In the UK there is a drive to develop referral pathways for a ‘seamless service’ which for ambulance services has led to a series of reports advising on emergency care networks and collaborative practice (DH, 1997, 2000, 2004) aiming for the ‘right response, first time, in time’ (DH, 2005). In addition changes in doctors’ working hours and their out of hours practice have led to the emergence of the emergency care practitioner (ECP) role (JRCALC, 2000). ECPs are defined as an ‘‘advanced practitioner (paramedic or nurse) capable of assessing, treating and discharging/referring patients at the scene’’ (DH, 2005 p. 51). As part of a larger study on inter-professional collaboration (Cooper et al., 2007a,b) (which has been granted full NHS ethics approval) we undertook a review of West country ECPs’ practice in a regional patient survey. Of the 25 ECPs that responded the majority were paramedics, but 3 were qualified nurses and 2 were dual qualified (paramedic/nurse). All were employed by West country Ambulance Service NHS Trust (WAST) (UK), and were either completing or had completed a full time 3 month Certificate level programme or a part time Bachelors level programme in emergency care. ECPs shifts were based in response cars or in treatment centres from where they responded to emergency calls. Our objectives were to identify contemporary practice and performance in this unique and emerging role.