Paramedics (EMT-P) are leading members of emergency medical teams around the world. In Israel, paramedics are team leaders of civilian EMS teams, and senior caregivers on a battalion level in IDF and they carry the medical responsibility in military and civilian rescue units. Israeli EMT-P holds permissions to manage advanced airway (intubation, supraglottic AW, surgical AW), perform needle and chest thoracostomy, insert a gastric tube and Foley catheter, insert a central line and provide sedative agents. The training of IDF paramedics is similar to the civil training with similar permissions. During the IDF field hospital mission in Nepal in 2015, 5 IDF paramedics joined the hospital team and were stationed in different hospital wards: ER, OR, ICU, and admission ward – a shift from their primary role in the rescue mission. The second opportunity to utilize paramedics in a hospital setting was during IDF medical assistance mission in Equatorial Guinea. Paramedics were stationed in the ER, OR, and field clinics. During the presentation, I discuss the challenges, opportunities, successes, failures, and lessons learned from paramedic functioning in a hospital setting.