contribute an important role in the chain of survival. It is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid and oxygen administration, with the possible exception of automated external defibrillation, which is still a regulated medical act in Canada, although one which is increasingly performed by members of the public under a legal exemption that allows members of the public to undertake some controlled medical acts in emergencies. This level of training is equivalent to an Emergency Medical Technician in the United States. Many paramedics in Canada at all levels from Emergency Medical Responder (EMR), Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP) and Critical Care Paramedic (CCP), are combining their diplomas of paramedicine with a bachelor's degree of paramedicine which is heading towards the standard of educational requirements in Canada. Emergency Medical Responders would not be eligible for these educational advances due to their limited scope of practice and education. In the United States History The U.S. Department of Transportation (DOT) recognized a gap between the typical eight hours training required for providing basic first aid (as taught by the Red Cross) and the 180 hours typical of an EMT-Basic program. Also, some rural communities could not afford the comprehensive training and highly experienced instructors required for a full EMT course. The First Responder training program began in 1979 as an outgrowth of the "Crash Injury Management" course. In 1995 the DOT issued a manual for an intermediate level of training called "First Responder." This training can be completed in twenty-four to sixty hours. Importantly, this training can be conducted by an EMT-Basic with some field experience, which is a resource available in-house for many volunteer fire departments which do not have the resources or funds to conduct full EMT training. The first responder training is intended to fill the gap between first aid and Emergency Medical Technician. The American Red Cross conducts a course titled "Emergency Medical Response" that fits this definition. In the US the term "Emergency Medical Responder" has largely replaced the term "Certified First Responder" or "Medical First Responder" beginning in 2012. "Emergency Medical Responder" or "EMR" is an EMS certification level recognized by the National Registry of Emergency Medical Technicians. The term "emergency medical responder" is used loosely in many states, with "first responder" and "medical first responder" still