I've been roleplaying EMS for around 10+ months consistently on this server, and adding horrendous fees would uh. Probably kill all the cool calls we do actually get.
I'll touch on the point about ambulances not responding to calls, you have to realize RPing EMS, we have a SMALL amount of staff compared to LSSD/LSPD, but waaaay more calls. I'd say we have three calls to every one call LEO's get on average per day. So we're scrambling resources to respond to every call, and they usually come in waves, which means some calls are simply not going to get answered by us. Which means we have a few crews responding to these calls and if they log off? Calls don't get responded too, which leads to heavy burnout. These calls are also super low quality unconscious stab/gunshot/blunt force trauma calls. Where the patient is unresponsive, usually afk/talking to an admin, and there is very poor RP quality. This makes up 60-70% of our calls. And they're awful, so much so that I usually log off after getting a wave of them.
It goes wave of 3+ calls --> no calls for six hours --> wave of 8+ calls
The calls we do have a lot of hype for are unique medical/rescue calls. Something stuck on a roof or someones having a bad asthma attack or a strange illness that we have to suit up for. These calls are tremendously rare, shit overdoses and diabetic emergencies, the most common type of EMS call in the US, almost never happens in LS. I think 10 months playing a Firefighter/Paramedic, I've had one asthma attack, one diabetic emergency (actually it was probably nothing) and four-ish overdoses.
Meanwhile I've had almost 1000+ GSW/Stab wounds, heavy trauma, where somehow all the patients are unconscious for some weird reason. I mostly blame this on the tremendously awful wound script which causes people to not talk magically. And is frankly, ridiculously unrealistic.
Actually being able to talk to your patient makes EMS fun, and the trauma calls on this server suck due to that single script.
As for actual fees, you need a hospital in place first, with an actual healthcare system that's been developed, adding fee's only hurts EMS and the fledgling medical clinics/hospitals that are trying to get their feet on the ground. You need a proper system in place first, which is fair to the patient, EMS, and other medical personnel. Adding baseline fees will kill any good roleplay I have with the unique call patients. Because those unique call patients only happen when the player wants them to happen. Medical conditions that are thought out are so tremendously rare, that anytime someone says they have some chronic illness or even a basic allergy, I look at 'em like a god damn unicorn, because that's what they are.
TL;DR rework the stupid injury script, don't bully yer ems for not responding, we're stressed enough as it is, and fees without a hospital/healthcare system is like stabbing someone without the pointy bit of the knife.
P.S no another EMS service would not help, unlike LSSD/LSPD, only a small niche fraction of people actually want to give EMS a try, any new agency would be good for a couple months, then run into a personnel problem real fast.