Helmet Fire's contribution is well presented as usual. At the recent ISAS conference in Adelaide (Australia) a speaker summarised the distinctives of about 5 US EMS operations he had visited on a "study tour" recently. On the summary of one, appeared the motto
"WE NEVER SAY NO".
That kind of sentiment/motto would be rightly howled down in any safety minded environment . It sums up a culture/attitude of management that seems to be a product of the competitive nature of much of the US health system. Simplistic perhaps, but until there is a fundamental change in that attitude, I can't see Points 1,2,3,5,7,11,13 and 14 of Helmet Fire's recommendations being possible.
It is unrealistic to expect the needed change in that attitude leading to changed behaviour without it being initiated arbitrarily by the regulator. I cannot see industry operators doing it unilaterally unless they are backed by a management structure that can and will support them through a long winter of being uncompetitive with those around them.