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Rural Ambulance Services Are in Jeopardy as Volunteers Age and Expenses Mount

DUTTON, Mont. - Vern Greyn was standing in the raised bucket of a tractor, trimming dead branches off a tree, when he lost his balance. He fell 12 feet and struck his head on the concrete patio outside his house in this small farming town on the central Montana plains.

Greyn, then 58, couldn't move. His wife called 911. A volunteer emergency medical technician showed up: his own daughter-in-law, Leigh. But there was a problem. Greyn was too large for her to move by herself, so she had to call in help from the ambulance crew in Power, the next town over.

"I laid here for a half-hour or better,"...