If I had...Cataract.

in some cities in the USA,6 but the general level of health consciousness and the public attitude to family medicine and emergency care are so different in the USA that it is far from clear that American experience is relevant to the United Kingdom. The number of lives that MCCUs can be expected to save in the United Kingdom is therefore small, so establishing MCCU services on a wider basis must be considered in competition with other developments that may well seem less dramatic to the public. Until patients' behaviour patterns change, the only way the MCCU concept can usefully be extended in this country is probably by equipping every ambulance that deals with emergencies with a defibrillator and training the crew to use it. The capital cost would not be great, and relatively few lives could certainly be saved for a reasonable outlay, provided that the extra cost of more highly trained ambulance crews was not excessive. The increased cost of the crews would probably be unacceptable unless the different ambulance functions were more formally separated.A few well-equipped ambulances, manned by specially trained crews, should be used in emergencies, while the "bus" functions of ambulances could be performed by simpler vehicles, manned by crews with only basic training. MCCUs should be developed only as part of a national move towards a "two-tier" ambulance service.