The EMS system in the Netherlands is great, but its hard to compare it to a place like the US. My state (North Carolina) is 3.5x larger than The Netherlands but with 1/6th the population density. When you combine that with the good network of roads across The Netherlands and the fairly flat terrain, you can see how it is possible for the Dutch to have an EMS system that employs more highly educated (and presumably higher paid) emergency workers.
Australia is one of the largest nations in the world with very low population density outside of the eastern coastal cities and a few other places. They now every Ambulance Paramedic to have a Bachelors Degree.
Canada is many times larger than Australia where something like 70% of the population lives within one hour of the US border. Primary Care Paramedics require between one and two years of education whereas Advanced Care is either another one or two years. This includes very rural areas of Alberta, Ontario, BC and Novia Scotia.
In these nations and in the US other allied health professions require a Bachelors Degree (exception noted for some in the US eg an LPN) .... so once agian, that argument is invalid. Quite simply people do not want to pay for it, the system is not designed to support it and most providers probably do not want to spend that long getting the education that would make it work.
Who do you think has to call for ALS (Intensive Care Paramedic) more often? Two Paramedics 300km from nowhere in Australia who have a wide selection of clinical dexterity including a range of IV drugs or some 100 hour wonder in the rural USA who can give oxygen? Which is more efficent and costs less in the long run? Which ensures better patient outcomes? Nah forget that, which do people want to pay for is probably the more important question
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