St John Ambulance is a household name synonymous with the teaching and provision of first aid. Recently the organisation has developed pre-hospital emergency care services through the introduction of the StÊ John Ambulance Australia Advanced Casualty Management Team in New South Wales. The Advanced Casualty Management Team represents a move away from the practice of first aid by lay personnel and is a natural extension of the traditional work and principles of St John Ambulance. This article provides an overview of the Advanced Casualty Management Team and discusses its contribution to pre-hospital trauma care delivery.