People in the smallest towns deserve the same chance as someone in a big city. If EMS could start training all basics to be intermediates, now; and Only have EMT-Intermediates, EMT-Critical Care, and EMT-Paramedics; we will be doing all we can, giving everyone the same chance at survival. When I volunteer, as an EMT, it breaks my heart to sit beside someone and know that I cannot do a goddamn thing for the pain they are in, or I cannot do any more that CPR, knowing that person is going to die because the Paramedics just aren't close enough. I'm all for more ambulances, more paramedics, maybe even more trauma centers, and also better trained personnel. Because right now, we are doing all we can, personally, but the people in charge aren't doing all they can to make sure that we can increase the survival rate of prehospital survival of cardiac arrest, trauma, serious medical conditions, etc.
EMS could be better. I can't think of just one thing to change, in fact this post was about 16 paragraphs long, really. I deleted most of it.
If the pay were raised, I don't think we would lose as many of the great EMT's and medics we do to nursing. The ones that are extremely smart and compassionate may love working the streets, but realize they can earn so much more.
Now that the basic requirements for becoming a paramedic are higher, a lot of people go from being and EMT to an RN. Most of the ones I know did it strictly for pay.