<P> Another operating model for publicly operated EMS is what is generally referred to in the industry as the' third service' option . In this option, rather than being an integral part of (or in some cases, an' add - on' to) one of the traditional' emergency' services (fire and police), the service is organized as a separate, free - standing, municipal department, with organization that may be similar to, but operated independently from, either the fire or police departments, . In a variant of this model, the EMS system may be recognized as a legitimate third emergency service, but provided under a contractual agreement with another organization, such as a private company or a hospital, instead of direct operation . This model is sometimes referred to as the' public utility' model . This may be a cost - saving measure, or it may be because the community feels that they lack the resident expertise to deal with medical oversight and control issues, and the legal requirements that typically surround an Emergency Medical Service . </P> <P> In yet another model for publicly operated EMS, the system may be integrated into the operations of another municipal emergency service, such as the local fire department or police department . This integration may be partial or complete . In the case of partial integration, the EMS staff may share quarters, administrative services, and even command and control with the other service . In the case of full integration, the EMS staff may be fully cross-trained to perform the entry - level function of the other emergency service, whether firefighting or policing . Many communities perceive this as providing' added value' to the community, since municipal workers are fulfilling more than one function, and are less likely to be idle . </P> <P> Ambulance services operating on a private / for profit basis have a long history in the U.S. Often, particularly in smaller communities, ambulance service was seen by the community as a lower priority than police or fire services, and certainly nothing that should require public funding . Until the professionalization of emergency medical services in the early 1970s, one of the most common providers of ambulance service in the United States was a community's local funeral home . This occurred essentially by default, as hearses were the only vehicles at the time capable of transporting a person lying down . Funeral home ambulance operations were sometimes supplemented by' mom and pop' operations, which were not affiliated with funeral homes but rather operated on much the same basis as a taxi service . There were no national standards for ambulance services and staff generally had little, if any, medical training or equipment, leading to a high pre-hospital mortality rate . Such companies continue to operate this way in some locations, providing non-emergency transport services, fee - for - service emergency service, or contracted emergency ambulance service to municipalities, as in the public utility model . During the late 1970s and early 1980s, more than 200 private ambulance companies in the U.S. were gradually merged into large regional companies, some of which continue to operate today . As this trend continued, the result was a few remaining private companies, a handful of regional companies, and two very large multinational companies which currently dominate the entire industry . These services continue to operate in some parts of the U.S., either on a fee - for - service basis to the patient, or by means of contracts with local municipalities . Such contracts usually result in a fee - for - service operation which is funded by the municipality on a supplementary basis, in exchange for formal guarantees of adequate performance on such issues as staffing, skill sets, resources available, and response times . </P> <P> The Emergency Medical Service system in the United States typically follows the Anglo - American model (bringing the patient to the hospital), as opposed to the Franco - German model (bringing the hospital to the patient) of service delivery . Apart from a handful of doctors who work on Medevac aircraft or perform training or medical quality assurance, it is extremely uncommon to see a physician deliberately responding to the scene of an emergency . </P>

History of emergency medical services in the united states