I believe mendo's post and vent's reply to be accurate. I was waiting for someone to acknowledge that either FB or TS EMS could work equally well if ran properly. For the public's benefit, timely delivery of ALS care, by competent providers is desired, with adequate txp units available. This can be accomplished by TS fly cars, or FD medics on suppression apparatus. As long as the end result is the same, who is showing up is unimportant.
NYC EMS, with FDNY units, hosp units, or private units, strive to keep response times short by having many units posted on street corners throughout the city, for a quicker response than if you were coming from a station. FDNY engine crews are CFR-D only, and aren't really necessary on most of the calls they are dispatched to.
CCEMS, a municipal third service agency in SC, runs every unit ALS out of stations dispersed throughout the county. Charleston City, N Charleston, James Island(very competent), Awendaw, St. John's, and St. Andrews FD's give BLS backup for extended response times. No ALS with the exception of Mt. Pleasant FD, who seek to have txp units of their own in the furure.
Fairfax County FRD operates as I've stated previously, with a small contingent of vollie ALS/BLS buses.
These are personal experiences of which I draw my opinions from.
As an employee, your goals will be either to do EMS as a stepping stone, go EMS only as a career, or go fire(EMS). Many do go FBEMS for superior working conditions, pension, bennies, $$$'s, solid medical coverage, DROP, etc. The paramilitary structure is beneficial in some areas, but not so much for pt care.
TSEMS municipal could potentially be just as satisfying for the employee as FB, but EMS doesn't have the political clout or collective bargaining strength of the FD's. Medics are becoming a dime a dozen if not so already(Ohio and FL come to mind) courtesy of medic mills. As such, the employer is under no obligation to improve your $$$/bennies, as there are plenty of warm bodies to fill your spot when you get fed up and leave.
There's also nothing wrong with a muni TSEMS using the local FD for ALS back for timely ALS care. That could work just as well as EMS in Fairfax.
FBEMS with crosstrained personnel will typically have the advantage with staffing, as personnel are versatile, to reduce forced OT and putting units OOS. TSEMS tends to burn out their employees with high call volume, holdovers, and micromanaging. The employer will seek to get the job done with as few units as possible, with little regard for the employee.
If one wants to do EMS as a career, as a lifer, I highly recommend going municipal TSEMS, or FB single role EMS(Alexandria Fire and EMS for example). On the whole, since employers have gone largely from defined benefit(pension) to defined contribution, it's been proven over and over again that people do a poor job of managing their retirement.
Most municipal employers, to my knowledge, have state/city retirement, with an optional deferred comp(457) with no employer contribution. A 401k/403b will eventually run out. a pension, especially with yearly COLA adjustments, will not. You don't want to grow old, have to take out a reverse mortgage on your house, and rotate meds due to financial difficulty.
