In regards to Independent Practitioners, you see a lot of community paramedicine (years before we considered it), you see a lot of treatment, no transport (Not AMA kind, but policy driven supported with EBM kind). You see the Paramedics being allowed to function as Clinicians, where they can make decisions based on their assessments as opposed to following an algorithm. They could have multiple similar drug choices for a condition, and are allowed the autonomy of deciding which one is best for that patient in this moment...without calling medical control or facility. A service I currently dabble in, there is metoprolol...take it or leave it. No cardizem as an option, a better option in many cases. Ketamine....have to call Big Daddy for permission, even when getting arse kicked by agitated patient. RSI? Forget about it...not even willing to discuss it here in Maine, even though this is exactly where it would be most indicated....difficult extractions, long transport times, bad weather, etc.