Louisville Metro EMS

Infobox Ambulance Company
name = Louisville Metro EMS

motto =
established = February 2005
headquarters = Louisville, Kentucky
jurisdiction = Jefferson County, Kentucky
staff type = Public
employees = 250
BLS or ALS = Both (tiered response)
ambulances = 50+
helicopters =
chief =
commissioner =
CEO = Dr. Neil Richmond [http://www.louisvilleky.gov/EMS/Staff/ Louisvilleky.gov - EMS Staff] ]
director = Col. Craig Rodgers
medicaldirector = Dr. Neil Richmond
revenue =
yearly responses = 100,000per year
website = [http://www.louisvilleky.gov/EMS/ Louisville.gov/EMS]

Louisville Metro Emergency Medical Services (also known as LMEMS and known locally as simply "Metro EMS") is the primary provider of pre-hospital emergency medical care within Louisville-Jefferson County, Kentucky. With an authorized strength of 250 Paramedics and Emergency Medical Technicians (EMTs), LMEMS is the amalgamation of Jefferson County EMS (JCEMS) and the EMS Bureau of the Louisville Division of Fire (LFR). LMEMS was created early in 2005 and was the last of the major public services in the area able to be combined under the city-county merger of January 6, 2003. LMEMS is a government-administered, third-service EMS provider meaning the agency is not a division or bureau of either the police or fire department but is its own agency. Since its creation LMEMS has averaged 100,000 calls for service, both emergency and non-emergency, each year. The current Chief Executive Officer is Dr. Neal Richmond, MD and the Director of Operations is Colonel Craig Rodgers, EMT-P.

History

Louisville Metro EMS has its history rooted in the two major EMS providers that served the area since the earliest days of pre-hospital care of the 1970s.

Police officers transferred the severely ill or injured to hospitals in Louisville until 1972 when the Jefferson County Medical Society created the first EMS service."The Encyclopedia of Louisville" By John E. Kleber (University Press of Kentucky 2000) page 610 ISBN 0813121000] The first licensed paramedics in Kentucky graduated in 1975 from a pilot program at the University of Louisville Hospital. Included were fifteen City of Louisville EMS paramedics and one Jefferson County Police officer paramedic.

City of Louisville

Louisville EMS (LEMS) was created in 1972 before the county's program. The program was operated by the city and was the first EMS service provided in Lousiville. In 1996 LEMS transferred control to the Louisville Division of Fire in an effort to streamline emergency services in the city. The EMS bureau of the Louisville Division of Fire utilized firefighters cross-trained as EMTs and paramedics as well as non-firefighting paramedics.

Jefferson County

Jefferson County EMS had is beginnings in the now-defunct Jefferson County Police Department. Beginning with police officer paramedics in 1975 and eventually evolving into non-law enforcement personnel assigned only to providing emergency medical care, the "Emergency Medical Squad" of the county police became Jefferson County Emergency Medical Services in 1987.

Merger and Metro

The merger of the governments of the City Louisville and Jefferson County took place on January 6, 2003. The most visible (and publicized) merger activity of the new government was the integration of the county and city police forces. No pre-merger preparations were made in regards to emergency medical services; Louisville Fire Department and Jefferson County EMS continued to operate separately as before. The new Metro Mayor, Jerry Abramson, eventually appoints a task force to review the current EMS practices and determine in what manner EMS will be provided in the new consolidated government. [ [http://www.louisvilleky.gov/EMS/News/2005/Louisville+Metro+EMS+To+Enhance+Medical+Response.htm Louisville Metro EMS To Enhance Medical Response] ] The fire services in Louisville-Jefferson County were (and still are) unable to be combined as nineteen of the twenty fire departments are independent of Metro government and were not subject to any merger legislation. After the findings of the EMS task force and without a unified fire service in place to consider, Louisville Metro EMS was created on February 5, 2005 by the combining the Louisville Fire Department EMS Bureau and Jefferson County Emergency Medical Services.

ervices

LMEMS is a full-time provider of Basic Life Support (BLS) and Advanced Life Support (ALS) and is accessible through the 911 system. LMEMS employs an entirely full-time workforce of Kentucky-licensed Emergency Medical Technicians (EMTs) and Paramedics (also known as EMT-Ps). Several employees have become certified by the National Registry of EMTs [ [http://www.nremt.org National Registry of EMTs] ] , a national EMS certification group.

