The NW spouter who remarked, "We pay high taxes to the city which pays for the salaries, benefits and equipment for the fire and rescue department, but God forbid one needs an ambulance. They send one along with a ladder truck and if they take you to the hospital they send you an invoice," must live in a vacuum. FD-based EMS is the norm in most of the U.S. The ladder company goes along with the ambulance to provide extra manpower and does not "cost" anything extra. User fees accompany almost all ambulance services in the U.S., taxpayer-based or not. They are one way a city recoups expenses.