Your current commentary holds a lot of true as to how local EMS systems evolve.  Unfortunately, as you stated, politics tends to determine how "well" or poor of a program a community will receive.  Over the years, I have traveled to many locations (and worked in some as well) where the overall effectiveness of multiple local organizations would have been better served by mergers or establishment of regional "authorities".  Instead of having several marginally-managed, underfunded organizations attempting to provide whatever level of service they could manage, they could experience better efficiencies and economies of scale by joining with neighboring sister agencies.  Of course, turf battles and the reluctance to relinquish any type of control (usually by politicians but sometimes by career bureaucrats as well) usually doom any such suggestions of planning of this type.  How many times do we see communities that straddle political borders (i.e. county lines) be underserved? Neither county is willing to place the resources in that community to respond to calls since they feel they would have to respond into the "other" portion of that town and pick up the neighboring county's "slack."
 
Community expectations are usually formed by watch they watch on TV and therefore assume their community has a high level of service.  As the old slogan says, "it takes someone important to die" to actually attempt to improve anything.   And by then, the community's trust in the current EMS provider organization has eroded due to the bad press that typically follows such an event, even if it is the precipitating event that eventually does create a change for the better..
 
EMS is provided by a multitude of organizations, public, private, non-profit, volunteer, hospital-based, etc. and trying to get all othose folks to sit down together to determine how they can best jointly serve their communities is sometimes extremely difficult since each one of them "has a dog in the race" (as a former boss of mine used to state.)

Dale
at excellance.com