I think you nailed it when you typed less people calling ambulances perosnally, and extended and supported that with your comment to Greg about government pressures above. In Melbourne ambulances get called for stupid things ("I can't sleep", "The smoke alarm is maing a beeping noise" etc.) . If we could educate people better, get a better class of idiot, or change the policy of a guaranteed response if a request is made, I suspect that would go a long way toward solving the problem. A certain chunk of the problem is societal, rather than it all boiling down to logistics. In that respect I'm not sure that the flood of hospital and pre-hospital based TV dramas have done the ambulance world any favours by raising our profile. Society at large now seems to expect an ambulance withing 60 seconds of calling, staffed by cardiologists and neurosurgeons hyped to eyballs on 'Prozac' and Star Trek technology that can cure everything with the only hint of effort or ambiguity left for the sake of drama. :( Good luck with whatever you wind up doing.