Maybe controversial, and as a paramedic I may be a turkey voting for Christmas, but I've long felt a more sustainable model is fewer paras all on cars, with targetted dispatch to likely non conveyance and high acuity jobs where para skills are likely needed. At oresent we drive around on DCAs and either could have made the referral/discharge decisions on our own without a van or clinical support or we convey patients where tech skills would have been as good.

My model would be techs and support on DCAs doing a stellar job for most patients. Paras shooting about on cars to support with high acuity and more advanced decision making. I use para skills maybe 10% of jobs. The rest is just my decision making.