I debated jumping into this or not, but I was hurting myself trying to hold it all in, so here goes . . .
The Department I work for has 3 Paramedic Squads and 7 Paramedic Engines, out of a total of 31 County Fire Stations, all the rest of our Engines are BLS (EMT-D's). Serving the County Areas, the Private Ambulance Co's (3 of them) have a total of 19 Paramedic Ambulances.
Sounds like a good ratio, right - except at any given time during the course of the day, we may be down 2 or 3 ambulances for Private Interfacility Transports (you know - where they earn their profit). Then there are the "details" to their Company HQ's for paperwork, training, whatever. Then, of course, there ARE the 911 calls that require transport. That takes an amublance out of service for up to an hour at a time. It is not uncommon to be down to 1 or 2 Ambulances in any one City or County area, and yet there are still 4 or 5 Engine Companies available for immediate response, with ETA's in excess of 5 minutes faster to any location over the ambulance. That is not saying the Ambulances Co's are not living up to their end of the contract, it is just the way it is. And make no mistake, Private Ambulance Co's. ARE IN IT TO MAKE A PROFIT!
THAT is why most modern FD's have taken over the the EMS 1st Responder role. They just get there faster, and while getting there fast does not always make a life-or-death difference, sometimes it does. And if someone is alive today because an Engine Company, with medics "who went to the fastest, easiest medic school they could find only so they could get a fire job." then what is the issue there - they did the job they got hired to do. If going through Medic School was the route they took to get the job most Firefighters want from the time they are 10, then great - they made a difference.
I am going to say one more thing - I have worked with EMS folks who are dead-set against the FD's having any part of EMS. For the most part, the are (forgive the term) wanna-be Firefighters who just never get picked up for one-reason-or-another. Then for some reason, they become anti-FD, and should an Engine Co. beat them into a medical aid, think it is their God given right to walk in and save the day from these "firemen who are stuck being paramedics have no desire to do so". Their training is no better and no worse, but their attitude is just bad, and THAT makes all the difference in working relationships between ALL the 1st responders. And that can effect the care a patient receives.
Fortunetly, my Department and the Private Ambulance Co's that service our areas work very well together, and very rarely do we see this kind of problem.