In the United States, privatization of public ambulance services has created serious problems. In the United States, emergency medical response is carried out by a patchwork of different entities that vary from locality to locality. In cities, the Fire Department is often the first service on the scene of a 911 call, so they will do a lot of the heavy lifting for an emergency, with EMTs arriving close behind to do a secondary assessment and transport the patient. The fire department is tax funded, but the ambulance may be one of a dozen different private companies operating in just one municipality.