I started out Volunteer, continued there when I started out in non-9-1-1 system IFT (Inter Facility Transfer) ambulance service, and still continued the Volunteer when I finally got Municipal (I guess that qualifies as "provincial"?).
Some areas of the country, state/province, or county/parrish have had "organized" volunteer ambulance services for decades. Some have had contracts with private EMS operators, meaning "F&B Ambulance" was, and is, the 9-1-1 EMS responder. In yet others, 9-1-1 EMS is a service provided by either uniformed officers of the Police, Sheriff's Office, or Fire Department, or uniformed EMS members of those agencies, like the FDNY, or it is Hospital based. Everyone jokes at the expense of someone else's system, as that is just human nature: It ain't right, but it is what it is.
OK, I'm boring even myself by saying all that, yet again, but admittedly, I hope all involved, no matter what "base system" they're from, try to do some good.
Yes, some of the way EMS operates is flawed. I posit that no matter how good a local system is, there is always going to be room for improvement.