Where I live, the fire department has rescue trucks which sometimes can be large (like a ladder-less fire truck) but can also be as small as a heavy duty work truck. Some departments have enough money to have all kinds of various vehicles for special situations while other departments have just enough to own one vehicle to cover as many needs as possible. It would make more sense to buy something smaller but can they justify the cost to the county or city? And in cities, they still need the big ladder truck and likely need to host an ambulance in the station and probably a fire chief vehicle too. The money is limited as well as the space. I'm sure cities are already rethinking what they actually need now versus 50 years ago. I've already seen paramedic vehicles that are not ambulances, they look like a work van or truck, just enough for two paramedics and enough supplies to treat someone that doesn't need to immediately go to the hospital or to serve as an auxiliary during a mass casualty event. The truck is way cheaper than an ambulance.