Given the current economic climate, it's hard to anticipate exactly how local fire departments' missions will change in the future, if at all. (Although substantial changes are certainly occurring in many places, such as privatization, public safety officers, contracting, outsourcing, etc.)
Depending on the specific jurisdiction and its fiscal situation, it's likely that some departments will expand their services (probably without additional staffing or equipment), and some will be forced to reduce the range of what they currently provide their communities.
EMS, of course, is likely to be a big part of that discussion, depending on how it is presently delivered and the fire department's level of engagement, training, and standard of care.
Departments that currently provide EMS, as described in the presentation at Fire-Rescue Med, sometimes do so with varying levels of attention and commitment.
Ultimately, how any fire department (or any other organization, for that matter) delivers EMS is primarily influenced by the training, skill, and attitudes of the providers who make it happen in the street, 24/7/365.
I'll be honest, as a former firefighter-paramedic there were times I really didn't want to see Mrs. Smith at 3am, and I (regrettably) made sure she knew it.
That was unacceptable then, and it's unacceptable now.
There's an idea that being excellent at firefighting and excellent at EMS, as an individual or a department, are incompatible.
I know that's not true, but I also know from experience that it's not easy and takes a lot of time and effort.
The great thing about the fire service, however, is that we specialize in doing "hard things."
We need to figure this one out...