Due to the extensive use of BLS ambulance crews in Louisville-Jefferson County, many additional skills traditionally reserved for paramedics are authorized for trained EMTs. This expansion of the EMT's abilities has led to the unofficial use of the acronym ELS, or Expanded Life Support, to describe care provided by LMEMS EMTs.

According to LMEMS official web page [ [http://www.louisvilleky.gov/EMS/ Louisville Metro EMS] ]

LMEMS provides transportation to the emergency department of the chosen hospital. Currently, all scheduled service and inter-facility transports are handled by private ambulance providers retained by the patient. Only under extreme extenuating circumstances, and only with supervisor approval, will LMEMS provide inter-facility transfers.

tructure

LMEMS is headed by a medical doctor who serves as "Chief Executive Officer" (CEO) and the official head of the service (much like a commissioner). Under the CEO is the top uniformed officer holding the title "Director of Operations" and is the accepted chief of department. Traditionally, in the area, the chief of the emergency medical services is not referred to as "chief" but as "Colonel" or "The Colonel" as the person in this position wears the silver eagle of a US army colonel. Under the director of operations is a the "Assistant Director of Operations" wearing the silver oak leaf of a lieutenant colonel. A group of supervisors, wearing the gold oak leaf of a major, oversee day-to-day operations including scheduling and may be drawn upon to provide additional manpower. Some supervisors wear varying grade insignia in addition to that of major, such as captain and lieutenant. Supervisory rank is awarded based on tenure, responsibility, and proven ability. Field training personnel exist, exercising some supervisory functions, to train new paramedics and EMTs. The official, government-sanctioned use of military-style ranks as the primary descriptor of job responsibilities has ceased. However the respective collar insignia remains to provide integration with the police and fire services in corresponding levels of authority.

LMEMS is a "union shop" and all non-command level employees are required to become members of the International Brotherhood of Teamsters (IBT) Local lodge #783. Job assignments, shifts, and vacations are filled using a system based on seniority. However, promotions within the service are entirely merit-based although an employee's tenure may be taken into account to determine suitability. Any employees' first six months of service with LMEMS is considered a probationary period where the new hire is subject to dismissal without union representation.

In an effort to improve patient care, a "Medical Steering Committee" has been established to help provide input into protocol development and change. [ [http://www.louisvilleky.gov/NR/rdonlyres/1AB1C1EA-14EE-4F34-B8E5-D426CFCF567F/0/EMSArticle.pdf The Protocol Progress (.pdf)] ] . This committee includes EMTs and paramedics in the process of developing new, progressive patient care protocols.

Mutual aid

Even with Jefferson County and Louisville with merged a government several government bodies still operate independently within and near Jefferson County. With the different Fire, Police, and EMS services still operating in the area they have mutual aid deals which is a promise to provide support if needed by near by communities. Fire services can act as a first responder if an ambulance is too far away, and a different ambulance service can respond if closer in a critical situation.

LMEMS partners with the various fire departments and fire protection districts in the metro area in a cooperative effort to further reduce the amount of time from when a person calls for assistance to the time assistance arrives. The American Heart Association recommends early defibrillation to be beneficial to an individual suffering cardiac arrest and as such most fire apparatus carry automated external defibrillators (AEDs) with trained EMTs to medically assist prior to ambulance arrival. [ [http://www.americanheart.org/presenter.jhtml?identifier=3035517 American Heart Association 2005 Guidelines for CPR and ECC] ]

In addition to Fire & Rescue mutual aid deals, several other ambulance services exist within Louisville-Jefferson County such as Anchorage EMS. [ [http://www.anchoragefireandems.com/ Anchorage EMS] ] Other ambulance agencies like Rural Metro and Yellow EMS will provide services for parts of areas near by or within Jefferson County. For example Jeffersontown has a contract with Yellow EMS, which also provides mutual aid to LMEMS when needed. [ [http://www.loutrans.com/Ambulance.html Louisville Transportation Company - Ambulance] ]

