A Fire-Based EMS Blueprint for Small City Fire Departments that Are Struggling Financially

Key Takeaways

1. Fire-based EMS can be a lifeline for small career departments, offering funding for sustainable staffing, community outreach and operational relevance amid a nationwide EMS crisis.
2. The dual-role fire/EMS model improves fireground operations allowing ambulance crews to contribute to suppression, RIT, rehab, and other support roles.
3. The cultural shift at at the Meadville Fire Department made EMS an integral and respected part of the job, and supports workload sharing while allowing incentive-based advancement.

In the fire service, we often joke that the ambulance isn’t our favorite assignment. Given its deviation from the traditional image of fire suppression. However, for the Meadville, PA, Fire Department (MFD), which is a small career department in the northwestern part of the state, the ambulance didn’t represent a distraction; it became a path forward.

The rise of fire-based EMS in the department didn’t come from luxury. It came from necessity, and it changed everything.

A lifeline for small career departments

Across Pennsylvania, the emergency services landscape is in crisis. Volunteerism continues to decline, leaving vast geographic gaps in EMS coverage, particularly post-COVID. Meanwhile, demand for medical services climbs.

The traditional model simply isn’t sustainable, not for rural communities, not for taxpayers and certainly not for the dwindling workforce that’s asked to meet those demands. Fire-based EMS is the most immediate, scalable and efficient answer.

The city of Meadville and more than 20 surrounding municipalities were served by a privately owned ambulance company that was based within Meadville. It wasn’t affiliated with the city nor any municipal government.

The integration of EMS into the MFD allowed the agency not only to meet the needs of the community but also to revive a department that once was stagnant and in decline. Today, the MFD stands stronger, with more staff, more training, more community support and, most importantly, better service.

Minimal financial investment

The financial investment that was required to launch the MFD’s EMS transport program was minimal, in large part because of strategic planning and efficient resource allocation. All fire department personnel already were certified at the EMT level, and approximately 25 percent held paramedic certifications. Two additional members were enrolled in paramedic training that was funded through a separate county grant that was awarded prior to the department beginning to explore EMS.

The department purchased reliable, preowned ambulances to avoid placing financial strain on the city’s budget. Key medical equipment, including cardiac monitors and other ALS supplies, were acquired through grant funding. Additional grants covered non-EMS capital costs, which allowed the city to reallocate those funds toward the purchase of EMS units, which further minimized the financial burden on the city.

Growing a department through the ambulance

The introduction of EMS transport has given the MFD a renewed sense of purpose and direction. It has become the key driver behind exponential growth. What was once a department that struggled to justify its existence now operates with increased staffing, rising professional standards and a revitalized capital plan.

The phrase that elected officials and the community want to avoid is “tax increase.” With no other means of creating funding, the department was at the bottom of a seemingly unclimbable mountain.

Fire-based EMS allows for strategic, sustainable revenue that feeds directly back into the department. In 2024, the MFD generated sufficient EMS revenue to fully fund ambulance staffing, cover all startup and operational expenses, and reduce reliance on the city’s general fund, which effectively lowered the overall cost of the fire department to taxpayers.

The city contracts with a third-party billing agency to manage EMS-related insurance claims and revenue collection. Prior to launching fire-based EMS, private ambulance services were billed insurance providers. This meant no reinvestment into the city’s emergency services. By transitioning to a municipal EMS model, the department captured this revenue stream directly, without adding a dedicated EMS tax or resident service fee.

The EMS initiative was driven by two primary goals: to ensure consistent, high-quality emergency medical care for residents and to avoid any additional financial burden on the community. This approach has proven both fiscally responsible and operationally transformative, as it increased the number of available EMS units to our city and fire response numbers.

