Skool:
A few days ago, our Medical Base Manager made a comment that the job was getting more difficult because " the company is turning this into an aviation business". Therein lies a very important clue. I have said here before that, mentally, the crews are still in the back of the ambulance. Saving lives, going hell for leather, lights and sirens, to get there before " the hospital/volunteer squads/doctors(!) kill the patient". That is an inherent difference between the two groups.
As to the pressures,I believe, a lot of the pressure is self imposed. It could be something as mundane as --my paycheck will go away if my base gets shut down, or, as lofty as ---I am a part of the life saving equation. There is also an increase in the pressure (self imposed again) once the patient is on board.It is easier to abort on the first leg than on the second.These are the realities of the job and no amount of regualtion or deregualtion (i.e. take the medical equation out) or bells and whistles can fix them.
Just my 2 c worth---actually now I can only afford 1 c............!!
Alt3