I don't have a problem with the logical reasoning that if you send medics with more experience/training/expertise out to a casualty, that patient's chances of recovery are - on average - better than if they had been attended by staff with less experience/training/expertise. I'm quite sure that if it was practical to dispatch a big equipment-packed helicopter manned by a crack team of doctors, surgeons, anaesthasists, neurologists, paediatricians, gynaecologists, etc etc, to every single 999 call, then "survival rates" would go up. But this is the real world and this is a debate about the best use of available money. The point I think people sometimes fail to acknowledge is this. Let us fantasise for a moment that the budget for Ambulance crews' training/wages could be increased by 50% or so. This would allow every ambulance worker to be a paramedic. (And this is essentially the solution it seems a lot of people would like ideally.) But this would not be the best use of such a budget increase in terms of "saving lives". Given this extra money, it would still be better to get some extra ambulances and more EMTs to man them. The fact is: 100 ambulances manned by highly trained, higly competent medics would save fewer lives than 150 ambulances manned by medics who are "only" quite well trained and moderately competent. No matter how much extra money can be pumped into the ambulance service - within realistic limits - the most efficient use of that money (in terms of numbers of lives saved) will not be to increase training/quality of existing staff/ambulances but to get additional staff/ambulances at the current level of training/quality.