Officials say the city can no longer afford to respond to non-trauma calls for more than 2,000 county residents unless the rural neighborhoods agree to pay up.
Caroline Perry is a commissioner for one of three rural fire districts that received letters from the city last month. She called the plan "harsh" and "shocking."
"Unfortunately, somebody's going to end up dying because there's not going to be a medical response to our fire district," she said.
Perry said the city informed her it can no longer afford to send ambulances for less serious emergencies to the communities of Pacific Beach, Humptulips and Copalis Crossing because her district owes the city $16,000 for past services stemming from alleged budget mismanagement by others several years ago.
Perry and other fire district commissioners thought the city was willing to be more patient.
"With the agreement that we were going to be working on, (there was) a resolution to be able to make payments on those arrears," Perry said. "Unfortunately, evidently, they changed their mind."
Copalis Crossing resident Don Ring was shocked to learn he and his neighbors may be on their own for 911 calls about chest pains, shortness of breath or stroke symptoms.
"You've got to have an ambulance service. That's all there is to it," Ring said. "You can't plan your day around, 'I'm not going to get hurt. I'm not going to do anything today, I'm going to lay in bed.'"
Produce market owner Sharon Voss said it's not just about residents, either. She said tourists also need paramedics.
Voss understands that Hoquiam can't provide services without tax dollars, but she doesn't like how the situation is unfolding.
"I understand the crunch," she said. "I don't understand the hardball."
Hoquiam officials say they don't want to terminate non-trauma ambulance services to the rural communities.
The city administrator said fire districts have some options, including getting a loan from the county. He believes the districts have time to work something out before service is terminated.