Unlike some EMS systems in the world which work to protocols, UK Paramedics work to 'guidelines' which have been written by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) to allow Paramedics to treat patients to the full scope of the guidelines without physician approval on an incident by incident basis. Beyond the normal scope of UK Paramedic practice the practitioners are trained by Universities to apply a treat & release and treat & refer patient care.
The education takes on various forms. The College of Paramedics believe the level of education for ECPs should be set at PgDip or MSc, in reality it is currently BSc with a few exceptions.
There are degree programmes which range from 2 to 4 years B.Sc to M.Sc level. Much of the evolving area of prehospital care is being based on Evidence Based Medicine (EBM). All the practitioners are writing essays and dissertations based upon existing or perceived future working practice. Much of what is being written is not being read and as such we are not learning from shared experiences as a professional body. What is coming out of ECP work are potential trends toward paramedic practice in the future. It is unclear at this time if the higher ECP scope of practice will continue or a more restricted paramedic practitioner role will become the standard of an advanced role here in the UK. The thing that will determine if ECPs remain in its current form will be their ability to prove that they are not only clinically effective but cost effective. They will only be able to achieve this by the ambulance services and Dept of Health adopting a pre-hospital "payment by results' culture at the point of patient contact.
Some services have begun the process of Emergency Department avoidance cars using ECPs. It has been a very long time coming possibly because of a lack of understanding of the ECP role and its potential effectiveness and benefits to stakeholders. Also the dynamics of the NHS in England has recently changed with the realisation that out ED and hospitals can no longer cope with the increased volume of patient visits and as such are actively seeking out new strategies such as ECPs.