Splinting, wound care, history gathering, physical assessments, CPR, BVM use, oxygen application, EKG acquisition, and IV equipment setup are EMT skills done in the ED. But yea, just vitals.
I did my "clinical time" in an ER as well, but in 1999 it was either 16 or 24 hours, and I can honestly say it was the biggest waste of my time. I didn't do any of those things. maybe my ER was just too slow, or my preceptor wasn't interested. to be honest, I don't remember much of it, but I did get a lot of reading done during those 12 hours. medic clinicals were better because I could do more skills, but even that wasn't super realistic, because the nurse preceptor I was assigned to asked different questions that weren't asked in EMS.
As for the original questions, much of the EMT class revolves around getting the student to pass the NREMT or state final exam. independent and critical thinking isn't stressed. complicated patient presentations are rarely used. and the clinical standards used in class don't always match up to the local agency's clinical standards. And this doesn't even factor in instructors who have an EMT card, a HS diploma, and an instructor certification, and only cover what is in the books. Not only that but if an instructor has too many students who fail, they will often get fired, because their employers want high graduation numbers because it brings in more money. Kinda kills the motivation to do more and teach above the minimum standards...
Although, I will say that there is often a disconnect between classroom learning and "the real world." this is evident in fire academies and a probie's first year, an EMS academy and the new hires FTO time, as well as in LEO academy and their FTO time. Part of the issue is FTOs are operating off of experience, not off what is taught in class, FTOs don't know what was taught in class and as such, they are just doing their own thing, and every FTO has a different way of doing things. I know this might shock everyone here, but just because something is done in the field, doesn't mean it is the clinically correct way to do something, especially if they had to explain their actions to their agency director, the media, or a jury.
The last thing I will say is many EMT programs don't prepare students for the roles they will be performing. In many parts of the country, an EMT is simply a paramedic assistant, while the EMT program is supposed to prepare them to be a provider in charge of a crew. So you take an EMT student, who has been preparing to be in charge of a crew, be able to make treatment decisions, perform assessments and patient care decisions based on what they have studied (and yes, the clinical education is lacking, we won't disagree), and you put them on an ALS truck, where they mostly do what the paramedic says, drives the truck, and lets the paramedic do most of the thinking for them... well you see where the conflict can occur. I'm a horrible paramedic assistant. but I'm a decent provider; which is why I prefer to be on the BRT, where my captain lets me take the lead and make decisions, vs always waiting to see what the ambulance paramedic wants to do.
