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I have been reading this thread with interest. Here is my personal slant of this subject as a paramedic with a trauma patient in the field. I try to notify the docs in the ED as soon as it is possible. Most of the time it is en-route to the ED which can be anything from 10 minutes to 45 minutes. Sometimes I can notify when on scene - especially if the patient is trapped for a while and I have a free moment. What I want when I get to the ED is the most experienced, competent doc available. What I occasionally find is an inexperienced (in trauma) doc who struggles to come to terms with the basics of ED trauma care. Nurses and paramedics squirm at some of the decision making processes prior to senior doc arriving. In such circumstances an ED consultant coming in from home is invaluable and anecdotally makes a huge difference in the way the team work, the care plan and on occasion beneficial outcomes. If the consultant arrives 10 minutes after the patient it doesn't matter too much - the initial do is either really on the ball and done the right things and the consultant is their to reinforce the doctors decision OR it's a complete lash up in the past 10 minutes and the situation needs control "...perfect timing Mr. Consultant". Should consultants drive in from home - absolutely. Should they have blues and twos - yes. Most ambulance services can provide emergency driving courses for doctors (such as BASICS docs) and there is not reason this should not be extended to ED consultants. Should the vehicle be striped up and have light bars - arguably not. Ambulance managers seem to do OK with non-striped vehicles and are effective in proceeding through traffic safely. As long as the vehicle has a roof magnet, alternating headlights/white strobes and an audible warning devise, it is enough. Will the doc race through towns and villages like a bat-out-of-hell? No doubt some will - but they will soon be shown the errors of their ways by the traffic police for 'undue care and attention'. Remember that if you have an accident while running with two's and blue's you will automatically be cautioned by the police and your insurance company will have to be notified. You may find your insurance premium goes up as a consequence of the RTC. As do ambulance personnel. I support consultant having two's and blues. We need you chaps when we get to the ED. Mike Bjarkoy.