Mare, I agree with you, it seems like a lot of people use EMS as a stepping stone to become a FF. I attend two EMT classes, one at Chabot in Hayward and one at SJCC in San Jose (I am not a student in the Chabot class, but the instructors allow me to attend as long as I am not distruptive and I like to give other students input on what I learn differently at SJCC where I am really a student). In both classes, the majority of students want to go into Fire. I dislike that.
Nobody is going to make any comments on the Public Safety Officers that I mentioned on page 2 of this discussion? It's really neat in my opinion and seems to be working out. They are EMTs, FFs, and LEOs all in one!
On a personal level, I don't think it's necessary or useful for Fire to be cert. EMTs, but that's probably because I live in the Bay Area and the arrival of LEOs, FFs, and EMTs have little to no difference, and from what I have witnessed so far, extrication is usually not a problem.
LEOs don't have to hate criminals, love law abiding people, and etc.. just as much as EMTs don't have to love sick people, love pot/crack heads, love gang members that got hurt in a gang fight/shooting, etc.. Bloom, do you think the mindset of LEOs could change if they were taught about EMS in parallel?
[edit]We are taught that we are not there to judge, but there to treat like you guys said earlier. I don't know about LEOs, but I think they don't have to judge people there.. they are just there to enforce the law. You either broke the law or you didn't... You need treatment, you get treatment. Duh...
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I agree with Linuss, I think we do have more in common with LEOs than with FFs (if FFs didn't do any EMS related stuff). His list on the previous page was pretty convincing to me.
As far as the EMS to fire stepping stone thing, I think that depends on the area. I'm from NY, where professional EMS and fire are exclusively single role. FDNY has a seperate EMS, but that's it as far as combo depts. I didn't even know that there was any such thing as a FF/EMT or FF/medic. If you take your EMT, it's to work in EMS.
But here's the thing. Many realize that EMS isn't as sustainable or fufilling as other professions, mostly due to pay, working conditions, and lack of career advancement. So, even if the EMT or medic in NY didn't initially intend for EMS to be a stepping stone, it ends up being just that regardless. Maybe they stay in EMS per diem or something. In other areas, the total package that the FD gives is decidedly more attractive than what EMS offers there (generalization, of course). The young adult will look at EMS and fire and decide that the fire side offers a better future. Since fire based EMS is popular in many areas, the EMT cert is necessary.
As far as the PSO's, I've only seen two examples, one from you, and one from Linuss, I think. I don't know of any others. They may exist, but that goes to show that the PSO program isn't popular at this time. Given the poor state of our economy, I'm sure that many local governments have considered having PSO's. The fact that they have declined to do so tells me that it isn't as cost effective as having a seperate PD from other emergency services. Cost effectiveness would be the sole motivating factor to combine services to form PSO's in the first place.
NYPD ESU can extricate. It was amusing to watch ESU and FDNY fight over who can do the cut job.
As far as having LEO's crosstrained for ALS/BLS first response and also for txp, there's one major problem that sticks out in my mind. Where does the majority of our call volume lie? It originates from the lower socioeconomic classes. In these areas, law enforcement is held in poor regard. In NYC PD are assigned to each EMS job, although they don't show unless it's an EDP, shot, trauma, cardiac arrest, or domestic dispute. Police always had multiple jobs holding, and weren't available to back us up. The next time you're doing pt care and an LEO walks into the house, watch how the pt and their family change their demeanor, their body language. "Why are the police here?" is a common question I get. This is borne from suspicion and apprehension towards law enforcement, not the same as "why are there four firefighters on an engine here to help me"?
The thing I've heard time and time again from friends and family on the job as cops is that they hate being lied to, deceived, and disrespected. I've seen it firsthand in how LEO's and corrections officers treat my pts. The Cx pain at Rikers Island is "BS". They make fun of our drunks, and have handled them roughly (may not be a drunk, but a legit medical condition, you know). The pt gets a lengthy, hostile lecture from the cop at the MVA scene as I'm trying to do pt care. I can't see a cop tolerating the amount of abuse that EMS endures on a regular basis without reacting in a manner that adversely affects pt care. Even the mere presence of an LEO would cause a flight or fight response, let alone if the officer engages in an argument or questions the pt in a manner that puts them on the defensive. I've seen cops verbaly abuse my pts by cracking jokes about their condition, telling them to shut up, I'll take you to jail, etc. On many lover's spat calls (domestic dispute call) between life partners, I've witnessed cops behaving poorly. The cops have chuckled, snickered in the presence of the pt and their partner, and have cracked jokes within earshot. They can't seem to be able to keep a straight face, or probably feel that they don't have to. What's the pt going to say to them, anyway?
A good number in EMS get sick and tired of mistreatment from pts throughout the years, and can do nothing about it. Actually they can, as I've witnessed some punishing "pt care", such as punitive IV's, drunk tossing, taping the eyebrows, going over potholes at high speed with a backboarded pt, walking cardiac/respiratory pts, withholding certain treatments from perps, so on and so forth. Now you want a cop to be in charge of pt care, where they already have a lower tolerance of abuse from pts, and can mess with the pts in a physical or psychological manner to "get back", whatever they can do without getting jammed up.
You work in a station-you don't work in a station- you work as part of a team- you work in a group. I don't think most people would not have difficulty making that kind of transition. The differences that are apparent though are more deep seated: the psychological and philosophical make-up of the people who are attracted to LE as oppose to those to are attracted to EMS. Undoubtedly I am making generalizations and this are definitely overlap between the different types of personalities but the psychological differences in the types of people make combining the two somewhat at odds. 
. It seems like small communities don't need the three separate departments as it would be expensive and would need too many personnel.
