BY ANNIE HOLLER
MOUNTAIN CITIZEN

BELO, W.Va. — On a stretch of U.S. 119 near Belo, a building that once promised help now sits empty.

Feb. 6, without warning, Ohio-based Patriot Ambulance Service pulled its trucks and equipment from its station along Route 65, ending its operations in Mingo County, West Virginia. County officials said there was no notice, no formal announcement, no gradual transition — only the sudden disappearance of an emergency lifeline.

In a place where distance already complicates survival, the absence of an ambulance is a question of minutes, and sometimes, of whether help comes at all.

Patriot had arrived in Mingo County in July 2024, part of an effort to address persistent gaps in transport services across the region. The company, headquartered in Ironton, Ohio, also provides emergency medical coverage in several Eastern Kentucky counties, including Martin, Floyd, Lawrence, Magoffin and Boyd, as well as parts of southern West Virginia, including Wayne and Mingo.

The service landscape is uneven. Some counties have more than one provider. Others have none.

Martin County, Kentucky, for instance, depends solely on Patriot to respond to all emergency medical calls.

Mingo County had another option: STAT Ambulance, a local provider that has operated in the county for nearly three decades. STAT maintains five stations — Williamson, Matewan, Gilbert, Delbarton and Kermit — with seven ambulances available on a typical day.

But in rural Appalachia, even seven ambulances do not always mean seven ambulances ready.

Like most emergency medical companies, STAT often finds its crews tied up not only with emergency calls, but with the quiet, constant churn of rural health care: dialysis runs, hospital transfers, transportation for nursing home patients, rides to distant doctors’ appointments.

The ambulances move, but not always toward emergencies.

Patriot’s arrival initially offered relief. The company began with three Advanced Life Support ambulances, responding primarily to 911 calls, staffed with paramedics on each shift.

Yet the economics of emergency medicine in rural America are unforgiving.

By September 2025, Patriot had reduced its presence from three units to one. County officials said the company was averaging only 2.1 calls a day — far below the six or more daily calls needed to sustain operations.

In the end, the trucks left altogether.

“Our community must have access to dependable and adequate emergency care,” said Mingo County Commissioner Diann Hannah. “There is nothing more important than knowing if you have an emergency and call 911, an ambulance is going to respond.”

Hannah said she feared Mingo would not be the last place to face such uncertainty.

“From what I have read, Patriot is also planning to close stations in locations other than Mingo, so we aren’t the only county facing these concerns,” she said. “I’m grateful we have STAT in place, and I can’t imagine the plight of counties that do not have another option if additional closures take place.”

In Mingo County, geography compounds the crisis. The “perfect scenario,” Hannah said, would be at least three ambulance services to ensure quick response times across the county’s outlying areas.

But she acknowledged that such a system is almost unimaginable in today’s rural economy.

The closure, she suggested, reflects not only local call volume, but broader forces beyond the county’s control — particularly the instability of federal reimbursements that private ambulance services rely upon.

“From what I understand, the government shutdown played a large part in Patriot’s financial woes, as Medicare and Medicaid reimbursements were delayed and created a breakdown in funds coming in, while the bills and operational costs continued to rise,” Hannah said. “Everything was going out and very little coming in. Once the hole gets very deep, climbing out can become an impossible task.”

For private EMS providers, the margin between survival and collapse can be thin. Fuel, staffing, equipment, insurance and maintenance all rise steadily, while reimbursements remain uncertain and delayed.

“I sure hope Patriot can come up with a workable solution for their company that will allow them to serve the lower end of the county at least,” Hannah said. “But I do realize they have to make enough money to cover their operational costs and payroll.”

Now county leaders are searching for ways to prevent further erosion.

“Our county commission is searching to find a way to offer the ambulance services incentives to stay in our county and provide medical transport for our people,” Hannah said, adding that Commissioner Nathan Brown has been in contact with the West Virginia Division of Emergency Management in hopes of securing state funding.

But even incentives are complicated. County governments cannot simply write checks without legal constraints.

“We are depending on the state to give us guidance in regard to what fund we may be able to pull from that does not break the law to provide financial assistance and incentives to stay,” Hannah said. “We will be continuing talks with Patriot’s owners to try to find a solution we can both live with.”

The deeper question is one Mingo residents have confronted before.

More than once, Hannah said, voters have rejected a tax levy that would fund a county-operated ambulance service — like the system in neighboring Logan County.

She sympathized with residents reluctant to take on additional taxes. But she also spoke plainly about the stakes.

Private companies like Patriot and STAT are struggling to survive in rural counties, she said, and that instability threatens the dependability of ambulance coverage itself.

“There’s nothing scarier than the thought of having a medical emergency of any nature and being told there’s no ambulance heading your way,” Hannah said. “We have to find a workable solution to provide emergency services for everyone in our county. This is a battle we cannot lose because if we do, we will lose a lot more than ambulances; we will lose lives.”

For now, STAT remains operational. The trucks still run. The stations are still staffed.

But in places like Mingo County, health care is already stretched thin and geography makes every emergency harder; the empty building at Belo stands as a warning.

In rural America, ambulances do not always stay.

And when it leaves, what disappears is not just a service, but a promise.

This is a developing story and updates will be provided as they become available.