True, I guess I don't know much about rural EMS, I've always worked in the metro or suburbs. Our local doctors found much better outcomes in patient care allowing advanced prehospital care interventions. Even if only 5-10 minutes away from the hospital, we can get critical care started. We used to have all the different levels (Basic, I, A, Medics, etc.) but it was decided it was better for patient care if all providers were trained to advanced levels and allowed more versatile use of Medic/EMT trucks. It allows much better flow on critical calls to, to be able have the EMT do the IV/IO, start cardiac monitoring, etc. while the medic prepares performs other advanced procedures as needed, as well as allow EMTs to take more of the transports to allow medics to get more breaks and drive instead of being bombarded by transports. It also allows non-transport fire and other EMT first responders to apply early use of basic, but important medication and start IVs for the EMS crew before arrival. Overall works great for the providers and patients, at least in our area.