You must also consider that rural areas don't see as many system abusers as urban systems.  The population is less transient in rural areas, and also much less dense when compared per square mile.

It may only be antecdotal, but my experience has been that really about 80% of the people I have encountered on rural EMS 911 runs truly require an evaluation and transport by EMS.  I cannot say that my time working in South Central LA and Central Florida warranted such need.  I found much of my day was filled transporting people who needed detox or an urgent care, not an ER.  I feel lucky to have benefitted from serving in both very dense urban areas and very sparse rural areas to help round out my career and experience.

You make an excellent point for urban and even suburban EMS, but please don't compare apples to oranges in your assessment.  Yes they are both fruits and are both good for you, but they don't have the same flavor or growing conditions.  Yes rural and urban systems are both great safety implementations, and each serves their purpose and population well, but they too require different growing conditions.  Each operates very distinctly differently.  I have come to appreciate rural EMS quite a bit more than urban EMS because I can take time to develop rapport with my patients over the course of a run, rather than having to dawdle on scene just to get enough time to acquire a courtesy IV for an urban ER and complete a thorough secondary assessment, then still never getting to know WHO I was there to treat.  Even my critical patients in the rural setting can appreciate the ability to learn to trust their caretaker due to the sheer amount of time we share with them.  Over the evolution of a call requiring an extended response time due to distance versus traffic jams and red traffic signals, I can easily see saving ten minutes just getting to the incident and another small bank of time getting to definitive care by opersting in Code 3 mode.  Remember also that when you start calculating the golden hour, it doesn't start when you get there, it starts when the injury occured.  Cath lab times start at the onset of the stroke or MI, not when we got to the patient.

End point: Your article is preceded by, "'Insights' columnist Matt Zavadsky focuses on the implications of recent news from around the world and it's impact on EMS nationally and in your home town."  That depends on where your home town is.  I'm asking you to present the whole "EMS & Code 3" picture to us, not just the most dramatic points that capture the emotions we'd like to react to, as your article highlights.  It does no justice to compare urban response times with and without Code 3 ops, when you don't relate how rural compares.  In fact, you may inadvertently seal the fates of those in rural areas who need a Code 3 transport because you managed to abolish the practice of Code 3 runs based solely on urban mishaps.  That is a whole other lecture on proximate liability.

Best regards,
Christopher Matthews, NREMT-P, MICP, EMS-Instructor