2. I've said it before and I'll say it again, the psychomotor skill of intubation is not that difficult, and of those 7-9 medics on scene, I'd expect several of them (but not all of them) to be excellent at intubation.
Let's build on #2 and incorporate a counterpoint to some of the other thoughts in this thread. What happens when you put all your eggs in the basket of "one paramedic on scene", but that paramedic is a dolt and no one else on scene has enough training or education to realize that they're missing key signs that should be obvious to any ALS provider. Let's not pretend that the hiring standards for third service EMS agencies are such that only the cream of the crop can get those jobs, they have idiots who work there too who are also capable of murder through incompetence. When there isn't another ALS provider around to a. catch their mistakes or b. teach them, then the potential for disaster is high.
While the skill of intubation isn't difficult, it's a low frequency high risk skill in many systems (how many undetected prehospital esophageal intubations make the news), so while putting the tube between the cords is easy on a "routine" patient, it can have issues. Regardless, pick another high risk low frequency skill (needle decompression, dopamine drips, etc) and ask yourself: do you want someone who has done this procedure in the last week, last month, or 1 in the last 2 years?
BTW, I'm not saying 3rd service EMS agencies get the cream of the crop: I know from first hand experience that they have idiots, just like anywhere else. However, I am (maybe naively) optimistic that an 3rd service EMS agency, whose sole function is EMS, would terminate a new paramedic's credentials in their initial orientation if they could not function as a competent paramedic, as well as do mandatory competencies for people year after year... And have a robust QA/QI system to catch under performing providers. with a FD, when a department's primary missions is fire suppression, the focus on competencies is elsewhere, so if they can strech a hoseline, vent a roof, but have trouble reading that 12 lead, knowing their medication doses, well, we can work with that later in their career. Again, maybe not at your department, but I can assure you it happens at ABC Fire Dept.
While it may sound cumbersome to have 7-9 medics on scene, I'd argue it's convenient to have 7-9 ALS minded folks on scene who can do whatever needs to be done but can also catch mistakes or offer insight when necessary.
Ehhhh, 7-9 medics sounds like horrible plan... skill dilution, worse quality, less experience with sick patients...
Now, do I think 1 paramedic on scene of a critical patient is a good idea? hell no. As you said, if the paramedic is a dolt, and no one else can pick up on key signs, it's a potential recipe for trouble. Those serious calls (cardiac arrests, penetration traumas, seizures/status ep, serious MVAs, etc) need to have a flycar paramedic/supervisor or second ambulance respond to the scene, to provide the second ALS provider for exactly the reasons you describe. While I do know there are some paramedics who refuse to work on a truck with another paramedic (after all, who is in charge of the patient or some other BS like that), there are times when having another ALS provider is beneficial.
