John Miller was driving on S.C. 160 in Fort Mill when an oncoming driver made an illegal turn into his lane, causing him to crash.
Miller sat in his wrecked car wincing from neck and back pain as two ambulances arrived.
"I just chose the first one that got there," he said.
Two ambulances coming just for him struck Miller as unusual. But in Fort Mill and Lake Wylie, where EMS services compete for patients, it's common.
As competition and tension intensifies between York County's contracted ambulance service and non-profit rescue squads, officials say they want to create a safer, more efficient system of rushing people to hospitals.
"Two vehicles traveling 60 miles per hour just to get the (ambulance) transport doesn't make sense," said Gary Loflin, York County Public Safety Communications director. "It's time to address this issue."
The pursuit of patients is strongest in Fort Mill and Lake Wylie, where once all-volunteer rescue squads now run full-service operations with paramedics and ambulances available 24 hours a day.
Piedmont Medical Center in Rock Hill has contracted with York County to provide ambulance service throughout the county.
All three are plugged in to the emergency dispatch system.
When a 911 call for an ambulance in Fort Mill comes in, for instance, both Piedmont and the Fort Mill Rescue Squad can respond.
And they often do.
"Just about 100 percent of the time," Fort Mill Police Capt. Bryan Zachary said. After accidents when police have been present and an ambulance is needed, Zachary said, "they're both responding consistently."
Ambulance drivers and paramedics have a mutual agreement, Piedmont and rescue squad officials said: First to arrive transports the patient. And thus collects payment.
"The reason you're seeing the competition is there's money there," York County Manager Jim Baker said.
But rescue squad leaders said interaction at the scene is civil. If one crew needs help, the other jumps in. Emergency Management Director Cotton Howell said he's not aware of any ambulance wrecks related to the competition.
There was a time when rescue squads and Piedmont EMS worked even closer together.
A 1995 amendment to the county's contract with Piedmont stipulates that its ambulance service "cooperate and coordinate with ... the rescue squads."
Dual dispatch was added at rescue squads' request so they could respond to 911 calls along with Piedmont, according to Howell.
They helped each other treat patients, sometimes riding in each other's vehicles. Crews socialized and met for lunch.
"Fifteen years ago," Howell said, "if Piedmont had a broken ambulance, they would borrow one from a rescue squad."
That no longer happens.
But not all of the county's rescue squads compete.
Volunteer squads in York and Clover aren't always on duty. The Rock Hill squad specializes in water rescue and extricating people from vehicles. It doesn't run an ambulance or transport patients.
In fast-growing, more affluent Fort Mill and Lake Wylie, however, the River Hills and Fort Mill rescue squads ramped up along with Piedmont. Tax forms show the non-profit Fort Mill squad employs 15 people. They work with some 40 volunteers, Assistant Director Tim McMichaels said. The group, which also extricates people and performs water rescue, has four ambulances.
River Hills Emergency Squad is staffed by five employees and about 50 volunteers who run two ambulances.
Piedmont has increased its ambulances in the area. Fort Mill rescue squad employees said they've seen as many as five on patrol.
Competition was inevitable.
Emergency response in York County has evolved into a complex, strategic exercise fueled by software that analyzes past 911 calls to predict where the next call is likely to come from.
Crews from Piedmont EMS and the rescue squads park in key spots and lie in wait.
One afternoon this fall, a Fort Mill rescue squad ambulance sat in a CVS pharmacy parking lot downtown, about 200 feet from a Piedmont ambulance.
In Lake Wylie, River Hills crews often park along busy S.C. 49. Gone are the days when drivers and paramedics sat comfortably at the station or local diner waiting for a call, River Hills squad director Dick Mann said.
"Because Piedmont will not allow their people to do it, we can't," he said.
Squad leaders said they see their organizations as community pillars providing a valuable service. They help train emergency medical technicians.
Dueling with Piedmont, they said, has them fighting for their existence.
Piedmont seemed to have a "paradigm shift all of a sudden, like 'We're going to treat York County like the rescue squads don't exist,'" Fort Mill Rescue Assistant Director Tim McMichael said.
Rescue squads rely on donations and grants as well as fees from patient transports to survive.
Those fees range from $400 to more than $1,000, depending on the service, McMichael said. Piedmont charges similar fees, Piedmont Medical Center President and CEO Charles Miller said.
The rescue squads' revenue this year includes $96,470 from taxpayers, which all squads split. But the county council is phasing out those payments over four years.
The squads are outgunned by Piedmont, which, as part of Tenet Healthcare Corp.'s national chain of hospitals, can add ambulances to force them out of operation, McMichael said.
Rescue squads "are outlets for people in the community to volunteer and serve," McMichael said. "It's kind of the death of a community service."
Piedmont CEO Miller disagrees.
"It's just a couple of competing businesses," he said. "We all charge for services. We all have paid staff.
The problem, officials said, stems from dual dispatch and a vague contract. For example, Piedmont's contract says the company must work with the rescue squads, but Piedmont is the only one contracted to send ambulances. The county's attorney determined that made legal sense, Howell said, because there's no guarantee anyone else will show up.
The contract "was poorly worded 15 years ago," Howell said. "It didn't close a lot of loopholes or fill in blanks."
A solution isn't near or clear, but officials said they're working on one.
Howell and Loflin have a proposal to do away with dual dispatch and employ new software to pinpoint the ambulance closest to a call and automatically dispatch it.
"Rather than have the races, we would kind of call the race before it starts," said Baker, the county's manager.
Miller, Piedmont's CEO, declined to discuss the proposal because he was unfamiliar with it.
While the proposal sounds like a good start to a long-term solution, McMichael said, it doesn't require Piedmont to work with the rescue squads or prevent the hospital from flooding the area with ambulances to ensure they get dispatched.
"There's nothing in our proposal that deals with that," Howell said. "It certainly could be discussed. We're putting something on the table to start the discussion.
"It may require county council to enter negotiations to amend the contract."
County council member David Bowman is pushing for that.
"I'm afraid the competition is about to run our volunteer squads out of business," he said. "We've changed a lot in the last 10 to 15 years.
"The contract needs to be revisited. We've gotten to a point where there's tension instead of cooperation."