aspects of practice which have evolved since it was written. ECG interpretation is a good example, where in-depth 12 lead ECG interpretation is now taught at ILS level as part of the degree where at the time of writing the Standard (2008) this level of skill was generally reserved for ALS practitioners given the number of practicing graduates was smaller at that time. Like other similar systems around the world such as South Africa, the UK and Australia, and in sharp polar contrast to the United States and (to a lesser degree) Canada, the system of practice is entirely based upon the professional discretion of the attending ambulance officers, and there is no need for "online medical direction" to obtain approval for drugs or procedures. There is however a strong system of collegial support via the communications centre Clinical Desk (and on-call Medical Advisors) to assist with clinical decision-making when required, this however is not a system of seeking permission. The below Delegated Scopes of Practice are as per the 2013–2015 Clinical Procedures and Guidelines First Responder Basic pre-hospital emergency care (PHEC) medication can be used by staff in the entry level of ambulance care (event staff and new volunteers). Current scope of practice: Paracetamol, ibuprofen, aspirin, oxygen therapy, intermittent positive pressure ventilation (IPPV), oropharyngeal airway (OPA), nasopharyngeal airway (NPA). Additionally, certain medications from the EMT scope of practice may be given by a First Responder with Clinical Direction from an EMT/Paramedic/ICP at the scene or via the St John/WFA Clinical Desk. Emergency Medical Technician General pre-hospital emergency care to assess and manage both life-threatening and non-life-threatening situations using knowledge, skills and clinical judgement appropriate to generally non-invasive techniques and non-intravenous drug regimens. Current scope of practice: 3/12 lead ECG acquisition, nasopharyngeal airway, nebulised salbutamol, nebulised ipratropium, GTN (SL and Transdermal), IM glucagon, laryngeal mask airway, ondansetron (intramuscular), loratadine, Ibuprofen, Methoxyflurane, PEEP valve, adrenaline (IM, IN and nebulised), Prednisone, Prednisolone, Tramadol, urinary catheter troubleshooting, laryngoscopy, Magill forceps. Paramedic Knowledge and skill to provide invasive care that significantly builds upon BLS capacity in terms of clinical judgement and capability including a wide range of pharmacology. Current scope of practice: All of the above plus manual defibrillation, synchronised cardioversion, IV cannulation, IV fluid administration, IV glucose, morphine, fentanyl, naloxone, ondansetron, adrenaline (IV) for cardiac arrest, amiodarone (IV) for cardiac arrest, ceftriaxone, naloxone, midazolam (IM) for seizures, oxytocin, ceftriaxone, clopidogrel, lignocaine (SC) for