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Rising operational costs and software sustainment concerns have driven the Air Force to move to newer technology to ensure that the Air Force Standard Base Supply System (SBSS) can continue to provide affordable and sustainable mission support in the years to come. This paper aims to summarize the successful software modernization effort the Air Force undertook to achieve that objective.

The paper describes the preliminary system updates that were required to isolate the SBSS software from all internal and external system and user interfaces in preparation for the subsequent successful code roll effort. Once the legacy SBSS component was fully isolated, the SBSS software modernization objective was achieved via a “code roll” conversion of the SBSS software from legacy COBOL to Java code, and movement of the integrated logistics system-supply application from a proprietary information technology (IT) platform to an open IT operating environment.

The SBSS system modernization yielded immediate and significant IT operational cost reductions and provided an important foundation for achieving Air Force logistics system consolidation and cloud computing objectives going forward.

The SBSS modernization experience should be useful in assisting similar data system software modernization efforts.

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.