Louisville Metro EMS

Louisville Metro EMS
Motto: "Louisville's Lifeline"
Established 2005
Headquarters Louisville, Kentucky
Jurisdiction Louisville-Jefferson Co, KY
Total area (sq. miles) 399
Dept. type Public
Employees 250
BLS or ALS BLS/ALS tiered
Ambulances Daywork 23 (19 ALS+4 BLS), Latewatch 16 (14 ALS+2 BLS)
Fly-cars 6 BLS (10a-10p only)
CEO Dr. Neil Richmond[1]
Chief Vacant
Asst. Chief LTC R. Lee Dennison [1]
Medical director Dr. Neil Richmond
Responses 100,000 per year
Website www.louisvilleky.gov/ems

Louisville Metro Emergency Medical Services is the primary provider of pre-hospital life support and emergency care within Louisville-Jefferson County, Kentucky. LMEMS is a governmental department that averages 100,000 calls for service, both emergency and non-emergency, each year.

The current chief executive officer is Dr. Neal Richmond, MD and the acting chief of service is Lieutenant Colonel Lee Dennison, EMT-Basic.

History

LFD (left) and JCEMS (right) ambulances at UofL Hospital

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 and Jefferson County until 1972 when the Jefferson County Medical Society created the first EMS service.[2] The first licensed paramedics in Kentucky graduated in 1975 from a pilot program at Louisville General Hospital, now University of Louisville Hospital. Included were fifteen City of Louisville EMS paramedics and one Jefferson County Police officer paramedic.

City of Louisville

Louisville police officers transported patients for many years until Louisville EMS (LEMS) was created in 1974. The program was operated by the city and was the first EMS service provided in Louisville. In 1995 the city transferred EMS duties to the Louisville Division of Fire in an effort to streamline emergency services in the city.[2] The EMS bureau of the Louisville Division of Fire utilized firefighters cross-trained as EMTs and paramedics as well as non-firefighting personnel.

Jefferson County

Further information: Jefferson County EMS

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 (JCEMS) in 1987.

JCEMS provided emergency medical services to all areas within Jefferson County outside of the cities of Louisville, Anchorage and Jeffersontown. JCEMS always fielded ambulances containing at least one paramedic. The JCEMS Disaster Response Team (DRT) responded to all hazardous materials and technical rescue incidents within Jefferson County outside of the City of Louisville. After the creation of LMEMS all hazardous materials responsibilities, along with specialized vehicles and equipment, were transferred to the Jefferson County Fire Service.

City-County Merger and Louisville Metro EMS

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. Immediately after the merger, the Louisville Fire Department EMS and Jefferson County EMS continued to operate separately as before. The new Metro Mayor, Jerry Abramson, eventually appointed a task force to review the current EMS practices and determine in what manner EMS will be provided in the new consolidated government.[3] 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. The findings of the EMS task force presented several methods of EMS delivery. Included ideas were retaining two separate services, tasking the Louisville Division of Fire to provide EMS coverage to the entire city-county, the subordination of EMS duties to another "parent" organization such as the police or health departments, or the creation of a stand-alone department. After much debate the mayor's office chose to create a new department and Louisville Metro EMS was created on February 5, 2005 by the combining the Louisville Fire Department EMS Bureau and Jefferson County Emergency Medical Services.

Services

LMEMS is a full-time provider of Basic Life Support (BLS) and Advanced Life Support (ALS) and is accessible through the 9-1-1 system. LMEMS employs an entirely full-time workforce of Kentucky-licensed Emergency Medical Technicians (EMTs) and paramedics (also known as EMT-Ps). Most employees maintain optional certification by the National Registry of EMTs,[4] a national EMS accreditation association.

According to LMEMS official web page[5]

“ 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 provides transportation to the emergency department of the chosen hospital. LMEMS does not return patients home nor does it offer transportation to immediate care centers or hospitals without emergency departments. All scheduled ambulance service and inter-facility transports are handled by private ambulance companies retained by the patient. Only under exceptional circumstances will LMEMS provide hospital-to-hospital transfers. These types of transfers are at the request of an emergency department physician wishing a very high level of care and rapid transportation of patients with time-sensitive or critical conditions to more capable facilities (i.e. major trauma, imminent child birth). Most of the time the crew is coincidentally at the hospital for other matters when the request is made for the transfer.

Skills

Louisville Metro EMS utilizes two levels of care providers. EMT-Basics (referred to as technicians or EMTs) and EMT-Paramedics (usually just called paramedics) have drastically different scopes of practice but all exist to provide care and transportation to the sick and injured. A technician specializes in ambulance operation and basic life support care as well assistance to advanced providers. Most technicians have an initial six months of training receiving at least 110 hours of formal classroom training, often reaching or exceeding 120 or 168 hours, with some training institutions requiring initial unspecified numerous clinical hours within a hospital. Basic Emergency Medical Technicians are required to pass skills training and are required to challenge the National Registry of Emergency Medical Technicians exam to become NREMT certified. Paramedics use complex diagnostics, perform medical procedures, and administer medications and additional advanced care that would otherwise only be provided by an emergency physician. Paramedics in Kentucky generally have three years of initial training including at least 750 hours of internship and clinical instruction in addition to about 1200 hours of formal, classroom instruction. An increasing number of paramedics possess at least an associates degree, many have bachelor's degrees.

Technicians are trained to operate independent of a paramedic and when such situations arise they are capable of caring for and transporting any medical emergency to the hospital on their own.

Although the Kentucky Board of Emergency Medical Services allows for the use of EMT-Intermediate providers, LMEMS does not utilize this mid-level of care provider.

