These work conditions include, but are not limited to: performance of essential job responsibilities in a moving, ground ambulance, hospital as well as the potential to do so in an outdoor environment (inclement weather, extremes of temperature, accident scenes, steep terrain, back country, etc.), exposure to noise, vibration, and dehydrating environment of a ground ambulance, exposure to patients with known or unknown infectious disease in an enclosed space. Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.