Lyn Medinger has received calls in the middle of the night from friends and neighbors with heart pains asking him whether they need to go to the hospital.
He'll listen to the descriptions of their symptoms, advise them, and, if necessary, pick them up and take them to the hospital.
It's a simple reality of heading an ambulance service in a small town where everyone knows you - and your phone number.
"It comes down to dedication and commitment," said Medinger, who is accustomed to his pager going off at all hours after 20 years with the volunteer Bellevue Ambulance Service.
It's also a reality that could be changing in Bellevue, in Iowa, and across the nation where volunteer paramedic teams serving small towns and rural areas are being hit by rapidly increasing certification requirements, growing coverage areas created by shifting populations and an aging volunteer force.
"Every (volunteer) ambulance service is probably having problems right now," Medinger said.
With a team of 34 members who mostly have out-of-town careers and a district that spans 172 square miles, Bellevue is struggling to find the manpower to cover daytime calls.
"This story is wherever you look," said Ric Jones, the public policy chairman of the Iowa Emergency Medical Services Association and a retired Dubuque firefighter.
"The reality is the volunteers are just getting stretched thinner and thinner," said Jones, who estimated that 90 percent of Iowa's geography is covered by volunteer ambulance services.
While they don't serve the majority of people in the state, that doesn't undermine the importance of what volunteer services do.
"If it's your relative, it's the most important call in the world," said Bellevue City Administrator Loras Herrig.
Expectations have changed from the days of the first volunteer forces, when Jones said they typically adhered to the motto: "you fall, you call, we haul, that's all."
"That's kind of what ambulance services were all about," Jones said. "(Now) there's a great deal more demanded of them."
Many volunteer services were born in the 1970s; succeeding the traditional model of ambulance services provided by funeral homes.
"It was kind of a natural offshoot," said Jones, who said for years hearses were the only size vehicles that could accommodate people for emergency transports.
Bellevue joined the trend and started its volunteer ambulance service in 1972.
"Just like a lot of other towns, funeral homes were getting out of ambulance services," said Max Reed, one of the original Bellevue volunteers who is still on the force today.
By the 1980s, paramedics were required to do more than give rides, they also needed to provide patient care.
The standards have continued rising since then, and the demands are making it increasingly difficult to scout out new volunteers when larger urban departments offer paid positions.
Medinger works in a paid position for the Clinton Fire Department and as Bellevue's director of emergency services during his free time, but he is the exception rather than the norm.
Considering the training involved in being a paramedic, it isn't surprising that not everyone has the luxury of time to share.
To become certified, today's volunteers need to undergo hours of EMT training, meet increased driving requirements and learn a litany of OSHA rules.
There's finicky regulations about handling various pathogens and bioterrorism training - not to mention becoming adept at completing detailed medical reports.
"Back in 1970 if you filled out a little ticket for your call, that was probably all that happened," said Jones, noting the lengthy computer reports that now have to be filed.