Where the MFD’s engines once were 30 years old and its station doors failed to function, the department now operates with front-line compliance, a state-of-the-art fitness facility, a new exhaust system and a modern HVAC system. What once were staffing numbers that were far below NFPA standard, personnel numbers continue to rise. All of this was made possible in large part by the MFD’s shift to fire-based EMS. Insurance revenue from EMS calls—revenue that, again, was billed by private EMS agencies, with no return investment into the department or the community—helps to offset impact on the general funds.

Equity, buy-in and excellence

At the MFD, every firefighter also is an EMT. Paramedic certifications are encouraged and rewarded. Incentive bonuses for advanced-level providers are offered, and those incentives are paying off: More personnel than ever before are pursuing advanced training, with more than half of the personnel complement holding paramedic certification. That said, it isn’t just about the money; it’s about the culture shift. EMS isn’t a burden; it’s a respected, integral part of the job.

How calls are approached also was changed. EMS incidents now receive structured riding assignments, just as fires do. Each EMT, paramedic and firefighter has a clear role. This practice not only builds consistency but ensures rapid, effective patient care. Members know their assignment, and they train just as hard for the next cardiac arrest as they do for the next three-alarm blaze.

Equity has been a cornerstone of the MFD’s model. The department is small (fewer than 30 career firefighters), but the model ensures that ambulance duty is shared across all ranks and seniority levels. No one is above EMS. That expectation created buy-in from top to bottom, to forge a department that pulls together for every response.

Firefighting from an ambulance

The unique feature—at least for the MFD’s geographic location—is the fact that the department ambulance crews are assigned duties on the fireground.

Although the primary responsibilities of incoming EMS units remain victim care and firefighter rehabilitation, the MFD’s fire-based EMS model enables these crews to also support initial fireground operations.

Because staffing limitations are a persistent challenge, the capability to deploy additional personnel early in an incident significantly contributes to operational effectiveness and consistently low fire loss statistics. In contrast to neighboring areas, which primarily are served by EMS-only agencies, the MFD’s integrated model has led surrounding departments to incorporate MFD EMS units into their structure fire response plans, even when the MFD isn’t on the assignment for structural firefighting equipment, such as a pumper and a ladder. Having EMS personnel who can fill multiple roles (initial RIT, search and rescue, back-up, treatment, transport and rehab) respond has become a critical operational component in the department’s jurisdiction and the surrounding area, too. Many departments continue to rely on their EMS-only companies for medical care while simultaneously assigning MFD units for supplemental personnel with firefighting capability.

The unintended consequence has been an increase in MFD personnel wanting additional time on ambulances, because the rigs statistically see more fire scenes with the addition of EMS to other departments’ alarm assignments. This is a drastic change from the perceived “anti-ambulance” mindset and culture that exists within today’s fire service.

Community commitment, elevated

What truly sets fire-based EMS apart is the trust that it builds. MFD’s firefighters aren’t just the ones who citizens call when their house is on fire. They’re the ones who the citizens see when their child is sick, their parent fell or their neighbor can’t breathe. That consistent presence fosters deep-rooted community connection.

Meadville residents know the members of the MFD. They trust them, and that trust matters. It’s why the department went a step further by empowering EMTs to lead. MFD EMTs aren’t just riding in the third seat; they’re making decisions, setting up equipment, leading CPR. That empowerment boosted morale and professionalism, and it shows on every call.

A model worth replicating

The success of the MFD isn’t unique in theory, but it is in execution, particularly within the commonwealth of Pennsylvania. The department embraced the full potential of fire-based EMS, and in doing so, it unlocked a future that many thought was out of reach for a small department.

Today, the MFD isn’t just surviving; it’s growing, innovating and leading.

The MFD is stronger because its members stepped up. They took on more work, more responsibility and more training, not because they had to, but because they believe in protecting the community. The men and women of the MFD should be proud for making this vision a reality.

If you are a chief in a department that’s searching for sustainable growth, meaningful effect on the community and operational efficiency, look no further than fire-based EMS. When you put the patient first, the community follows. When you embrace EMS, you just might revive your department.