Q&A with Bill Metcalf

This spring, Bill Metcalf, chief and CEO of the North County Fire Protection District in Fallbrook, CA, was named the 2012 recipient of the IAFC's James O. Page EMS Achievement Award, which is given to a leader who has influenced fire service EMS on a national scale.

Metcalf began his career in 1974 for the Anne Arundel County (MD) Fire Department, where firefighters had basic EMT training and answered both fire and medical calls. “If it was a medical call, we jumped in the ambulance; if it was a fire call, we jumped on the fire truck,” he says. “Early on I figured out I enjoyed helping people more than I enjoyed squirting water at a Dumpster.”

In 1979, Metcalf graduated from the first paramedic class in Maryland; soon after, he became involved in a grant project to expand the ranks of volunteer paramedics in the state, which remains one of his proudest achievements. Other career highlights include developing the curriculum for the nation’s first paramedic bachelor’s degree program at the University of Maryland Baltimore County and working as director of EMS for the Colorado Department of Public Health. He was elected to serve as second vice president for the IAFC during the 2010–2011 term, is currently first vice president, and will become president in August 2013.

In July at the Pinnacle EMS Leadership Forum & Management Conference, Metcalf participated in a panel that included leaders from the three largest private ambulance providers with a discussion on areas that divide but also unite EMS agencies of different stripes. He continued the conversation with Best Practices in Emergency Services. The following excerpted interview can be found in its entirety at emergencybestpractices.com.

What are the biggest issues facing EMS today?

I divide that question into external and internal threats. Externally, one of the real challenges is that we talk about ourselves as a public safety service, yet we have created a system that is based on a different financial model. Financially, we have tied ourselves to healthcare.

If we’re going to use the healthcare system to pay for emergency service, that means we are subject to the healthcare debate—and, recently, the reduction in dollars available to pay for healthcare. But if we are going to be a true public safety service, we have to be ready whether or not people use the service. If your financial model is based on fee for service, you are setting yourself up for failure almost from the beginning. In order for EMS to continue to develop and grow, we need to find an alternative or at least a hybrid model for funding EMS that combines a component of fee for service but provides a steady revenue source, or at least one that is less subject to peaks and valleys.

Do any systems come close to having that steady source of money to support EMS?

Medic One, which provides ALS in the Seattle area, is funded in part by a special tax, and they also bill for services provided. If we’re going to move EMS forward and continue to grow, develop and enhance EMS, you have to not only pay your day-to-day cost of doing business, but you have to have money and resources to do research and try innovative things. If you’re in a pure fee for service system where every nickel is wrung out of the system for delivering service, there is very little ability to be innovative and try different things. One of the things that could be done with a national pot of money or even regional pot is to encourage innovation, encourage people to try new things and do research to find out what works and what doesn’t.

The fire service has suffered unprecedented cuts and there has been considerable pushback to the unions by city managers trying to manage budgets and pension costs. Do you see this as a long-term trend?

It is going to be long-term. Those of us who have been in this business for a while have seen peaks and valleys in the economy that can affect our budgets. What has happened this time is there has been a change in public attitude that has gone with it.