I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere?
I doubt that you are going to find good numbers on that. Very little in EMS has been subject to rigorous outcome-based research.
Even if you were to see a difference in mortality between the US, and, let's say, the fine land of Lichenstein, it would be difficult to know how much of this difference is due to preventative medicine, demographic factors, or in-hospital care. It's extremely difficult to control for these things.
On the surface at least, the US has a higher infant mortality and lower life expectancy than many other industrialised nations. But it also has a lot of poverty, poorer access to medical care (many uninsured versus almost all other industrialised nations having universal healthcare), lots more penetrating trauma, a much greater overall rate of violent death, and probably a greater amount of illegal immigration than many others. It's hard to reasonably suggest that this difference is due to EMS care. This isn't to bash on the US -- I'm not American, you guys choose to run your country however you want. They're just factors that would be confounders if you tried to do this sort of research.
Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states.
I don't think this research has been done. At least if you're talking about hard outcomes like death, disability, etc.
As Mr Brown pointed out, there are some instances where surrogate outcomes are better in other countries, e.g. intubation success rate -- although I wonder if the numbers reported have actually been published in a peer reviewed journal? But, of course, a greater rate of putting a tube in the trachea might have nothing to do with actual patient survival.
It is possible that further education and training beyond the average in the US has little impact on mortality and morbidity. It may not be cost effective, either. I think at this point, we can only guess.
But I would suggest that professionalising EMS is in the interests of everyone working in it currently. Certainly moving toward a BScN entry to practice for the RNs has done nothing to harm their care, professionalism, income, career advancement or mobility. When you compare what a paramedic is able to do, in terms of monkey skills, to other health care providers, and the responsibility that comes with these skills, we're woefully undereducated.
If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?
I agree that there's probably an upper limit, but it's a limit that seems to move slowly upwards as time goes on. In my short time I've seen interventions like RSI become much more prevalent (actually, universal), and widespread use of thombolysis, new agents for sedation/intubation (e.g. ketamine), administration of drugs by non-paramedic providers, etc. It seems like each year we're asking paramedics (and EMTs) to do more and more complicated medicine, with the support of only a very brief training program. We risk becoming technicians, if we don't push for more education.
We have a tendency to see the benefit of EMS in terms of cardiac arrest outcomes, response times, trauma scene times and transport times, etc. In terms of that 5% of critical calls that you mention. But perhaps over the next decade or two, the area where EMS is going to expand is into diverting people away from the hospital, referring them to other agencies (home care, family physician, etc.), and treating and releasing on scene (I realise that you mention community outreach and education in your post). This is going to require a keen sense of professionalism and greater education.