OK. Before I start, I am aware Dr Crippen stated that "paramedics don't thrombolyse". Whilst this may well be the case where he lives, after everything else he has written, I certainly wouldn't take that as gospel and he may be well counselled to check before he judges any further. In our area we do thrombolyse. I however am only a mere techie......the type our Crippen would doubtless wipe his boots on. I can think of a very recent job where we arrived on scene to find a patient with a cardiac history, short of breath but with no pain whatsoever who "just didn't feel right". (Our Crippens patient was pain free I recall.) We took him out to the vehicle, in the carry chair......walking such a patient is not only a sackable offence but rather more importantly may kill him ........did the ECG he considers so irrelevant, to discover he had raised ST. GTN, aspirin and O2 under his belt, with a 32 minute run to hospital we went through to control and established the nearest paramedic single responder was a mere 4 minutes away and was dispatched at once. On arrival he clarified our findings, asked a handful of more probing questions whilst we drew up the necessary drugs and thombolysed the patient there and then. At that point, we blued the patient straight to the cardiac ward, a 32 minute run, during which the gentlemans ECG reverted from a scarily raised ST to a near normal sinus rhythm. Clearly, if I had been at our Crippens surgery, he would have noted the double tech crew and sneered at our management of his patient (he'd not have walked to the vehicle if I'd been there, sneering doctor or not) and timed my treatment inside the vehicle (I have managers like him). However, my "stay and play" management of this case without doubt preserved the future quality of this mans life and may even has saved his life. Crippen. You are a GP. You are (I assume from the usual quality of your blog) not bad at it. I'm not bad at what I do. How about we be part of the same team eh?