Answer: This is a difficult question to answer through this format. There are multiple factors: emerging new literature or evidence/guidelines as to best practice, identified gaps in care with the current system, new medications or new procedures that can be adopted into the pre-hospital setting. All of these considerations and more are then balanced with indications, contraindications, scope of practice of PCP/ACP/CCP, existing legislative framework and the limitations imposed therein, as well as financial considerations and the input and feedback from all stakeholder groups such as OBHG, OAPC, CACC and MOHLTC. Not an easy process!