Chicago's not alone in facing these challenges. Most cities are seeing big drops in fire calls and big jumps in medical calls. But few are really reforming their departments to meet this changing emergency landscape.

“We have been using ambulance vehicles that were purchased during the First Med bankruptcy, and used units purchased from various dealers,” said Bertie County Manager Scott Sauer at the time. “These units have gotten us through our initial startup, but are becoming more and more costly for the county to repair. We are also experiencing frequent breakdowns with these vehicles and are in desperate need of more reliable 911 ambulances.”

He says he fell in love with fire trucks and firefighting as a child, and that he still feels a deep connection to the work even though he's retired. So he bought an old fire truck and outfitted it to carry a casket so that firefighters and paramedics can be carried on board during their funeral processions.