Maintaining a full-service fire department on a tight budget can be difficult. One of the greatest challenges that municipal governments face is negotiating wage deals with labor unions.

If not kept under control, wages can overwhelm budgets. In Kansas City, Missouri, the city council just voted to approve a four-year wage deal that will give firefighters and ambulance workers annual raises of 2.6 percent. This is higher than what was initially budgeted in the city's five-year plan, and could be difficult to finance.

When EMS agencies can't meet their staffing and funding needs, lives are at stake. In Boston, the city government responded to a surge of emergency calls by proposing more funding for emergency medical personnel. But officials still aren't sure why call volumes are increasing, or if demand will ever level off.