LMEMS also provides mutual aid to other agencies as well. The Louisville paramedics are often called upon to provide assistance to BLS ambulance crews from other services and other counties when their own advanced providers are unavailable.

pecialized teams

In addition to the primary task of providing emergency care and transportation, LMEMS also maintains employees assigned to provide specialized service such as Tactical Medics to the Louisville Metro Police Department (LMPD) Special Weapons and Tactics Team (SWAT), Dive Medics and Swift-Water Rescue Medics, as well as retaining a highly visible bicycle team. Personnel are also assigned to the federally administered Joint Emergency Service Unit which seeks to combine all aspects of public safety in a large area into one task force to better coordinate activities in the event of a major emergency.

Deployment

Ambulances may be staffed by two Emergency Medical Technicians (coded a "BLS unit") or by an Emergency Medical Technician and a Paramedic (coded an "ALS unit"). ALS units are occasionally staffed with two paramedics although this is highly unusual.

Equipment

LMEMS utilizes a fleet of Type III modular ambulances manufactured by Lifeline Emergency Vehicles from Sumner, Iowa [ [http://www.lifelineambulance.com/ Life Line Emergency Vehicles] ] and Ford Explorer paramedic response vehicles called "fly-cars". Currently three styles of ambulances are in use. Specimens of the former LFD and JCEMS (slant-sided) ambulance types remain in use until retirement with new paint and striping. Also in use are the new "Metro Style" box ambulance, Lifeline brand "Superliners" built on the Ford E450 Superduty chassis.

Neither Louisville nor Jefferson County government has ever maintained a helicopter for air ambulance use. The "medi-vac" system, proven effective during the Vietnam conflict, was provided in the 1970s by the United States Army Reserve on an "as available" basis for non-military use in the Louisville area. Later, several enterprises providing aeromedical services emerged since 1982 through either privately-held companies, corporations, or hospital groups. The original civilian air ambulance services, "SkyCare" (Jewish Hospital) and "StatFLIGHT" (Humana Hospital University), merged in 1996 to become "StatCare". "StatCare" was the longest serving aeromedical service in the area to maintain the same name and ownership though it has since been superseded.

Divisions

The Louisville-Jefferson County metro area is subdivided into six geographical "divisions" numbered one through six with divisions 1, 2, and 3 identical to the divisions established by JCEMS and divisions 4, 5, and 6 comprising the area former known as the City of Louisville. The divisions used by LMEMS are not the same as the divisions of the Louisville Metro Police Department and are not co-extensive with any particular boundary line or political subdivision. Before merger the divisions of JCEMS were further subdivided into smaller sectors to help with faster area recognition. When the new divisions formed from the former City of Louisville were integrated no effort was made to create sectors within them. Therefore, sectors are no longer used in dispatching.

Communications

All LMEMS resources are dispatched and tracked by "MetroSafe", an independent unit of Metro Government that handles all public safety communications. In addition to radio telecommunications "MetroSafe" is the primary answering point for all 911 calls placed inside Louisville-Jefferson County.LMEMS resources in Divisions 1, 2, and 3 use one radio channel for dispatch and operations; resources in Divisions 4, 5, and 6 use another channel to help alleviate on-air congestion. All units share eight other channels for information, special operations, and hospital communications.

With the implementation of the National Incident Management System by the Federal Emergency Management Agency (FEMA), the use of 10-codes by LMEMS has, at least officially, ceased. According to FEMA using "plain speech" radio traffic can help eliminate misunderstandings and confusion among different agency with dissimilar radio codes. While the use of 10-codes is discouraged by LMEMS policy the use of coded radio traffic continues and is widely tolerated. [ [http://www.nimsonline.com/nims_faq.htm#14f NIMS FAQ :: NIMS Online :: Serving the National Incident Management System (NIMS) Community ] ]

Response

By department procedure, response requests are assigned to LMEMS resources based on their proximity to the incident and the skill level anticipated by using information gathered from the caller. When a BLS unit is closer to an incident believed to require advanced care a paramedic "fly-car" response (or, alternatively, another ambulance containing a paramedic) is also dispatched. [ [http://www.wlky.com/target32/10139485/detail.html Target 32: Louisville's EMS Service Facing Challenges - Target 32 News Story - WLKY Louisville ] ] Using information gathered from the call, assigned resources are also instructed response with red lights and siren (termed Code-3) or without lights and siren (termed Code-1). If the BLS ambulance crew first arrives and determines that advanced care is not needed the ALS resource may be canceled and ready to respond elsewhere. Patients are transported to any of the area hospitals either Code-1 or Code-3.

