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The area I cover is only 212 sq miles, but it is a different kind of challenge. Although you cover a large area, I'm sure you have multiple hospitals to choose from, correct?
We are serviced by a local clinic, which is staffed with PA's, and a few non-certified MA's. Medical control comes from the closest hospital, which is a 3.5 to 4 hr flight via MEDEVAC to the mainland. So, when we end up taking a rescue boat to a vessel to extricate a patient, we routinely have to assist the clinic with services to get the pt stable enough to sustain the flight.
northern California born and raised!
I want to eventually move out of state, for the protocols, and just to experience something different but that's a little down the line.
You have most of us beat in remoteness. But I know I have a Lvl 4 hospital as my only receiving hospital by ground. Anything that is the least bit serious gets flows. Usually meeting a fixed wing on the runway. Part of that is the only things they can do that I can't is blood and scans.