Most ambulance service in the Portland tri-county area is provided by privately owned for-profit ambulance companies that work in conjunction with local fire departments – the firefighters usually arrive as first responders to provide initial medical care, then a few minutes later a private ambulance crew will arrive to take the patient to the hospital if necessary. The level of initial care provided by the firefighters varies from place to place, with larger agencies usually providing paramedic level care and small (mostly volunteer) agencies providing basic emergency medical technician (EMT) level care. The private ambulance always has at least one paramedic on the crew