There are some models, most notably the Netherlands, which use a blend of a number of these models, including the Franco-German, Anglo-American, and Autonomous Practice models. In Netherlands, for example, all paramedics are in fact registered nurses with one year of additional training, usually in anesthesia but other critical care training is also acceptable, who then complete an additional year of training in ambulance care. All such individuals are licensed by the Dutch Ambulance Institute(DIA), and are employed by one of approximately 45 private companies providing emergency ambulance service under government contract.