A paramedic is a healthcare professional, predominantly in the pre-hospital and out-of-hospital environment, and working mainly as part of emergency medical services (EMS), such as on an ambulance. The scope of practice of a paramedic will vary between countries, but generally includes autonomous decision making around the emergency care of patients. In some countries Paramedic is a protected title, although it is not unusual for people to use this when referring to lower levels of healthcare providers such as EMT's or CNA's.