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Originally, fire departments only dealt with fires. In the 1960's and 1970's it became clear that a rapid response health service would be beneficial. Rather than create a whole new system from scratch, that function was tacked onto the existing fire service by having EMTs and paramedics on staff. And the initial focus was primarily on providing rapid transit: delivering the victim to a hospital as quickly as possible. Response time was the dominant metric used to grade emergency medical providers. It took more decades to fully appreciate that treatments applied at the accident scene or in transit could be as important as, or more important than, response time.
There's an argument to be made that fire departments are somewhat obsolete. They spend most of their time dealing with medical and mental health issues, not fighting fires. We would probably benefit as a society by replacing a lot of firefighters with house call nurses to help manage people's long-term health issues before they become emergencies.
Keep in mind most firefighters in the USA are volunteers who just drive to the station when there's a fire - not paid professionals.
My station just hired our first full time paramedics, we have a few part time paid firefighter+EMTs, and some volunteer firefighter+EMTs.
While we're not getting that many fire calls, the few we get are pretty bad. Like, would burn down a neighborhood bad, because everything is now made from fast burning plastics. Sofas, carpets, house paint, siding, roofs, furniture, and clothes are all pretty much petroleum based. And will burn extremely hot and fast when it catches, spreading to all the surrounding exposure buildings.
My buddy works at Underwriters Laboratories and was saying they just did a burn test that showed the typical house today will catch neighboring houses on fire just from the infrared radiation through their windows. Even if the neighboring houses are soaking wet, the insides can still catch fire through the windows.
So we're in a jam - we hardly ever have real house fires, but they are extremely dangerous and will burn the whole town down if we don't get there asap.
Not to mention all the car crashes, hazmat spills, EMS lift assists. I'm sure there's a way we can improve the situation, but I honestly don't know what it would look like. The US is a huge place that's very spread out, I don't think we're ever going to fully go away from volunteer firefighters, as much as I think it would be more efficient.
Long story short, if you're able to lift a 30lb box overhead, the volunteer fire service is desperate in most places. Volunteerism is down like 90% from it's peak. But most fire stations are entirely volunteer. So there's a very real need for more folks to pitch in. I'm happy to chat with anyone who is curious and wants to get into it. I highly recommend it, it's done wonders for my personal life.