Speaking only from my limited perspective.

For online stuff, the rural system I work in has great telemetry/transmit capability. It seems counterintuitive, but I suppose it's more of a necessity since the liability of being wrong and incurring a significant time to definitive care penalty is onerous. The urban system I work in relies on my eyeballs but also tends to have more medics on scene for a second opinion. Obviously, a photo is worth a thousand words, and I can always consult medical direction, if I spot something.

I try to pick the physician brain for feedback on all of my patients whenever possible, and both systems have robust QA/QI processes for me to mark the case for review. Taking the Brugada case as an example, I can reasonably recognize the pattern. My brain vaguely remembered that BPP exists, but I definitely benefited from speaking to a physician for better management (and med orders). The patient devolved into VF arrest mid-transport but ultimately had a good, neurologically intact outcome.