Louisville Metro EMS
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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. Employing nearly 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 "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, both de jure and de facto.
In 2006 LMEMS responded to nearly 100,000 calls for service, both emergency and non-emergency.
The current Chief Executive Officer is Dr. Neal Richmond, MD.
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[edit] 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.
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.
[edit] 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 dedicated only to providing emergency medical care, the Emergency Medical Squad of the county police became Jefferson County Emergency Medical Services in 1985.
[edit] City of Louisville
Louisville EMS (LEMS) was created a little earlier than the county's program and did so from the beginning as a third-service. In 1995 LEMS was subordinated 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.
[edit] Merger and Metro
The merger of the governments of Louisville and Jefferson County took place on January 6, 2003. One of the administration's first tasks was the integration of the county and city police forces. The fire services in Louisville-Jefferson County are currently 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 agency called Louisville Metro EMS was created in January of 2005.
Though no data exists to support the claim, it is widely thought that LMEMS is one of the largest third-service EMS agencies in the United States.
[edit] Services
LMEMS is a full-time, full-service 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). Many employees are also certified by the National Registry of EMTs, a national EMS education accreditation group. All LMEMS care providers are able to retire with full benefits and pension upon completion of twenty years of service.
According to LMEMS official web page [1]:
| “ | 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.
[edit] 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 under the current deployment.
[edit] Equipment
Utilizing a fleet composed of Type III modular ambulances manufactured by Lifeline Emergency Vehicles of Sumner, Iowa [2], and Ford Explorer paramedic response vehicles called fly-cars, LMEMS resources are located throughout the metro area fire stations. All ambulances and fly-cars are equipped with the Medtronic LifePak 12® monitor/defibrillator/pacer. Currently three styles of ambulances are in use. Specimens of the former LFD and JCEMS (slant-sided) ambulance types will remain in use until retirement, many with new paint and striping. Deliveries have begun of the new "Metro Style" box ambulance, Lifeline brand Superliners® built on the Ford E450 Superduty chassis.
[edit] 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.
Division One - Northeast including Harrod's Creek, Eastwood, Middletown, Lyndon, Springhurst, and St. Matthews. Division Two - South End including Okolona, Highview, Camp Taylor, Buechel, and Fern Creek. Division Three - South West including Riverport, Pleasure Ridge Park, Fairdale, and Shively. Division Four - West End including Portland and Russell. Division Five - Center including the downtown area and Beechmont. Division Six - East Side including Douglas-Highlands, Crescent Hill, and Hikes Point.
[edit] 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 two other channels for information 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 ceased. According to FEMA using "plain speech" radio traffic can help eliminate misunderstandings and confusion among different agency with dissimilar radio codes [3].
[edit] Response
Calls are assigned to units 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 is also dispatched [4]. Using information gathered from the call, assigned resources are also instructed response with 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 fly-car is canceled and ready to respond elsewhere when needed. 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 four hospitals owned by Norton Healthcare (Suburban, Downtown, Audubon, and Southwest), Saint's Mary and Elizabeth Hospital, Baptist Hospital East, and Jewish Hospital downtown and Jewish East. 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.
[edit] 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 (COL) and the title Director of Operations. Under the director of operations is a lieutenant colonel (LTC) 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 (LT) and sergeants (SGT) 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 "bid 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.
[edit] Medical care and protocol
All LMEMS EMTs and Paramedics provide medical care under firmly established guidelines put into place through cooperative agreements between department administration and the service's medical director. The EMS medical director, a licensed physician, provides the legal ability for LMEMS employees to practice a limited scope of medicine through proxy. The medical director must approve all standard operating guidelines, called protocols, for patient care and is therefore a preeminent and indispensable member of LMEMS administration.
The current medical director for LMEMS is Dr. Timothy Price, MD.
In recent months, in an effort to improve patient care, a Medical Steering Committee has been established to help "funnel provider provider input into protocol development and change" see: The Protocol Progress (.pdf). This committee includes EMTs and paramedics in the process of developing new, progressive patient care protocols.
[edit] Mutual aid
[edit] Fire Service Participation
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 [5] recommends early defibrillation as most beneficial to an individual suffering cardiac arrest and as such most fire apparatus carry automated external defibrillators (AEDs) with trained EMTs to operate them. LMEMS provides training and supplies to the fire service and provides them with medical direction. Fire departments respond to other emergencies as determined by their own standard operating procedures and their individual mutual aid agreement with LMEMS.
There are two municipal fire departments and eighteen independent fire protections districts within Louisville-Jefferson County, all of which participate in the mutual aid program with LMEMS.
[edit] Other EMS Services
Several other ambulance services exist within Metro Louisville including Anchorage EMS, an ambulance taxing district serving the City of Anchorage, Kentucky in eastern Jefferson County. Anchorage EMS provides 24 hour-a-day, 7-day-a-week EMS to their city as well as providing assistance to LMEMS during high call volumes. Both of Anchorage EMS's two full-time ambulances are staffed to the ALS level.
