To be honest, it shocks me that there isn't CPD training being provided, and definitely shocks me that you are not continuously assessed on your skills. Even first aid providers have to have a yearly re-assessment = whilst I understand people may argue that ambulance staff are doing their job every day and therefore are not going to forget the skills, I still think you need regular assessment any way; how often do you, for example, have to give CPR or deliver a baby. I think a major problem is that very often people who run the courses/departments concerned are too removed from the road staff they are delivered to. what you need is an ex-medic taking over ;-) Or at least someone who has 'shadowed' a working crew to see what they really need...