Back when I was hired in 2006 and going through fire school we were told 70% of the United States is volunteer.

Either due to the remoteness of rural living or just people in rural areas have more grit, the call volumes are much lower.

I live in Florida, but I am from a small rural town in MO and my mom still lives where I grew up. I was just there in August and I picked up a brochure for the county ambulance. They have 5 ambulances for the entire county and their call volume was approximately 3000 calls per year!

The county fire department I worked at has approximately 40 station and the busiest station doing 3000+ EMS calls on its own. Our department did all the 911 transports. When I left in 2020 we ran approximately 90,000 calls.