The City of Jeffersontown [6] in southeastern Jefferson County has for many years contracted with Rural/Metro Corporation [7], a for-profit private ambulance service based in Scottsdale, Arizona, for their primary EMS response. Rural/Metro also supplies non-emergency patient transportation throughout Louisville-Jefferson County and the surrounding area. Rural/Metro Ambulance is the second largest private EMS provider in the nation, second only to American Medical Response (AMR).
Yellow EMS, a for-profit subsidiary of Louisville Transportation Company, also provides emergency and non-emergency patient transportation within Louisville-Jefferson County. In addition, Yellow EMS holds many contracts with local governments to provide 911 emergency medical services throughout Indiana, Kentucky and Tennessee. Until merger, Yellow EMS responded to all non-emergency calls fielded by the EMS bureau of the Louisville Division of Fire.
LMEMS 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.
[edit] 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 maintaining 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.
[edit] Recent controversy
[edit] Response times
LMEMS has been criticized in the media during 2006 by citing inefficiencies contributing to poor response times [8]. One instance referring to an injured high school football player never receiving the ambulance called for made local headlines and spawned a series of investigative reports by most of the local television stations.
LMEMS makes roughly 115,000 runs per year and the vast majority of those meet or beat response-time goals and standards. The agency makes approximately 87 percent of its advanced-life support runs in eight minutes or less.
[edit] Morale
Employee morale is rumored to be low among some due to claims that personnel shortages have increased mandatory overtime, though this has not been reported widely by the media and has been officially denied by LMEMS leaders [9]. Allegedly widespread strife between labor and management in regards to mandatory overtime as well as friction and "turf battles" with the fire departments are also believed to contribute to employee dissatisfaction [10].
[edit] Rest
LMEMS workers have made claims that mandatory overtime has increased some working shift from ten hours to upwards of sixteen hours. Some crews have said they are required to work sixteen hour shifts for up to four days in a row preventing them from receiving adequate rest during very short off-duty periods. Sleeping on-duty is prohibited by policy.
[edit] Communications
LMEMS along with the police and fire services in Metro Louisville communicate through dated radios. City government has completed the first two phases of a state-of-the-art communications system, called MetroSafe. The third phase, including a new radio network, is underway.
The completed phases of MetroSafe allow agencies that operate on separate radio systems to communicate with one another, bridging incompatibile UHF and VHF radios. MetroSafe also puts all emergency agencies' information into the same computer system allowing dispatchers to better manage an incident requiring a combination of police, fire and EMS response.
Until MetroSafe's final phase is complete, the actual radio equipment will remain dated. Crews are required to listen to the radio throughout their tour. Unlike firefighters, there are no buzzers or pagers to alert the EMS crew of a call, therefore the crew must listen for their unit number to be called by constantly monitoring the radio.
The city is working to implement a global positioning system for real-time tracking of LMEMS resources.
The length of time to complete MetroSafe and its costs have been the subject of some media reports. [11].
[edit] National exposure
The August 2006 issue of the Journal of Emergency Medical Services (JEMS) magazine, a leading publication for the national EMS community, featured a full article on Louisville Metro EMS. see: "Louisville Slugger"
Louisville Metro EMS is the only government-administered EMS system in Kentucky to be certified by the Commission on Accredidation of Ambulance Services (CAAS). See: CAAS-certified agencies by state. Before merger both JCEMS and LFR were accredited by CAAS.
In 2006, the Centers for Disease Control and Prevention (CDC) selected Louisville as one of seven communities where relationships between the emergency-care and public-health agencies are established and operate at levels that effectively respond to events that may cause large numbers of injuries.
[edit] See also
[edit] References
- Garza, Mannie (August 2006). "Louisville Slugger". JEMS 31 (8): 56-61.
- LouisvilleKy EMS. Retrieved on December 30, 2006.
- "Suburban districts to help EMS", The Courier-Journal, Gannett, March 29, 2006. lou28152471. Retrieved on January 2, 2007. (in English) “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.”
- Erich, John (January 2007). "The Protocol Process". EMS Magazine 36 (1): 58.
- Cooperative, WLKY Channel 32. "MetroSafe Still Facing Concerns", Internet Broadcasting Publishers, Inc., Oct 25, 2006. Retrieved on January 10, 2007.
- CAAS Accreditied Agencies by State. Retrieved on January 14, 2007.
[edit] External links
- Louisville Metro EMS official webpage
- The unofficial Louisville Metro EMS website (includes discussion forums)
- LMEMS Response Areas (includes divisions and sectors, .PDF file)
- Kentucky Board of Emergency Medical Services
- Jefferson County Fire Service
- Louisville Division of Fire
- National Registry of EMTs
- The Kentucky EMS Connection
