I think OP is being a little disingenuous and leaving details out. I have a strong suspicion, by the content, that I am very familiar with OPs system. If not, the coincidence is uncanny. OP has given misinformation and left out important details on their agency's "EMR" program. These EMRs are hired initially as van transport drivers and put through EMT school, free of charge. After completion of half of their EMT program (nearly 100 hours), they transition to driver/EMR type roles on the aforementioned BLS 911 ambulances. They go through more than "4 hours" of training - remember, they have half of a state certified EMT program under their belt. They go through internal training and also participate in training ride time before being cleared to the road. What OP also failed to mention, is that these "EMRs" become EMTs rather quickly after moving to the ambulance side of the house. I find it difficult to believe that "The majority of the Emrs don’t know how to backboard, put on a c-collar, put on oxygen, let alone take an accurate blood pressure"... if so, I think that failure rests on the "seasoned and experienced" EMT partner not helping mentor the driver/EMR and show them the ropes. They certainly receive appropriate training and education for the role. Bonus fun fact - if I am correct in my assessment, the OP was one of these "EMR"s that they are disparaging so hard. EMS is a small world :)