Pre-hospital care is provided by a mix of professional (paid) and volunteer ambulance officers. In the major
metropolitan centres, almost all of the ambulance offices are professional and fit into one of the three tiers of such qualified officers (proficiency, intermediate care, or advanced care (paramedic). In the rural areas volunteer officers, who by and large have lower levels of training, give much more care. Most (90%) of pre-hospital ambulance services are provided by the order of St. John but there are other pre-hospital care providers. However, in any one geographic area there is only one emergency service provider. There is no competition for patients in pre-hospital care in NZ.