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Montgomery County will join Prince George's County, Washington, D.C., and other neighboring jurisdictions in charging a fee to use ambulance services.

The council voted Wednesday to allow fees of about $400 to be charged for out-of-county residents to use county ambulance services. Supporters say that insurance companies, for the most part, will pay the fee. Those without insurance will receive a bill, but the fee will be waived for those who cannot afford it.

The ambulance fee was one of several new fees and taxes the Montgomery County Council approved Wednesday to help fill the county's $1 billion budget shortfall.

The vote was 5-4, with council members Philip M. Andrews (D-Dist. 3) of Gaithersburg, Roger Berliner (D-Dist. 1) of Potomac, Nancy M. Navarro (D-Dist. 4) of Silver Spring and Valerie Ervin (D-Dist. 5) of Silver Spring opposed.

After the vote, Eric N. Bernard, executive director of the Montgomery County Volunteer Fire-Rescue Association, said his organization would oppose the five council members who voted in favor of the fee in this year's election.

"All they see are dollar signs," he said. "Not life signs."

Bernard said the public overwhelmingly opposes an ambulance fee, which was first proposed in the county about seven years ago. County Executive Isiah Leggett (D) has proposed an ambulance fee for the past three years, including this year, when he said the fee would help raise about $13 million in fiscal 2011.

The tax will support the county's fire and rescue services. During the first year, the fees can supplant other tax money, but in subsequent years, the money can be used only for new projects and programs.

"If we had failed to implement an EMS Transport fee, our options would have been to increase taxes further, take resources away from other critical county needs, or slow the pace of needed improvements in our emergency medical services," Leggett said in a statement.

"The County Council has made the right call — and county residents will be safer as a result," he said.

However, Andrews — the most vocal opponent to the fee on the council — said people will be less likely to call for an ambulance if they believe they will be charged a fee.

"We don't want people to hesitate when they are in distress," he said.

That view is shared by the volunteer firefighters, who also feared they would be asked by patients about billing.

Andrews said that could cause some volunteer firefighters to quit.

However, Councilman George L. Leventhal (D-At large) of Takoma Park said he has heard that before when there was a shift to a unified command structure for volunteers and career firefighters.

"(It was) threatened volunteers would quit," he said. "I've heard these threats before. I've heard volunteers say before that if the volunteer firefighters are not accommodated in what they want they will quit."

The volunteer fire service, however, is stronger than ever, he said.

Councilman Marc Elrich (D-At large) of Takoma Park voted in favor of the fee and said the county's budget shortfall made an ambulance fee necessary this year when in the past it could be avoided.

"The arguments that have been laid out against it just aren't true, and I think the county is in a very dire fiscal situation," he said.

Councilwoman Duchy Trachtenberg (D-At large) of North Bethesda has in the past opposed the fee. However, on Wednesday she said it was necessary to change her position in response to the county's budget shortfall.

The council is poised to approve layoffs and furloughs of county employees, along with widespread cuts to programs and services this week.

"There has been a reversal of fortune," she said. "Every dollar does count. We no longer have the luxury of leaving insurance money on the table."

In addition to the ambulance fee, the council agreed to impose a carbon tax that would place a levy on carbon dioxide emissions at the coal-fired Dickerson power plant operated by Mirant Corp. Members also agreed to increases in the energy and cell phone taxes.