There's still miles of countryside between cities in the Netherlands, Japan, Switzerland, Germany, and Denmark. Many of Canada's cities have fantastically walkable neighborhoods and light train services, and Canada has even more unreachable rural areas than the Sates. Urban solutions are almost completely unaffected by the size of the rural areas.
These solutions can all happen in individual cities and even towns. How many hours of car driving away the next urban center is doesn't affect where parking is placed, or zoning density, or where the highways are routed, or how fast the busses are, or whether a light train could be viable.
You don't need giant EMS vehicles is cities. I bet 95% of EMS vehicles in large cities never leave city limits. Even if absolute units of EMS vehicles are somehow necessary for rural service (I doubt that), smaller, safer vehicles could easily service urban areas.