Mike Metro didn’t waste any time Monday during his session at Fire-Rescue Med. Only a few seconds had gone by when the deputy chief with the Los Angeles County Fire Department let everyone attending know the Affordable Care Act (ACA) is going to dramatically change the fire service.

“If you don’t pay attention to the climate around us, in five years your fire department might not be around,” Metro said. “This will have a profound impact on all of us. … It’s a new game. We never had to compete before, but let me tell you what; we’re going to have to compete now. We have to prove we are more efficient, prove we have a better product and prove we offer a better customer experience.”

Metro, a 37-year veteran of the fire service, broke down some serious challenges the ACA presents. With 32-34 million more people having access to health insurance, the ACA will demand increased efficiency from everyone. He discussed how municipalities will be forced to consider doing things they’ve never done before – like privatizing America’s fire service. Not just EMS, but emergency response entirely.

“We need to make sure we’re on our game,” said Metro, imploring EMTs to deliver better services with better customer service because of the oncoming competition from private entities like American Medical Response and Falck.

“We need to start looking at it as what can we do for Mrs. Smith, instead of what can we do to Mrs. Smith,” Metro said.

The fact is, less than half of 911 calls require paramedic intervention. A large percentage of patients just need access to medical care, not expensive trips in ambulances to emergency rooms. “If Mrs. Smith isn’t seriously ill or injured,” Metro asks, “does she really need to go to the ER?”

Metro says the fire service needs to be forward-thinking. As the industry evolves, evolve with it. Possible suggestions include making EMS visits available through scheduling and potentially partnering with Accountable Care Organizations.

“We’re at a similar crossroad as we were in the 1970s,” Metro said. “Remember when guys said, ‘we aren’t going to put needles in the hands of my firefighters. We’re just going to put the wet stuff on red stuff.’ What happened? Many of them are not here today. We’re at the same crossroad now. … We need to design our future rather than become a victim to it.”