Tom, I'll take your points from both your replies if I may... Rideouts: These only deal with situations where staff don't know the "right" way to behave. Do you believe those that "hang-out" their jobs do so because they don't realise there's a quicker way of doing it! 8 minute response: Yes its an arbitary figure but then it doesn't suggest that you should respond in 8 minutes it suggests "less than 8 mins", bottom line "asap". Outcome targets: These are great in cardiac arrest where clearly "life" is a good outcome, however in all other cases setting a benchmark of "not death" is setting the bar pretty low and if you chose "life quality" then it is incredibly difficult to define at all and open to even more abuse than the ORCON is at the moment. You suggets that the 8 minute response is, in effect 20 years out of date, while in fact 14 minutes was the measured standard within the LAS up until about 8 years ago. Bottom line, standards, and we don't just use ORCON, show you whether you (the trust) are performing and they focus the minds and purse strings of all involved. Cardiac arrest survival is now superb within London, do you think this would have been possible without an 8 minute target? Truth is, we all, within the service agree on so many things, sadly we focus too much on the areas we don't agree on. As ever, just my two pence worth!