Current hospitals regularly served by LMEMS include "University of Louisville Hospital", the area's level 1 trauma center, the three hospitals owned by Norton Healthcare ("Suburban, Downtown, and Audubon"), "Saint's Mary and Elizabeth Hospital", "Baptist Hospital East", and "Jewish Hospital" downtown, "Jewish East", "Jewish Southwest", and the U.S. Department of Veterans Affairs Louisville Medical Center. LMEMS will also transport patients to hospitals outside of Jefferson County on occasion including "Baptist Hospital Northeast" in Lagrange, KY, "Jewish Hospital-Shelbyville" in Shelbyville, Kentucky, "Jewish South" in Bullitt County, Kentucky and both "Floyd Memorial" and "Clark Memorial" hospitals in southern Indiana.

Controversies

Louisville and Jefferson County area police, fire, EMS, and other public services still use the pre-merger radio systems, a combination of VHF-Hi band and UHF. Communications are still splintered and vastly segregated. The MetroSafe project had initially been intended to remedy these issues by 2007. However due to budget shortfalls, cost overruns, and delays the new 800MHz trunking radio system has yet to be implemented.

ee also

*Jefferson Co EMS (defunct)
*City of Louisville EMS (defunct)
*Louisville Division of Fire
*Louisville Metro Police Department

External links

* [http://www.louisvilleky.gov/EMS/ Louisville Metro EMS official webpage]
* [http://www.louisvillemetroems.com/ The unofficial Louisville Metro EMS website] (includes discussion forums)
* [http://www.kbems.ky.gov/ Kentucky Board of Emergency Medical Services]
* [http://www.jeffcofire.com/ Jefferson County Fire Service]
* [http://www.louisvilleky.gov/LouisvilleFire/ Louisville Division of Fire]
* [http://www.nremt.org/ National Registry of EMTs]
* [http://www.hultgren.org/ The Kentucky EMS Connection]

Notes

*cite journal |quotes= Louisville Slugger|last= Garza|first= Mannie|authorlink= |coauthors= |year= 2006|month= August|title= Louisville Slugger|journal= JEMS|volume= 31|issue= 8|pages= 56–61|id= |url= |accessdate=
*cite web |url= http://www.louisvilleky.gov/EMS/|title= LouisvilleKy EMS|accessdate=2006-12-30 |format= |work=
*cite news |first= |last= |authorlink= |author= |coauthors= |title= Suburban districts to help EMS|url= |format= |work= The Courier-Journal|publisher= Gannett|id= lou28152471|pages= |page= |date= March 29, 2006|accessdate= 2007-01-02 |language= English|quote= Dr. Neal Richmond, director of Louisville Metro Emergency Medical Services, said his agency cannot adequately cover all of Jefferson County without help from suburban fire departments.
*cite journal |quotes= Case Study: Louisville|last= Erich|first= John|authorlink= |coauthors= |year= 2007|month= January|title= The Protocol Process|journal= EMS Magazine|volume= 36|issue= 1|pages= 58|id= |url= |accessdate=
*cite news |first= WLKY Channel 32|last= Cooperative|authorlink= |coauthors= |title= MetroSafe Still Facing Concerns|url= http://www.wlky.com/target32/10154605/detail.html|work= |publisher= Internet Broadcasting Publishers, Inc.|date= October 25, 2006|accessdate=2007-01-10
*cite web |url= http://www.caas.org/caas-accredited-agencies/caas-accredited-agencies-by-state|title= CAAS Accreditied Agencies by State|accessdate=2007-01-14 |format= |work=

References