EMS on the US game appears to be misunderstood and neglected by the developers for whatever reason so here are some ideas for a EMS update.
Changes to Calls:
Upgrades and downgrades for calls: A system where a sick person call could end up being a cardiac arrest would be a realistic thing to add to the game. Or maybe a concussion Charlie patient could upgrade or a Echo or downgrade to an Alpha. This could also not be on a random basis and be based on the response time of your ambulance from the time of dispatch of the unit.
First responder unit usage: I am aware that the creators do not want to add death to the game but maybe if a non transport unit is closer to a patient than a transport unit, there should be some sort of benefit to sending that unit to that call. Maybe it could be combined with the prior suggestion and prevent the call from upgrading.
Hot and Cold responses: We already have ALS and BLS response, why not add hot and cold response. for example a cardiac arrest needs a ALS unit and x3 EMT trained (Will get to that next) manpower on top of that.
Difference in provider levels:
Adding different provider levels has been something that I have been looking for in this game for awhile. It should be broken down to only 3 levels: First Responder, EMT-B, and Paramedic. Each provider would be able to provide care at 3 different levels.
First Responders: This training is basically just CPR-AED + First aide, and it would be for all firefighters and police officers that are hired, no special certification required
EMT-B: All staff in the ambulance station would have this certification and it would be available in the fire training academy. If an EMT-B Staff on any apparatus that unit would be able to provide BLS treatment.
Paramedic: Training available in both the fire academy and the rescue academy. 1 needed to staff each of the ALS units (I.e ALS ambulance, EMS Rescue, ALS Fly-car, Hazmat Ambulance). When placed on a fire unit that unit can act as a ALS Fly-car.
Excuse the poor grammar I'm exhausted.