Cooper and Grant (2009) focus on the changing shape of out-of-hospital urgent care services by examining the international literature to establish which roles have evolved, what the scope of these roles are, and how they contribute to health care provision. The initial literature search returned 268 articles related to new or emerging roles in unscheduled, urgent care. After application of specific inclusion/exclusion criteria, 34 papers were identified as eligible for inclusion within this review. These fell into three categories: aspects of general role development; the emergency care practitioner (ECP) role; and the paramedic practitioner (PP) role. Although these studies were conducted in different contexts and locations, concerns about the expanding scope of practice for paramedics and emergency medical technicians, and the debate as to how best to educate and prepare these practitioners appear to be recurrent themes. Evidence indicates that the two new roles of ECP and PP appear to be linked to high levels of patient satisfaction; a reduction in unnecessary conveyance of patients to emergency departments; and increased utilisation of appropriate referral pathways. However, in all of these studies patient safety issues remain paramount, and the authors recommend that ongoing research and evaluation will be required to fully understand the impact and outcomes of the changes and role developments within out-of-hospital emergency care.