had to be undertaken to complete the paramedic course to practice and demonstrate the skills learnt during the hospital placements and residential course. Prior to regulation and closure of the title, the term "paramedic" was used by a variety of people with varying levels of ability. Paramedics could apply to register via a grandfather scheme which ended in 2002. However, university qualifications are expected for paramedics, with the entry level being an Honours Bachelor of Science degree in Pre-Hospital Care or Paramedic Science. As the title "Paramedic" is legally protected, those utilising must be registered with the Health and Care Professions Council (HCPC), and in order to qualify for registration you must meet the standards for registration, which include having a degree obtained through an approved course. It is common for paramedics to have master's degrees in Advanced practice or Paramedic practice and is indeed a requisite for paramedic prescribing. Paramedics work in various settings including NHS and Independent Ambulance Providers, Air Ambulances, Emergency Departments and other alternative settings. Some paramedics have gone on to become Paramedic Practitioners, a role that practices independently in the pre-hospital environment in a capacity similar to that of a nurse practitioner. This is a fully autonomous role, and such senior paramedics are now working in hospitals, community teams such as rapid response teams, and also in increasing numbers in general practice, where their role includes acute presentations, complex chronic care and end of life management. They work as part of the allied health professional team including Doctors, Nurses, physician Associates, Physiotherapists, Associate Physicians, Health Care Assistant and Clinical Pharmacists. Paramedic Practitioners also undertake examinations modelled upon the MRCGP (a combination of applied knowledge exams, clinical skills and work place based assessment) in order to use the title "specialist". There are also now a growing number of these advanced paramedics who are independent and supplementary prescribers. There are also 'Critical Care Paramedics' who specialise in acute emergency incidents. In 2018, the UK government changed legislation allowing Paramedics to independently prescribe, which will open new pathways to Paramedics to progress into. This came into force on 1 April 2018, but did not immediately affect practice as guidance was still being written. United States In the United States, the minimum standards for paramedic training is considered vocational, but many colleges offer paramedic associate degree or bachelor's degree options. Paramedic education programs typically follow the U.S. NHTSA EMS