In January 1985, the city of Roanoke implemented the first paid EMS program to supplement the then three volunteer agencies providing emergency medical service. In 1989, the city formed the Emergency Medical Services Department under the supervision of the Manager of Emergency Services. With the volunteer component declining, a consultant was hired to study options of providing emergency medical service. Options considered were privatization, creation of an authority, fire-based service, and remaining a third service. The consultant recommended the fire-based approach to delivery of emergency medical service. In November 1995, under the management of a new fire-EMS chief, EMS merged with the fire department to create Roanoke Fire-EMS. This merger took several years to mature and train all personnel.

Roanoke Fire-EMS is the sole provider of 911 emergency medical service in the city of Roanoke. We operate with six paramedic units, 24 hours a day. All front-line fire engines provide medical first response with automatic external defibrillators (ZOLL PD 1600 AEDs). Our average response time citywide is 5.50 minutes. We provide transport to three hospitals and the Veterans Administration Medical Center. Carilion Roanoke Memorial Hospital is our level one trauma center and Carilion Roanoke Community Hospital is our children and OB Hospital. All firefighter/paramedics are crossed trained, considered an integral part of the fire company, and rotate duties on the engine, ladder, and medic units.

The City of Roanoke adopted a user fee for medical transport in 1989 with rates based on the level of basic life support (BLS) or advanced life support (ALS) rendered and miles transported. We collect medical insurance information at the time of service and electronically bill patients' insurance companies. Fees range from $145 to $450, depending on services provided, insurance company and miles transported. Our billing and collection service can be reached at (540) 345-2570. Emergency medical service is never refused based on one's inability to pay, and payment is not discussed at the time of service.