As is done in the DC Metro Area (at least) , It would be nice to see a revamp for the ALS (Paramedic) Engines
In the DC area, the Paramedic Engines and Paramedic Ladders do not transport (on their units) but they carry around an ALS provider , similar to an EMS Rescue and Fly-Car, that can upgrade a BLS unit for transport.
It would be nice to see these Fly-Car/EMS Rescue style Engines and Ladders in the game to increase some of the area realism.