It all depends on the circumstance and the needs of the community...We have a combined and it works well...but our community is only about 2000 people...with a coverage area of 218 square miles....so most of our people are both Firefighters and EMS trained...
There is no one size fits all service. As Paul said, it depends on the needs of a community.
I have worked in private services under contract, and lets face it. Private services as a general rule, are out to make money. Of course they must provide satisfactory customer service or they don't stay in business, but some tend to low ball bids, services and staffing in order to obtain a better bottom line. There can also be an issue of being able to work together on scenes, as egos have a tendency to sometimes get in the way. But in all fairness, it does work in some communities.
I have worked in third city services which in most cases are better at providing consistent quality care than contracting a private service. Being tax supported, they don't have to rely on billing revenue to the extent a private contractor would. One of the main disadvantages to a third service is they must compete with the other services like; fire, law enforcement, or utilities for a share of operational revenue. Plus, some municipalities use EMS billing to bring in revenue to help pad the coffers. Although not as big an issue today as it was a few years ago, is communications. There can be a time lag between departments getting timely accurate call information, due to operating on different radio channels or bands. This can be critical in case of a hostile or unsecured scene.
A combined department is in my experience the better alternative. Most firefighters are already trained to at least basic EMT level. The infrastructure is already in place to house vehicles and equipment. A combined budget eliminates some of the competition for tax monies, and the collections for EMS services can be an asset for a department to help it break even on expenses. My department made the transition from fire only to a combined service handling all fire, rescue and ambulance services to our community in 1990. We have been able to achieve the same quality of service found in many big cities, including the latest medical equipment. This probably would not have been possible in our area had we not combined.
In DC there used to be separate Fire and EMS divisions. Now everyone is cross trained. Most don't like it at all. All firefighters are AT LEAST EMTs and some are paramedics. There are still single-role EMS personell around but they are getting phased out since we no longer hire them. The firefighters now staff all of the ambulances. The few single-roles that are left staff Medic units with FF/Medics on the engines. It wasn't very well how this was handled. Due to allowing EMTs to crossover to the fire side, we ended up with some terrible firefighters. If someone does not want to fight fire, they should not be forced to, especially in a busy department like the DCFD. They are nothing but a danger to themselves and others around them.
As you can see the answers are pretty common that such an issue depends upon the area/community.
The depts I was involved with did both fire and EMS. I prefer being on an engine or truck than to be on the ambulance, but that is my preference. Although it is nice to be on the squad (ambo) as well. We set up rotations to prevent burnout from being on the ambulance all the time though and that is the key if a dept is doing both.
EMS is also a revenue generator for the most part and helps to bring in income to the city vs just in taxes and can help sustain a dept budget.
As Capcity does mention though, one who wants to do strictly EMS probably shouldn't be forced into FF. Although if one knows FF is an aspect of the dept and they don't want to do it, then they should look elsewhere for employment.
I think the lines can get pretty blurry these days. I can travel a couple of miles and have-1. a city dept. that is fire/ems combined. 2. a city dept that has FF/PM assigned to each engine but transport is provided by a private ALS company. 3. A public/private co-op.
The zone I live in has the private ALS guys share the station. They buy in meals, take care of chores etc. Zone 5 ALS has to rent houses for the crews.
What will work for you and your city may not work in the next. There is a far better retirement package for the city paramedics than there is for the private companies. Defined package vs. a 401K type.
Here in Moab, Utah the departments of Fire and EMS are two different entities, as is Search and Rescue... EMS and SAR is governed through the county, whereas the fire department is governed through a district. We, as firefighters, do not respond with the EMS department, unless requested... and that is only to conduct extrication or other extenuating circumstances... I have noticed throughout the state, that several , if not most, run EMS and Fire services together..
I have seen the departments run separately and together, and it seems to work well both ways... if you are an adrenaline junkie like me, and you know you are, or we wouldn't be doing this job, then I would prefer to run the departments together... More chances and more opportunities to take calls and sharpen our skills...
Here in Indiana most Fire Depts run EMS. In Indy we are all EMTs alot of us are also Paramedics. We staff the squads with at least 1 Fm/Para. Sometimes two. We also have ALS engines. We use civilian emplyees on the transporting rigs. The county hostpital (knife & gun Club)..Also provides ALS & Bls Transport. Depending on the station. You may have a Hospital Bus or a FD Bus. Some Fire houses do not have a Bus at there station. The surounding paid FD use Firefighters on there transporting rigs. They fight fire off the Bus..Kinda like a squad.
About 12 yrs ago there was a study done that showed. Fire based EMS provided a better service than a Private one.
There are some dept. In Indiana that do contract with a private service. These are mostly smaller or Vol. Depts.
Our Department,and all Other stations in our City do None Ems Even no First responder calls!
Only we started with it a while ago!we are slowly getting there but only got 4 emt b/advanced,its hard to make the Other Brothers interested in Ems and FR calls!we cover 39,9 Square Miles 40.000people all volunteer,10 stations,and only got 2 24/7 ambulances!If more Ems Is needed we have to Call them in from Different citys!its Tuff some Time!so iam more likely a Fan of the combined system!
I like to see combined departments. It gives down time when you are running fire, and it gives extra hands available when the EMS load gets too high. For those that think splitting focus decreases the knowledge of the staff I offer this; most firefighters are volunteers that have other jobs and their focus is already split. If they can handle that, why do people feel that a combined department would offer any less service.