Louisville Metro 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 Everett Scott, 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 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 Louisville and Jefferson County took place on January 6, 2003. The Louisville Fire Department and Jefferson County EMS continued to operate separately; Jerry Abramson appoints a task force to review the services. One of the administration's first tasks was the integration of the county and city police forces. 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. Without a unified fire service in place, the stand-alone Louisville Metro EMS was created by the merger of the Louisville Fire EMS with the Jefferson County EMS in February of 2005 out of necessity.

Services
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, 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 Louisville Metro Emergency Medical Services (LMEMS) provides 24-hour-a-day, 911 emergency medical care throughout the Louisville Metro area. Medically focused and data-driven, LMEMS is committed to the development of the latest advances in basic and advanced life support patient care. Utilizing a comprehensive approach to education, training, technology and research, the goal of LMEMS is to provide a "Best-Practices" model for EMS to those whose visit, reside and work in Louisville Metro.

LMEMS only 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.

Structure
LMEMS is headed by a medical doctor who serves as Chief Executive Officer (CEO) and the official head of the service. Under the CEO is the top uniformed officer holding the rank of colonel and the title Director of Operations. Under the director of operations is a lieutenant colonel who exercises the functions of Chief of Service. A group of majors and captains, all paramedics, oversee day-to-day operations including scheduling and may be drawn upon to provide additional manpower. Lieutenants and sergeants exist exercising limited supervisory functions but mostly acting as field training personnel for new paramedics and EMTs, respectively. Most paramedics in fly-cars hold the rank of lieutenant.

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. . 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.

In addition to Fire & Rescue mutual aid deals, several other ambulance services exist within Louisville-Jefferson County such as 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.

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.

Specialized 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 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.

The first helicopter was brought into service on Jul 1, 1982 and was used by Jewish Hospital. Later when University hospital completed its construction it also added a helicopter transportation service.

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.

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. 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 served by LMEMS include University of Louisville Hospital, the area's 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 and Jewish Southwest. LMEMS will also transport patients to hospitals outside of Jefferson County including Baptist Hospital Northeast in Lagrange, KY, Jewish Hospital in Shelbyville, Kentucky and both Floyd and Clark County hospitals in southern Indiana.

Controversies
As a Government Agency and working with peoples lives things can become controversial for an Ambulance or Rescue service. Some of the things involve equipment supplied from government budgets and some involve pay. Sometimes in unique situations public out cry is herd regarding rare events that occur from time to time.

One of the biggest controversies with services like these can be money. Massive amounts of overtime and not enough employees, or cutting back hours or even jobs because of budgets running short can occur. Like in a February 6, 2008 article of the Courier-Journal talking about the City of Louisville tax revenues falling short causing the budget to be $9.4 Million (USD) short, is a prime example. Mayor Jerry Abramson has announced that several budget cuts will be occurring. No lay offs are included in this plan or tax increases and the plan will effect every public service. Louisville Fire & Rescue and Metro EMS, are taking a cut of about $1.58 million (USD). Dr. Neal Richmond, director of Metro EMS has explained that he will have to cut back training to fill shifts that was covered by overtime. Additionally a hiring freeze went into effect for LMEMS as well as other public services.

Another area of concern is equipment. For example, prior to the merger of Louisville and Jefferson County when the Louisville EMS services was handled by the Fire Department, communications appeared fine. However since the merger and the separation of the EMS service from the Fire Department and the increased communications problems from the police department, problems emerged in communications. Police, firefighters, and EMS crews used a mix of VHF and UHF radios. A plan called MetroSafe was implemented in 2006 to help reorganize the communication system. Part of the plan is to get police on one radio and firefighters and EMS on the other. Centralizing the communication dispatchers was another part of the plan, so no matter which public agency was talking to a dispatcher, it all goes to one room.