OK heres a mix ... things that I think would make ems/ambulance better ... and some responses to the posts already posted.
There is the ever present prob of funding ... was sort of 'funny' one of the reasons I joined the fire service was 'to see how the other half lived' and the deal with the fire service was way better than with ambulance .... the difference? FUNDING
As I have posted in the past ALL emergency services need to sort out the problem of having children (minors) riding on emergency vehicles or attending emergency incidents. We want to be taken seriously ... then don't as a matter of cause allow children to be present on the job (no other profession allows this).
Here in NZ we're lucky that the different levels of qualification are pretty much nation wide .... at least at a state level if not national that would be great in the US (would clear a lot of complications and mis understandings).
On a wee bit of a tangent but brought to mind from being allowed to spend some time working in with a paramedic mate in the US the multitude of services operating in the one city and meeting up with them in the varying hospitals ... was WOW an eye opener for this kiwi! Maybe more uniformity would be better for the general public ... I'm not really sure ... was just mega different for me.
And finally ... to invite the bullets and have people baying for my blood ... VOLUNTARISM ... where does it fit in modern day emergency medicine? I have worked both sides (as paid and vol) there are some communities that 'survive' on the sweat of volunteers but there are also services who constantly lower standards and under cut service because of the sweat of willing volunteers, and thats not on. They're making money of the system, the patients and the volunteers and basically as long as they are making money they don't care about anything else. This is WRONG. It undermines job, the qualifications, the service it gives all an unfair unjust deal.
The perfect EMS deal? It's an impossible dream .... patients wouldn't die, stupid people wouldn't do stupid things, innocent people wouldn't suffer for other's mistakes, CIS n PTSD wouldn't happen to the 'good guys', we would be paid enough so one job was sufficient to live on. Ambulance personnel wouldn't have to worry about assaults, robbery, blood/body borne pathogens.
But thats not how it is ... and it's never going to be. The constant change and unpredictability of the job is one of the biggest draw cards, we see people at there worst and sometimes (hopefully more than just sometimes) we are able to make a real life changing difference.
The things that could make EMS 'perfect' are 'pipe dreams' they are not a reality. Having said that emeregncy medicine has come a long way in the past 30+ years and is a growing evolving entity.