It's probably a lot of things. First off, I do believe that there is a culture of ignorance at least at the Basic level, and this culture is indoctrinated starting in EMT-B class.
EMT-B class is all monkey see, monkey do. It doesn't matter if you can explain what's going on, so long as you know how to do your "skills" ("skills" used in quotes because people honestly shouldn't be amazed that they can place a NRB or NC onto a patient. Yes, I'll admit that I was excited the first time I whipped out OPQRST, but that feeling of awe quickly wore off over the next 5 times using it). There is little anatomy/physiology/histology [I'm adding histo based on the "OMG, Albuterol dilates the lungs in CHF patients!!!11oneone" thread, conversely, there is little base for pathophysiology, thus there is little room for basics to critically think about their patient's underlying condition.
Of course this is self-reinforcing. There's no real reason to think about the underlying disease process if your treatments aren't complicated enough for it to matter (medical patient: O2 administration and... transport?), so education isn't looked up upon. Since education isn't looked up upon, there is no real justification besides the cool toy factor to increase the scope of practice. Because there isn't any toys that depend on critical thinking, education... Wash, rinse, repeat.
Since patient care/outcomes aren't really affected by discussion or education at this level (how many treatment scenarios are "high flow O2, call medics, transport?"), what else is there to talk about? Operational things (which set of blue lights or badge from Galls should I buy?) and "what if" scenarios (Which set of hemostats would go best with my neon green bag? I need to know in case I come across a crash involving a bus that was going to a hemophiliac convention when I'm off duty!).
The unfortunate thing is that this is taught, to a certain extent, in a lot of people's classes (debunked Golden Hour and how every second counts on all patients) and in their first job (trying to fit in with their new coworkers). The unfortunate part is that I can't really blame people new to the field because it is what they see, so it is what they think is important in the field. This is why we get the "OMG, JPINFV said that EMT-Bs don't get enough education/training, but my 200 hour class was both more than the minimum and great (yet I have nothing to actually base the quality of my training off of)! Why does he insist on bashing us?" threads.
