A firefighters' union says its members have inadequate training to take on medical emergency calls as is proposed under an agreement with St John.
The Fire Service and the St John ambulance service are trying to formalise arrangements they already have for firefighters to be deployed to medical calls.
They say firefighters will respond to cardiac and respiratory arrests, where a speedy response can save lives.
Rural firefighters and some urban ones already attend a variety of 111 medical call-outs. The United Fire Brigades Union says many volunteer firefighters will be glad to have their medical workload cut back to only cardiac and respiratory arrests.
However, Professional Firefighters Union secretary Derek Best fears the policy will be widened to other medical emergencies.
"If there's a 111 call and someone's in distress and the ambulance can't respond and we've got a formal understanding, then firefighters will be sent, no doubt about that," he says.
The Fire Service says staff are getting extra training and their equipment is being upgraded.
The Fire Service and St John will next month unveil a prototype specialist fire and medical response vehicle.