Seventy-three percent of American fire departments are all-volunteer departments. Volunteer, career and combination fire departments have a strong history of pre-hospital 9-1-1 emergency medical service response. The NFPA notes that fire and rescue departments provide approximately 68%of EMS response across the United States.

Providing EMS through a fire department makes sense because fire stations are strategically located throughout the community to provide a rapid response and fire departments are already engaged in the customer response business. Fire-based EMS requires a great commitment, however. According to the 2004 National Run Survey by Firehouse.com, once a fire department commits to providing EMS, that service will constitute 70% or more of all emergency activities.

The IAFC's Volunteer and Combination Officers Section (VCOS) and EMS Section came together to weigh the challenges, solutions and resources that a volunteer or combination department chief would need when considering how best to provide EMS response to the community. The result of that effort is this toolkit, which identifies the questions chiefs and local policy makers must answer when considering adding or increasing EMS response in their communities.