I am grateful to have the opportunity to provide a commentary on this paper, responding on behalf of the membership of the British Ambulance Services Medical Directors Group (BASMeD).

There is clear support from the membership for the idea and principles in the paper. BASMeD particularly welcomes the opportunity that this paper provides to stimulate the debate, but would like to emphasise that the paper should not be seen as an endpoint. The need for a sub-specialty and linkage to ambulance trusts is overwhelming, but in striving for that goal, any change must not alienate those doctors providing real and additional clinical care for patients, often before the ambulance response arrives.

There is a particular …