Most of the time when a fire truck rumbles out of a ­Minneapolis fire station, it’s not going to a fire.

Only 4 percent of the Minneapolis Fire Department’s 36,985 runs in 2012 involved running a water line to fight a fire in a house, commercial building, car, dumpster or a field. The rest of the time, firefighters were racing to a heart attack or some other medical emergency, a rescue, a hazardous condition or a false alarm.

The sharp decline in fires nationally — they are down 50 percent over the last decade in Minneapolis alone — has been credited to everything from better building codes to fewer people smoking. As the nature of firefighting jobs has changed, city officials across the country have begun looking at less costly alternatives to responding to medical and emergency calls.

In Minneapolis, next year’s proposed $58.5 million ­budget for the city’s Fire Department includes a $250,000 pilot program for an emergency-equipped SUV to handle ­medical calls in some parts of the city. If adopted, it would alter the department’s bedrock practice of sending a fire truck out on every call, which is why both Fire Chief John Fruetel and union president Mark Lakosky are wary of the proposal.

“This is the tone I get fearful of,” said Lakosky. “Don’t reduce rigs and service.”

The debate over next year’s fire budget will fall to newly-elected Mayor Betsy Hodges, who as City Council budget chair had an acrimonious relationship with the firefighting union. Hodges didn’t return a call for comment on this story.

Fruetel said he’s not sure what the department will look like in the future, in part because new demands and opportunities brought by the federal Affordable Care Act are also complicating the picture.

“It’s so hard to predict where it could go,” Fruetel said this week.

Fire trucks for everything

On a recent day in Minneapolis, a man who had parked near Nicollet Mall in the heart of downtown Minneapolis accidentally locked his two children in the family car. A 911 call brought a ladder truck and firefighters within seven minutes, the ladder truck equipped with tools to break into cars and buildings if necessary to free people trapped inside. A report on the incident said the firefighters stood by until a tow truck arrived to open the car, likely because the children were not in immediate danger and didn’t require the ­firefighters to smash into the car.

Such rescue and EMS incidents account for two-thirds of all calls handled by the Minneapolis Fire Department last year. False alarms, co-called “good intent calls,” service calls and hazardous conditions calls filled up much of the rest of the department’s workload.

The trend is similar across both Minnesota and the country. Fifteen years ago, about 12 percent of calls to fire departments in Minnesota were for fires. Last year it was 7 percent. The United States recorded 3.3 million fires in 1977, but by last year that number had fallen to 1.4 million, a 58 percent drop, according to the National Fire Protection Association. Considering that the nation’s population grew during that period, an even steeper fall of 70 percent was recorded in fires per 1,000 people.

The pilot program that would bring an SUV to the Minneapolis Fire Department next year would follow similar moves made by other departments around the country.

A pilot program in Boulder, Colo., this year allows firefighters to use a pickup truck outfitted with basic life support equipment for some medical calls. Boulder Fire Chief Larry Donner said response times are about the same with the smaller vehicle as they were with a fire truck, though it’s cheaper to run the smaller vehicle due to fuel savings. A host of other cities are taking similar steps, including Ann Arbor, Mich., Memphis, Tenn., Spokane, Wash., and Billings, Mont.

Lakosky, of the fire union, said the pilot program could work in Minneapolis but it would depend on how it was done. His first concern was that it would mean sending fewer firefighters to a rescue.

“Let’s not reduce the quality of service by going from three firefighters [in a firetruck] to two in an SUV,” he said. He said he doubted an SUV could get to an emergency any faster than a fire truck.

Fire chiefs everywhere have faced a similar dilemma as fire counts fall.

St. Paul Fire Chief Tim Butler put it this way: “How many fires do we need to have in your city for there to be a fire ­department?”

During the week of Nov. 20 through Nov. 26, the St. Paul Fire Department responded to 715 calls for service including two fatal fires. The department also trains for other hazards with several specialty units such as its chemical assessment and collapse teams.

“We are not just firefighters anymore,” Butler said.

In St. Paul, which has ambulances at 13 of its 15 ­stations, EMS calls grew from around 4,000 in 1972 to more than 26,000 in 2011. To better address medical calls, the Fire Department has three “super medic” companies that send six crew members total in an ambulance and a fire engine for major emergencies but only the ambulance for basic life support calls so that the fire engine is free to respond to other calls.

In Minneapolis, ambulance service is handled by Hennepin County Medical Center or North Memorial Medical Center, but Lakosky is concerned that the pilot SUV program could serve as a prelude to eliminating fire trucks or shuttering some of the city’s 19 ­stations.

The Minneapolis department has 390 firefighters after adding 19 this year, down from a peak of 426 in 2008. Both Lakosky and Fruetel said the city needs to make more hires as the number of retirements increases.

Lakosky supported Mark Andrew in the recent mayoral race, and directly blamed Hodges, the former budget committee chair, for the reduced fire department ­staffing.

Last week he struck a more conciliatory tone with the incoming mayor.

“I’m looking forward to Ms. Hodges as mayor and to see what her train of thought is on the Fire Department,” Lakosky said.