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"More and more volunteer services are finding this to be untenable," states Brock Slabach, primary operations officer of the National Rural Health Association. Rural ambulance services rely greatly on volunteers. About 53% of rural EMS companies are staffed by volunteers, compared to 14% in city areas, according to an NRHA report.

A delay of minutes can mean life or death In Montana, a state Department of Public Health and Person Services report states, about 20% of EMS companies frequently have trouble responding to 911 require lack of readily available volunteers, and 34% periodically can't respond to a call. When that happens, other EMS firms should react, sometimes having to drive cross countries when a hold-up of minutes can be the distinction between life and death.

According to state data, 60% of Montana's volunteer EMTs are 40 or older, and less youths are actioning in to replace the older people who offer to save the lives of their family members, friends and next-door neighbors. Finding enough volunteers to submit a rural ambulance crew is not a brand-new problem.

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Dutton EMS Crew Chief Colleen Campbell displays an ambulance at the Dutton ambulance barn. Aaron Bolton/Montana Public Radio Aaron Bolton/Montana Public Radio Dutton EMS Team Chief Colleen Campbell displays an ambulance at the Dutton ambulance barn. Aaron Bolton/Montana Public Radio Currently the Dutton team has four volunteers, consisting of Campbell.

At its floor, she says, her crew included 2 individuals: her and her buddy. That made reacting to calls, doing the administrative work and organizing the training needed to maintain accreditations more than they could manage. In 2011, the Dutton ambulance service was absorbed by Teton County.

"It's simply a big obligation that individuals aren't happy to leap into, I guess," Campbell says. Medicare and Medicaid payments only cover a third of the EMS costs In addition to workers scarcities, about a third of rural EMS firms in the U.S. are in instant functional jeopardy since they can't cover their costs, according to the NRHA.