I agree with many of your points. As a student each year of my course I am tested on my BLS, breakaway, and manual handling. I also think every year or two paramedics should have a day in theatres to practice skills such as intubation. In all honesty what we need is the ambulance service targets changing to make training a more important factor. I think that all members of management should spend at least one day a year shadowing a crew to see what it is really like.