I'm going to take the dim view that I don't think anyone else has taken yet.
Note: Where I see EMS going and where I WANT EMS to go are two different things.
Give the current culture (both in and out of EMS), I think US EMS is going to continue to degrade to the lowest common denominator (LCD). At the present time, the wages are too low to keep most skilled and educated providers around (there's a reason so many look at EMS to go into another field), so you're going to continue to see the average paramedic be a LCD.
Politicians don't really care about EMS since most of the time the public only cares about whether someone shows up or not. They know that they are getting (or at least believing they are) the best care that the provider can give, even if they don't understand that there is a another level that can do more. Since the constituates feel that their needs are being met (even if they aren't truely being met), then the public isn't going to complain.
The average provider in EMS seems to only have EMS in their life. Seriously. So few providers can take a step back and look at the big picture that it's kinda of sad. Any time something negative is said about a level, providers at that level come out of the wood works like it was some personal attack. As such, until the culture changes it will only get harder to increase educational requirments. Conversely, too many people think that they know enough to provide X intervention or use Y diagnostic that there is a push to increase the scope of the lowest provider.
Increase scope+slight increase in education to focus on new scope=happy LCD providers
public apathy=little reason for the politicians and public to complain about who is responding.
Overly sensitive providers makes increasing requirments harder.
Combined, EMS is going to continue to regress until there is a shift in the EMS culture.
