Also included in the outpatient component are ambulance squads, whether they are community, municipal, or police or fireman rescue squads. Ambulance assistance is an outpatient vice that has taken on increased status with the advent of paramedics, emergency medical technicians (EMTs), and emergency medical systems, such as the cardiopulmonary resuscitation teams that have saved so many lives. Physician group practices are common in larger medical centers and are also part of this outpatient category. Even more dramatic than the decline in inpatient hospital use has been the increase in community hospital outpatient visits, The increased volume of surgical procedures done on an outpatient basis accounts for much of the growth in outpatient visits. The shift toward ambulatory surgery is not the only factor behind growth in hospital outpatient visits, Community hospitals have expanded the number and variety of outpatient services they provide. Inpatient The third institutional component, and the largest in terms of cost and personnel, is the inpatient component. The inpatient element is measured by the number of hospital inpatient beds. Americans have asked the country's hospitals to provide a spectrum of inpatient care ranging from very sophisticated intensive care to minimal care, and all of these types of care take place inside the hospital