Poor leadership and management with high turnover rates. EMS specifically does not like to cooperate or play well with other emergency agencies. Mindset is getting trucks on the road and will turn blind eye to bad practices and attitudes. County leadership definitely holds the agency back as it refuses to allow for changes needed. Recent change in hiring lower level providers to increase truck volume which helps but still does not address issues with unable to retain paramedics at an ALS service. Training is catered to the lowest "denominator" and focus on minimizing mistakes through system changes versus actually addressing poor education and lack of knowledge of some providers.