discusses many changes that have taken place in the department as it has stayed at the forefront of research and development in emergency care, including protocols for patient treatment and department equipment. He explains the role of the physician director, the tiered response of the department in dispatching equipment in response to 9-1-1 calls, the department’s ability to respond to mass casualties, and its call volume.