Here's something else to think about. Certainly most of us can agree that in the US, the gold standard of pre-hospital care is treatment by a well-trained experienced paramedic. But I have a different perspective on this issue, being that I have spent the better part of the last week having a one-person "Emergency" marathon (thanks Hulu). Now, Johnny and Roy might have been quite good at their job, but they never had to interpret a 12-lead or intubate a patient. In fact, they were allowed to do very little without explicit doctor's orders, however they always had a doctor available to assess the situation and order the appropriate treatments for the patients.
Even at our EMT-B level, a good bit of our training goes into underlying mechanisms of disease, the pathological aspect behind treatment. Aside from the ability to start IVs, I, as an EMT-Basic, have been trained to a much higher understanding of medicine than the paramedics on "Emergency". With very little additional training, I could do what they do.
So, again, considering that an ideal system includes paramedics on every emergency truck, would there be a problem with training EMTs in the skills necessary to intubate a patient, or to start an IV when under online medical oversight? This thread has spent a lot of time discussing fluid balance and dynamics, but as an EMT, I am not asking to work as an independent licensed care provider, I work under a doctor's licence and usually with a paramedic. If I am performing these skills that have medical implications above my understanding, I do it knowing that I have direct access to a provider who does understand what's going on.
It would never be my intention to have an EMT who wasn't entirely competent in these skills performing them, but I think if a system is willing to train their EMTs to use a few additional skills and give online medical advice to guide their care, this can allow EMTs to both be more useful to paramedics they are working with as well as provide for more advanced care in systems where it is impractical to have a paramedic in every unit at every corner.
That is all...