I'm kind of in the same situation here. I went from a busy San Diego station to a rural station on an Army base in the middle of the island of Hawaii. Here, we average about two runs a week. My last cardiac arrest I ran on was at the summit of Mauna Kea, almost 14,000' elevation. Even though we are the closest unit, our response time is still about 45 minutes to the summit by 4x4 ambulance. CPR was in progress for about 40 minutes prior to our arrival, then we transported the patient down to the 9,000' level where the chopper met us. From there, it is a 25 minute flight to the hospital. This patient didn't have a chance! On Feb. 1st next year, we might lose our ambulance due to military politics and funding. If this happens, the closest ambulance will have about a 1.5 hour response time to Mauna Kea and Mauna Loa summits, and a 1 hour response time to the area I work. Not a good place to get sick!