Was told this could be the largest OSHA fine for an ambulance service.

The only unique thing about this company is that they were caught. I've had the pleasure of working for a company that hadn't been caught yet. I also had the pleasure of putting in my 2 weeks after my second shift on the job.
 
@Grimes is spot on.

OSHA likes to add up the numbers and put out a press release. The number is then negotiated to a significantly smaller amount.
 
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