Montana

is the only way to save an operation. Depending what state regulations are staffing would probably have to include basis, advanced or paramedic service. A lot of the training is done in-house with people from other county agencies, additional at the hospital.

You can get on-duty staff and get volunteers to help drive the ambulance. Rural is a problem everywhere.

My town pays for those that have no insurance, but in reality most have some form of insurance or medicare. There is still the volunteers, but immediate care is regulated to the paramedics, either full or p/t . There are 6 ambulances and about 6 fly cars. Unfortunately, they get dispatched to adjoining towns to service those w/o a staff. It had the same problems and shut down for a time its is now one of the top combined services in NY State.

Billing is done by an outside firm freeing up people.

This is a nationwide crisis in both the ems & fire service. Free isn't really free, when there is no one to provided it. Having a paid incentive might help boost interest.