BARBOURVILLE, Ky. -- When her 85-year-old father became ill, Brenda Campbell grabbed a telephone book and looked up the number for a local ambulance service. For her, dialing 911 wasn't an option.

"We just don't bother," said Campbell, who didn't want to be routed to emergency dispatchers up to 100 miles away. "It's quicker to look up the number you need."

Despite a mandate from Congress that residents of every community have 911 service by last November, more than 400 U.S. counties have minimal emergency calling capability, according to the National Emergency Number Association.

That means thousands of Americans do not have quick access to police or paramedics, said Roger Hixson, an official with the organization that promotes improvements to America's 911 system.

"It's an issue of public and personal safety," Hixson said. "It also now is a growing issue for homeland security. The eyes and ears of the public are the first to recognize something unusual."

While small towns like Barbourville in southeastern Kentucky struggle with basic 911 service, more prosperous communities have spruced up their systems. Some can even pinpoint cell phone callers who need help.

Far from ideal

For smaller counties, the Federal Communications Commission requires telephone companies to ensure that 911 calls are answered by emergency dispatchers, even if those dispatchers are in a neighboring county or beyond. That's an improvement from when dialing 911 resulted in a busy signal or a recording, but far from ideal.

Hixson's organization found the largest number of underserved counties in Georgia, Kentucky, Missouri, Montana, Nebraska and South Dakota. All had at least 25 counties with minimal 911 service or no service, according to surveys done last year.

"Some localities don't have the financial wherewithal to do it," Hixson said. "Most that don't are rural, don't have a large population and may have trouble covering the expense of a police force, let alone a 911 center."

Dialing 911 in Barbourville leads to a brief recording before the call is transferred to an emergency center 100 miles away in Winchester. There, dispatchers can alert the Kentucky State Police, who would then call local police, firefighters or ambulance service personnel.

Like everyone else in Knox County, Campbell has been paying a $1.25 telephone tax for the past five years to cover the cost of a 911 emergency call center. But she isn't sure she can get help quickly if her father, who is bedridden with heart problems, needs an ambulance again.

"We're paying for 911," she said. "We've been paying for years. We should have it."

Sheriff John Pickard agrees. The day the county has reliable 911 service, he plans to have lettering for D-I-A-L 9-1-1 applied to the department's cruisers. For now, the cars are blank.

"We can't advertise 911 unless we have 911," Pickard said. Authorities say their 911 situation has not been blamed for any deaths.

Knox County Judge-Executive Raymond Smith was elected after promising to improve 911 service, and was recently able to get 911 calls to go directly to the state police in Harlan, 50 miles away. But he said the county has collected $906,000 for 911 improvements and spent $550,000 with little to show for it.

"I'm sick. I'm nauseated about it," Smith said. "We should have had 911 service long ago."

Other Appalachian counties have problems, too. In Letcher County, Pam Walker was on her way to work on a bitterly cold morning in January when she happened upon an elderly an Alzheimer's patient who was lost in the rural community of McRoberts. He asked for help.

Walker said she had to walk around in the snow until she found a place where her cell phone could reach 911.

"I got Clark County, two hours away," Walker said. "I was furious. I don't usually yell, but I did yell that time.

"Getting help isn't as easy as dialing 911," she said. "At least not around here."

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On the Net:

National Emergency Number Association: http://www.nena.org