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The County Council became responsible for the fire brigade service in Middlesex on 1 April 1948. At this date there were thirty-eight fire stations sited for local pre-war needs in three districts, with public calls routed to stations. Abolition of street alarms allowed communications to be gradually centralised into one control at Wembley. A reorganisation scheme was embarked upon based on twenty-eight stations strategically sited and involving sixteen new stations, the last of which was ready in 1965. Fire prevention work, handled in 1948 by two uniformed staff and one civilian officer, by 1964 required twenty-eight uniformed and ten civilian staff. The entire fleet of appliances taken over from the wartime National Fire Service was replaced by modern appliances, and a scheme was undertaken to improve and standardise hydrants.
From 1948 to 1964 the Brigade responded to over 170,000 calls to incidents of all kinds. Notable incidents included fires at a timber yard in Hayes (1952), at a Brentford soap works (1959), at a Wealdstone furniture repository (1961), at a furniture factory at Ponders End (1964) and the Harrow and Wealdstone railway crash of 1952. Three British Empire Medals and two Queen's Commendations for gallantry were awarded to fire fighters and the Royal Humane Society made awards to ten members of the Brigade.
The Council became responsible for the Ambulance Service on 5 July 1948. The ambulance service used the accommodation, communications and control organisation of the fire service. In 1959 the sick removal branch of the ambulance service (that is, taking people to hospital for routine appointments) became part of the health service administration and the fire and ambulance services were separated in 1962.