Critical Care Paramedics  There are currently national and local discussions as regard to education, deployment and scope of practice for CCPs here in the UK. Unlike the CCEMT-P programme in the US which takes weeks, it looks like we are going to have to do the course over 2-3 years. I will let the reader draw their own conclusions as to why this is. I am unable at this time to fully explore the CCP programme on this site as I do not wish to present a conflict of interest with the work I am engaged with in my service. As soon as I get the OK I will publish, but until then I do not want to compromise myself or the project.  Key Drivers Anaesthetists Increased demands on ITU staff to stay on site Need to redcue the frequency of on-call ITU teams being brought in for cover Keeping ITU teams off duty redcues the potential for next day theater lists to be cancelled Ambulance Service Decreasing local facilities giving increased demands for both routine and urgent A&E/ITU transfers Emerging roles for primary, secondary and tertiary roles inmajor/terrorist incidents Emergend specialist roles requireing critical care support   The key drivers are basically about money and resources.   Hosptial: From a hospital perspective they want to keep their specialists on site to ensure levels of clinical care is maintained on their wards and not being bounced around the UK in the back of an ambulance. By keeping the ITU doctor and nurse on the ward the need to call in the off duty teams are reduced and that has a potential positive impact on the next days theatre lists – from being cancelled.   Ambulance: From an ambulance perspective we have three key drivers (listed above)   1. We are travellling greater distances between hospitals due to patient clinical needs for a higher dependancy unit. So theneed for a greater skill/drug regime necessitate sstabilisation of the patients haemodynamic status in transit between one hospital and another.   2. It prepares us for our roles in major incidents. Primary role beind the advanced critical care treatment of patients tha the scne on an incident nad en route to the A&E dept. Secondary role being one of support for the A&E /ITU staff which may at times be overwhelmed by shear numbers of casualties. Tertiary role being the transfer of ITU patients from hospitals at ground zero sites to alternative units throughout the UK.   3. To support USAR, Tactical Medic, CBRN, MIRG and ATACC teams.   The ambulance service are moving away from a transport only resource and taking on a greater variety of specialist roles. Critical Care being just one of these roles and we must embrace these exciting roles as part of our service development.