Health,
No one is lying, you said such an article exists, (you have not yet produced the article), I pointed out that the dynamics are different. Comprehension my friend.
With the call volume, you call me a liar, but then say you doubt.. you either know or you do not.
Regarding the multi-tiered system, Is that your opinion or is that the consensus? Does it make sense to tie up an ALS only crew for a BLS call when a different ALS crew has to cover the next call in the area?
The progressive systems have two-tiered systems, such as Kings county medic one, it makes sure that there are adequate resources available at all times, it also makes sure that the medics treat patients that require ALS care instead of being tied up with patients that can adequately be managed by BLS, they can also downgrade the patient to BLS after appropriately assessing the patient, so they are exposed to more higher acuity patients and retain their skills and knowledge.
To put it in context, even on a busy shift, a single tiered ALS truck can respond to BLS only calls, vs a tiered response system would have these medics respond to ALS only calls. Which means more experience and more exposure to sicker patients. As Hatzolah does.