In such circumstances, these Paramedic Practitioners or Emergency Care Practitioners are almost always very senior and experienced ALS providers, and retain their ability to practice these skills. In many cases, the practice of these individuals has gone well beyond what we normally consider to be the role of traditional EMS. There are locations in which these practitioners are providing E/R leadership after hours in small, rural hospitals (Australia and the U.K.), while in other locations these practitioners are actually taking night 'call' for group medical practices (U.K.). In some cases, the Practitioner retains the ability to summon a physician to the patient when the limits of the scope of practice are reached (U.K.) while in others, the finite limits of treatment are those within that scope of practice, and no physician 'back-up' is normally provided (South Africa).