Wyoming: Rural ambulance crews are running out of money and volunteers - CNN
EMS services are only considered essential services in 10 states, none of which are in Rural America.
In Rural America EMS services are mainly provided by Volunteer EMS services. These volunteer services are running out of both volunteers and money to be able to continue to operate.
Because they are not considered essential services they are not funded at the state level. Individual towns often provide the equipment, but in many cases the equipment is also donated.
The way EMS services work, they don't get paid unless they transport a person to the hospital. Meaning any call they respond to that does not result in a trip to the hospital results in zero pay.
In addition to to that, many services go unpaid because the person they transport is uninsured or their insurance won't cover the costs because they are "out-of-network".
In rural America, the average transport to the nearest hospital is a 2 hour drive. So a 4 hour round trip for the voluntary EMS.
In the event of private ambulance services. Such as one mentioned in the article that provides services to a country in Wyoming the size of the state of Vermont, they lost more than a million dollars last year. And have opted out of renewing their contact in June. No other bidders have applied to replace them.
The story is the same for much of Rural America. With ⅓ of rural counties within one non profitable year of going out of business.