There was a time when most 911 calls to fire departments involved emergencies in which something—a building, an automobile—was actually on fire. But for years now, medical calls to fire departments have greatly outnumbered the calls to put out flames. That’s led to some ugly scrapes between localities and firefighters unions over downsizing. Some cities and towns across the country, however, are embracing strategies to change the job description without issuing pink slips—at least for now.

A number of localities are trying to use cars and trucks outfitted with medical gear and smaller crews to respond to medical calls in hopes of saving money and even improving response times. It’s a welcome development for advocates of fire service reforms, who note the national average is 20 fire calls for every 80 emergency medical calls.

Asked by its city council to reduce fuel costs and find savings, the fire department in Boulder, Colo., came up with a plan that will dispatch a short-bed pickup truck as a first response to medical emergencies, instead of a full engine and crew. Over the next two years, the department will gather data on usage, response times and savings to decide whether the program is worth expanding beyond a two-year pilot. Spokane, Wash., is dispatching several Ford Explorers to less-serious medical calls, an idea borrowed from Oregon’s Tualatin Valley, says Deputy Chief David Leavenworth.

Some departments are diving deeper into a medical role. Anaheim, Calif., is working more with local hospitals to provide some primary care and basic emergency medical treatment. Minneapolis is running a pilot program to explore ways the fire department can deepen relationships with area medical providers in light of the Affordable Care Act. Firefighters on Bald Head Island, N.C., are adding preventive care, stitching wounds and treating jellyfish stings so people won’t have to seek medical care on the mainland. In Fargo, N.D., firefighters now spend far more of their time doing home inspections aimed at fire prevention and safety. Scottsdale, Ariz., is targeting places in the home where seniors may slip and fall.

It’s a shift that’s been ongoing in the United Kingdom, where some local fire departments are more akin to community centers that serve as places for fire prevention, recreation and basic medical care, says Tom Wieczorek, director of the International City/County Management Association’s Center for Public Safety Management. “The change is [that] rather than having companies waiting for the alarm bell to ring, they’re doing inspections, classes and getting out in the community,” he says, “kind of like what we saw with community policing 20 years ago.”

Some fire safety advocates say that, while these changes aren’t bad on their face, fire departments must not lose sight of their most critical role. Desperate to save money, some cities have attempted to outfit emergency medical vehicles with fire suppression equipment and cut staffing levels perilously low in response to budget constraints and shifting demands, says Pat Morrison of the International Association of Fire Fighters. Deaths in cities that had slashed staff have been reported in Flint, Mich., and elsewhere.

But so far, these changes haven’t met a lot of resistance from unions. And both fire chiefs and city leaders say they see change as inevitable. “We’re seeing at least some acknowledgment that times are changing,” Wieczorek says.