there have been delays in assembling a realistic framework to transition totally away from an in-service education model. The degree is required to be referred to as a Paramedic. The degree is a comprehensive education program over three years consisting of 3,600 hours of learning which enables students to build a solid foundation of knowledge, skill, rationale and clinical judgement to the ILS level as a mixture of classroom, simulation suite and practical (on-road) experience catering for both school leavers who wish to pursue a Paramedic career (in the same way at other health professional degrees) and also for working Ambulance Officers who wish to upgrade their knowledge and obtain a tertiary qualification. There were previously suggestions by St John that the organisation may follow Western Australia, the Northern Territory and the Ambulance Service of New South Wales by offering employment at a defined exit point of the Degree allowing the student to essentially become a BLS Emergency Medical Technician full-time and complete the rest of the degree over a number of years and qualify as an ILS Paramedic. This pathway appears to no longer be being considered. Postgraduate Certificate A Postgraduate Certificate (Level 8) is, as of 2013, the required qualification to reach ALS level (known as Intensive Care Paramedic) and is offered by AUT as the Postgraduate Certificate in Emergency Management or Whitireia as the Postgraduate Certificate in Specialty Care (Advanced Paramedic Practice). The Postgraduate Certificate is required to be referred to as an ICP (Intensive Care Paramedic). The focus of this qualification is to build upon the Paramedics' knowledge and skillset to deliver advanced resuscitation interventions such as intubation, rapid sequence induction, chest decompression, thrombolysis and pacing as well as developing more advanced capability in clinical leadership and decision-making. Clinical Practice The revised New Zealand Ambulance and Paramedical Service Standard (NZS8156:2008) defines three levels of practice and gives guidance as to their depth and breadth but it does not however define the specific interventions to be included in each (scope of practice). The specific scopes of practice are set every two years as part of the Clinical Practice Guidelines developed by the Clinical Working Group (part of Ambulance New Zealand) which consists of the medical directors, medical advisors and paramedic representatives from both St John and Wellington Free Ambulance as well as the New Zealand Defence Force. Although the standard is more or less correct, there are