Ride-outs - It may just be that they don't know how to behave - realistically though a ride-out would be a chance to better tailor a 'chat in the office'. For targets, and I really should do a blogpost on it, there needs to be a better determinant than 'it was classified as a Red, we got there in eight, Huzzah!'. How about condition specific targets. Rate of MI diagnosis and speed from call to needle/angioplasty? Stroke recognition and transport to stroke centre. Asthma treatment and keeping people out of ITU. Sickle Cell Crisis - adequate use of pain relief. Cardiac arrest survival rates (something that I'll be posting about when I get my hands on this months 'pulse')? Time until a 'proper' ambulance arrives? How about ratio of paramedic cover? Number of vehicles off the road? Even better - amount of time that there is spare capacity? All these things are recorded already - why aren't *they* the 'gold standard' target? By improving these we improve patient care, and isn't that what targets are for? These are the targets we should be chasing, and the eight minute ORCON takes resources away from this. I also think that cardiac arrest survival rates have more to do with the new resus guidelines (and perhaps dispatcher instruction trial) than with an ORCON rate that has remained pretty much unchanged from year to year. (Thanks for the comments DSO.)