There will always be differences of opinions regarding Fire-based EMS. Using the FDNY as one example, EMS, against the wishes of both EMSers and Fire Fighters, were made by then Mayor Rudy Giuliani, into "one big happy" family, as EMS was removed from NYC Health and Hospitals Corporation management, and placed under FDNY's management. FDNY's own literature calls becoming a Fire Fighter, from being a department EMT or Paramedic, a "promotion". On some FDNY "rant boards", they objected to FDNY Paramedics Carlos Lillo and (Phostumously promoted to Lieutenant)Ricardo Quinn being included in the "343" from the World Trade Center disaster.
It is also my understanding that in other jurisdictions where EMS is run by the FD, a Fire Fighter going to EMT or Paramedic is considered the promotion, with higher pay and more benefits. I kind of wish FDNY had done this.
There are also some FDs that routinely rotate personnel, as in one week, a crewman or crewwoman is on the Truck, the next week on an Engine, and the next week on the Ambulance. All are trained to at least EMT, with a few trained to Paramedic.
Sadly, there are still "combined" departments, where EMS is used as the disciplinning area. "You messed up, Joe, so you're going to the EMS for the next week". I view these departments as being the knuckledraggers of the "combined" departments.
Whichever of these combined FDs, I can only hope that in whatever capacity the personnel are used, they perform to the best of their training and abilities in all areas the departmet is responsible for.