Some time back, an individual basically came here looking for information on starting a medevac helicopter service. We ended up "shooting him down", as the person knew nothing about city/county/state/province/country requirements for even what should go into an ambulance, let alone the costs that would be incurred just running a helicopter as an aircraft. Little things, like fuel, insurance, the $3/4 million for the aircraft purchase... The current Hawaii Five 0 TV show has an interesting character, an ex felon shrimp food stand truck operator, who took and passed a helicopter pilot's license test, purchased a used helicopter, and opened a sideline business as a tourist ride with himself as the pilot. Nice fiction, but improbable outside of Oahu...er...Hollywood. Note I'm saying improbable, not saying "ain't gonna happen". Someone with a good amount of money invested in hardware, software, the proper personnel, and a couple of tons of luck could start up a business. I have to be a realist. Several companies I used to work for were later purchased by other companies, then the purchasing companies were themselves folded into other companies. A few of them survived, many folded. In today's market, does anybody know if a startup ambulance company could or would survive? All I can suggest, if you still want to open an ambulance company, first research the hell out of what all the costs involved would be, extrapolate what the costs might go in the next year, decade, supply availability, and probably a bunch of stuff I, as an individual retired EMT, have no clue what they are, just that they are there. As indicated, perhaps you'll be a lucky one. On a bit of a side note, a dose of Narcan went for a few dollars only a few years ago. Now, both the original company and manufacturers of generic Narcan are charging almost $100.00 a dose, That's a new expense some companies may not want to spend, as Nasal spray Narcan is still in "Pilot Program" status, here in New York State. Not everyone can get a medical director to sign off on using it. You and your crews going to have it on your ambulances? BLS or ALS levels, or both? Good luck with your endeavor of a new ambulance company, none the less!