Chief Harry Brown goes everywhere with a packet of maps. There's the map that shows the 911 addresses assigned along every snowmobile trail in the North Country. There's the map that shows where bags of medical supplies have been stashed with first responders. There's a map with town boundaries and fire stations. One shows the spots where helicopters can land near heavily wooded areas.

The maps, stuffed in a sack and pinned on the walls of a trailer, show the territories covered by the North Country's new ambulance service, the 45th Parallel. The territory is massive: 1,200 square miles. The area is dominated by more snowmobile trails than paved roads and includes 10 communities in two states.

Named for a line of latitude running through Stewartstown - said to be the halfway point between the equator and the North Pole - the 45th Parallel is unlike most EMS providers in the state. It's a true regional system, where a group of communities developed a shared plan, came up with a budgeting formula and helped fund an independent nonprofit organization to provide round-the-clock ambulance coverage to their small, rural communities.

"You can't get anywhere from here," Brown said recently, gesturing toward one of his many maps. Yet these communities now have something that many of Concord's rural neighbors lack: a full-time, advanced life-support ambulance.

It's a model that experts say is popular nationwide, even in areas far less rural than northern New Hampshire. But regional ambulance services have failed to take root in New England, where clashing community cultures and a tradition of volunteer ambulance services keep most service local.

Up north, local leaders say the advantages of the new system are clear: more reliable service, better-trained staff and stable costs to many towns. But selling the plan politically was a long and fraught process.

"If we could make it happen up here in the northernmost part of New Hampshire, where I think the definition of damn Yankee pride came from - if we can make it happen, I think anyone could make it happen," said Louise McCleery, the CEO of Upper Connecticut Valley Regional Hospital in Colebrook, a leader in the effort to develop the 45th Parallel. "But you have to have a few people willing to take risks and stick their necks out on the line."

As it awaits construction of its new building in Colebrook, the 45th Parallel operates out of a trailer behind the hospital. It's a small building filled with comfortable chairs. In one corner are two twin beds for the overnight crew.

Working for the ambulance means a lot of waiting. Unlike a busy city department, the North Country doesn't have many medical emergencies. In the organization's first year of operation, it responded to 843 calls - about two a day.

But the staff finds plenty of ways to keep busy. Brown and Michelle Hyde, the deputy chief, manage billing, apply for grants and monitor the progress of the building project. The shift EMTs train, exercise and frequently wash their ambulances. Brown, a North Country lifer, also likes to pass the time by telling stories about particularly grisly snowmobile wrecks and watching internet footage of his son, Chris, a professional snowmobiler, who specializes in death-defying tricks.

But though the alarm sounds less frequently than it does in the city, the full-time structure of the department means there's always someone at the ready when it does. Every shift includes at least one intermediate-level EMT, who is able to provide some advanced life-support techniques.

The 45th Parallel was born in crisis. The hospital, which had long subsidized Colebrook's volunteer ambulance, said it could no longer afford to pay. Volunteerism was waning as locals got busier and had to travel farther for work. On average, it took more than 10 minutes between the time someone called 911 and the time an ambulance even left the station in Colebrook or Pittsburg, the two local towns with volunteer ambulances.

And that was the average.

Often, "there would be three, four, five, six tones trying to get a crew together," Brown said.

In communities where distances are significant, that time is about all crews can control. There's not much ambulance crews can do to speed the trip between Colebrook and Errol on a wintry day. But by bringing in a full-time staff, the 45th has cut that time to under two minutes. A call comes in, and staff members hop right into an ambulance and leave. For injured snowmobilers in the woods, it could be the difference between 40 minutes and an hour of waiting.

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