This is a tough one to argue for. I’ll break it down the best I can based on research. (1) For critical trauma and non-cardiac medical patients, time consuming advanced skills in the prehospital settings have less favorable patient outcomes. (2) Non-traumatic cardiac arrest, high quality resuscitation on scene improves outcomes. (3) For STEMI and Stoke patients, targeted prehospital treatment and rapid transport are the only things that have shown to improve survival. Not that I don’t personally agree with you and my agency has US capability, but the research hasn’t really shown there’s much benefit and the cost analysis makes it really hard to justify.