No one right way in EMS
Most of us are unknowingly myopic about how EMS "should" be delivered. We often work in only one region or town, and are accustomed to how things are done there. In fact, as more than one EMS leader has said, when you've seen one EMS system, you've seen...only one EMS system.
The fact is that EMS in this country is delivered though an incredible variety of models. I am not sure if there is a "right way" versus a "wrong way" to provide services. There are so many variables to consider including financial, educational, and political factors. I think it's a bit ridiculous when someone starts with the declaration, "the best way to provide EMS is..." when in fact he or she means, "the only way to provide EMS is..."
On the other hand, if the service model exists because that's the way it's always been done, that doesn't work either. Times change, technology changes, medicine changes. What may have "worked" 40 years ago at the dawn of modern EMS may not work today.
Like any complex system, EMS operations should develop and evolve; a system that does not is one that is stagnant and is at risk of losing touch with the community it is supposed to serve.
In this current era of fiscal tightness, many towns and regions are struggling with maintaining a "normal" level of service. I'll throw out the notion that now is an excellent time to see if there may be a "new" level of normal out there that can be effective and responsive.
Innovation often comes out of adversity — we already know that as prehospital care providers. Why don't systems do the same?