One thing I was thinking about recently is the idea of training personnel to be paramedics, and have them ride suppression pieces.
Where I live (Fairfax County, VA) and the DMV Area as a whole, we generally have at-least one paramedic on-board suppression pieces. So when an ALS Emergency call is dispatched, we send the closest suppression and the Medic unit.
Maybe an idea for later down the road could be if you train a firefighter to be a paramedic and then put that firefighter on the suppression piece, and if you send that piece to a medical call, they can start giving care to the patient but not ultimately transport.
It's like fly-cars, except we don't use fly-cars around here.
Obviously this idea caters more to the realistic players, as I don't have to send suppression pieces to medicals, but it's how I play the game and that is how I want to play the game.
On my second account, (Prince Georges's County, MD) they are not like Fairfax where every rig has a paramedic on it, they have a few engines designated as "Paramedic Engines" other places on the West Coast have this as well, basically it's having a paramedic on board. I feel like they should serve some purpose, I think the game shouldn't require players to put paramedics on suppression pieces, but it should be an option to players who are building areas that do not have fly-cars.
If you have any other questions feel free to ask I don't believe I explained this as well as I could've.