The cost isn't about the actual mileage though, it's having two paramedics each earning about 100k/yr per ambulance, while having coverage 24x7x365. So fully loaded, the labor for one ambulance might be in the high six figures to seven figures.

Even if we assume we need to cover their downtime between rides, at a conservative estimate of "we're the only call today" that's $2400 of labor at your rate (≈$400/d, 2 paramedics, 3 shifts). TFA suggests they're not paid well.

Except the paramedics are actually making mcdonalds wages.