BY ANNIE HOLLER
MOUNTAIN CITIZEN
BELO, W.Va. — Patriot EMS abruptly ended operations in Mingo County, removing its trucks and equipment without notice Feb. 6 and leaving county officials searching for answers in one of Appalachia’s most remote regions.
When the Ohio-based Patriot EMS abandoned its station along Route 65 in Belo, county officials said there was no notice, no gradual transition — only the sudden disappearance of an emergency lifeline.
“We weren’t provided any advanced notice that Patriot was pulling out of Mingo County,” Mingo County Commission President Nathan Brown said. “At approximately 8 a.m. on Saturday, I was contacted by our Emergency Services director Doug Goolsby informing me that Patriot Ambulance Service had suspended operations effective immediately.”
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.
While some counties depend solely on Patriot for emergency medical calls, Mingo County has another option: STAT Ambulance. This local provider has operated in Mingo 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. That consists of dialysis runs, hospital transfers, transportation for nursing home patients and 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 November 2025, the county commission allocated $24,666.50 in state funds to both Patriot and STAT to help offset their operational costs.
“We have received additional funding for the next fiscal year, and those funds are ready to be awarded as well,” said Brown. “I understand there is a great need for financial subsidization for EMS operating in rural areas. And I believe that unless there is a solution that provides either county or state funding to offset costs and fill in the gap, Mingo County will not be the only location affected. We’re all facing the same dilemma.”
Brown said the county has funds available for emergencies, but strict rules govern their use. He and the Commission are weighing possible solutions and seeking guidance from the state EMS office.
“Our community must have access to dependable and adequate emergency care,” Mingo County Commissioner Diann Hannah commented. “There is nothing more important than knowing if you have an emergency and call 911, an ambulance is going to respond.”
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.
Brown echoed that reasoning.
“The federal shutdown sped up the financial crisis for EMS companies, as the majority of our residents are insured by either Medicare or Medicaid,” he said. “When reimbursements stopped during the government shutdown and claims weren’t being processed and released, the result was little to no money coming in. When you think of the cost per day to operate an ambulance service and the reimbursements that are their lifeline to continue operating, it’s a recipe for disaster when they stop. They are dependent on those payments.”
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.”
The deeper question is one Mingo residents have confronted before. More than once, Hannah said, voters have rejected a tax levy to fund a county-operated ambulance service like the one 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. That instability threatens the reliability of ambulance coverage.
“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.”
Brown said his concern about a tax levy is whether Mingo residents can afford the added cost, given that many families live on fixed incomes. He also noted that, even with a levy in place in Logan County, in 2025 the Logan County Commission received a request from its EMS provider, Logan Emergency Ambulance Service Authority, for approximately $500,000 in additional funding.
“There’s no simple solution,” said Brown. “The bottom line is we have to provide EMS services to the residents of this county. There’s no statement truer than that. At any given time, we never know when a member of our own family may have a medical emergency. The safety of all Mingo County residents is, and will always be, our top priority.”