> What you are forgetting of course is that paramedics practice autonomously from day 1! There is no option to phone the on call doc, call the crash team etc. That is a BIG difference. Nurses struggle with autonomous practice because nothing in their training prepares them for it and very little of their experince encourages it. [Fred] Point accepted, Fred... > But I think that if this list are not prepared to accept the concepts of prehospital thrombolysis that they would go mental over things such as prehospital central lines and RSI - no matter what length of training we have. [Mike] I can't imagine why you might want to do a central line prehospital, Mike; I rarely see them being inserted in A&E these days, except for the "long haul" resus case that's lining up for ITU. Adrian Fogarty