I didn't read much of this thread, but I felt the need to point out that such saying as "BLS before ALS" and "EMT's save medics" make no sense. The medic's title is EMT-P. We know how to do BLS; it was required to learn BLS before we moved up to medic. My medic partner can do all the BLS that an EMT can, in addition to the ALS assessment and skills. In the NYC 911 system, it's often just the two medics on the scene by themselves. No one's saving them, and the BLS gets done before we drop a lock and push meds. What's the issue? EMT's are useful, they have their place, but their scope is limited. It doesn't give the medic the right to s*** on them, but the EMT needs to know their boundaries. In many medic/EMT txp systems, the EMT is basically performing tasks for the medic. It's not to belittle the EMT, but they lack the education and skills to have much of a say in pt care, unless the medic is weak and is neglect in performing a basic diagnostic or intervention before moving on.
It's like when you test for your medical or trauma scenario - you have a few partners, be they imaginary or real for the evaluation. You're ordering vitals, C-spine, bleeding control, assisted vents, a NRB, etc. That's kind of how the medic runs the scene. They need various tasks and assessments completed, not someone of a lower cert level offering opinions as to the pt's treatment course. When managing the scene, that doesn't give the medic the right to belittle the EMT's, however. If you run your scenes like that, you'll lose confidence from your crew (or other responders), you'll lose respect, and they'll look to help you as little as possible, and maybe even try to jam you up.
Edit: At the EMT-P level, I don't really see pt care as "BLS" or "ALS." There's no division. It's all pt care. Some assessments and interventions are always going to come before others. I only use "ALS" to define the point where the EMT-B's scope and abilities end.
