Such services may be provided directly, or may be contracted out to a larger marine transportation company. Water ambulances may be found in Oslo and Stavanger, among other locations. Ambulances are usually staffed by two emergency medical technicians. Ambulances in Norway have traditionally been manned by EMTs with only 2 or 3 month courses in acute emergency medicine, however, an increasing focus on the importance of prehospital medicine has resulted in such courses being phased out, in favor of a far more comprehensive 2+2 year education process. At a national level, effort is being made to reduce the number of ambulances staffed by personnel on home call, but this arrangement still occurs fairly frequently in rural areas. EMTs newly entering the field are now recommended to have two years of training at Vocational school followed by two-year internships. This program has been offered since 2003, and is inspired by American EMS training. The system currently has individuals working at the Basic, Intermediate and Advanced levels, and for vehicles providing ALS service, the crew configuration is typically 1-ILS, 1-ALS. Those EMTs already working in the field, and with sufficient experience, are permitted to 'fast track' the new training, completing a degree with the equivalent of a single year of full-time education. Only those EMTs completing this education process are permitted to use the title "Paramedic". While the program is not yet mandatory on a national level, it is considered to be a prerequisite for employment in the Oslo region. Norway has also come up with the proposal to add qualified nurses on the ambulances, as other countries in Europe have done within its system. Norwegian ambulances are required to comply with the European Union standard CEN 1789 (types A-C) for ambulances, as issued by the European Committee for Standards. These standards include the types of vehicles used, their design, performance, testing, basic equipment, and markings or livery. As with all European Standards, compliance is voluntary, but has been mandated by the Norwegian government. The national goal is that any citizen should not have to wait more than 12 minutes (in urban areas) or 20 minutes (in sparsely populated areas) for emergency services. This goal is not yet being achieved consistently.