That's a lot.While I agree with most of what you said, I've never been a huge fan of the "keep adding more skills" plan for improving EMS. I would argue that most American paramedics don't even have the pharm/physio/pathophys education for the skills that they currently perform (those medic mills at the top of the page being good examples). So while I agree that doing advanced skills properly is a huge leap forward, I would argue that its a better leap forward if we can have the education to make the best use of our current skillset. Perhaps I'm more cynical than you about paramedic education in the US though. A part of my brain says that if we keep adding skills, we'll end up with paramedics operating at the level of a PA/NP, but with an associates degree instead of 6 years of education.
As a second point, I think that simply beginning definitive treatment in the field is not always as cut and dry as it appears. Therapeutic hypothermia is relatively effective when performed in a hospital, and ineffective when performed in an ambulance. This makes me suspicious of prehospital antibiotic administration for sepsis, for example. Not because I think paramedics can't give antibiotics, but because I find that we're very quick to jump on cool new things before we really know how effective it is.
I don't say these things to crap on EMS or to suggest that the scope of practice should be limited, just that I think we take things slowly, with the exception of increased education, which I think should be our #1 (or at least very high) priority.
Also these thoughts don't apply as much to critical care/HEMS stuff. I've worked in rural (I'm guessing) areas like you described in your post and am aware of the inexperience that a lot of the physicians there have with critical patients. I have minimal experience with CC transports, so I'd be talking out of my *** there anyway.
I'll respond in time when I've had time.