If the topic is whether the buck EMTB as it exists today is still a relevant provider, my response would have to be in the negative. There is just not enough of a rigorous didactic component to Basic education to allow much clinical evaluation beyond: not breathing equals bad. This issue, in my opinion, can be ameliorated by a more comprehensive and fundamental education with an accordantly increased scope to these providers.
If the question is whether there is a need for providers certified below the paramedic level, then I would have to argue in the affirmative, though I'm not sure anyone here is arguing this point.. There absolutely exist arguments against skill dilution, and the cost-efficacy of high level care in remote areas that necessitate a lower level of certification below that of the paramedic. Personally, I think a more skilled Basic provider would make mixed rigs more effective and increase the usefulness of BLS ambulances beyond the status they hold today.
Not to beat a dead horse here, but, the reason the Basic is going the way of the dodo is that even though it's BLS skills that form the foundations of ALS care, the education needed to properly and prudently apply them is lacking. Educating the first tier beyond near-mandatory O2 administration, and fear-based long spine boarding, as examples, is the first step towards more relevant and efficient EMS systems in the US. Furthermore, (in my opinion!) the bare bones EMTB is the biggest drag on EMS salaries out there. As long as there are undereducated and underskilled Basics hiding under every rock, whose primary role in the field is to determine whether or not they need to summon someone else, pay will remain low.