Treatment issue Emergency Medical Technician skills (EMT / technician) Paramedic skills (paramedic / medic)
Airway management Assessment, manual repositioning, oro- and nasopharyngeal airway adjuncts, manual removal of obstructions, suctioning, King LT-D blind insertion airway device (BIAD) tracheal intubation (oral and nasal), advanced airway management for endotracheal tube, tracheostomy. Deep suctioning, use of Magill forceps, surgical airways (including needle cricothyrotomy)
Breathing Assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, passive oxygen administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by Bag-Valve-Mask (BVM) device, pulse oximetry Active oxygen administration by endotracheal tube or other device using BVM, colometric, side stream, or inline end tidal carbon dioxide (EtCO2) capnography. Use of mechanical transport ventilators (rare), active oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracostomy)
Circulation Assessment of pulse (rate, rhythm, volume), blood pressure, skin color, and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets Ability to interpret assessment findings in terms of levels of perfusion, obtaining intravenous access (IV), intravenous fluid replacement, vasoconstricting drugs, intraosseous (IO) cannulation (placement of needle into marrow space of a large bone). Access central venous catheters or peripherally inserted central catheters (PICC).
Cardiac arrest Cardiopulmonary resuscitation, airway management, manual ventilation with BVM, automatic external defibrillator, ResQPod thoracic impedance device Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), 12-lead ECG interpretation, manual defibrillation, synchronized electrical or chemical cardioversion, and external cardiac pacing
Cardiac Monitoring 12-lead ECG BLS acquisition. Monitor interpretation only. 12-lead ECG monitoring and interpretation including modified chest leads, right-sided leads, and posterior adjunctive leads.
Drug administration Oral, nebulized, auto-injector or intramuscular Intramuscular and subcutaneous injection, intravenous and intraosseous boluses and infusions, endotracheal tube drug administration, rectal tube, and umbilical venous access.
Drug types permitted Low-risk/immediate requirements e.g. oxygen (hypoxia), aspirin and assisted nitroglycerin (chest pain/angina equivalent), oral glucose (low blood sugar), epinephrine auto-injector or intramuscular (allergic reaction), albuterol (asthma) Analgesics for pain, antiarrhythmics (irregularities in heartbeat), cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation, e.g. dopamine, Pitressin, epinephrine), atropine for slow heart rates, anticonvulsives (for prolonged seizures), antidotes (naloxone for opiate overdose), dextrose 50% in water (low blood sugar), sodium bicarbonate (acidosis)
Patient assessment Basic physical assessment, 'vital' signs, history of general and current condition, pulse oximetry, glucometry More detailed physical assessment and history, auscultation, interpretation of assessment findings, ECG interpretation, glucometry, capnography
Wound management Assessment, control of bleeding, application of pressure dressings and other types of dressings, splinting and immobilization Pain management

Structure

Ranks

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 Chief of Operations and is the accepted chief of department. Traditionally, in the area, the chief of the emergency medical services is not addressed as "chief" but as "colonel" and styled "The Colonel" as the person in this position wears the silver eagle of a US army colonel. Under the Chief of Operations is the Assistant Chief of Operations wearing the silver oak leaf of a lieutenant colonel. A group of operations officers, wearing the army insignia of major and captain, oversee day-to-day operations including scheduling and may be drawn upon to provide additional manpower. Other personnel that act in positions of responsibility wear varying grade insignia such as lieutenant and sergeant but their roles are currently undefined and unclear. Field training personnel (FTO) exist to train new paramedics and EMTs. Their authority primarily extends to clinical and operational competence.

The collar insignia of LMEMS is as follows:

Title Insignia
CEO
Chief of Operations
Asst. Chief of Operations
Operations Officer
Operations Scheduler
Obsolete Junior Officer
Obsolete NCO

Union

LMEMS is an established "union shop" and all employees beneath the rank of lieutenant colonel 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, an employee's tenure may be taken into account to determine suitability. Any employees' first twelve months of service with LMEMS is considered a probationary period where the new hire is subject to dismissal without union representation.

Several separate bargaining contracts exist within the service. Street operations personnel, including the majority of EMTs and paramedics and operations officers are covered by one contract. Ancillary services personnel in supply and billing have their own contract suited to their unique duties.

A chief and assistant chief steward are elected to oversee union matters for the entire service. Additional elected shop stewards are on duty at most times to assist members with concerns on a day-to-day basis.

Mutual aid

LMEMS Rapid Response "Fly-Car"

Fire service

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 begin stabilizing the patient prior to EMS arrival.[6] Each fire department or fire district is independent and as such have varying response guidelines. Some agencies respond to only the most serious calls while others will respond on nearly every call.

Other ambulance services

Several other ambulance services exist within Louisville-Jefferson County such as Anchorage EMS.[7] Anchorage EMS is an ambulance taxing district (as well as a fire protection taxing district) that serves the City of Anchorage as well as eastern Jefferson County with advanced life support services. Other, private ambulance agencies such as Rural/Metro Corporation and Yellow EMS provide services for parts of areas near by or within Jefferson County. For example the City of Jeffersontown in southeastern Jefferson County has for years outsourced its EMS needs. Currently a contract exists with Yellow EMS (YEMS) to provide emergency medical services within the Jeffersontown city limits. YEMS also provides additional assistance during extremely high call volume times to LMEMS and responds to many of LMEMS' low-priority calls.[8] Although these jurisdictions maintain their own ambulance providers, Louisville-Jefferson County government is ultimately responsible for ensuring emergency care is available and in the case that any of these providers cannot operate, LMEMS will ensure a response.

LMEMS also provides mutual aid to other agencies as well. 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.

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

LMEMS Transport Ambulance

Ambulances may be staffed by two Emergency Medical Technicians, one Emergency Medical Technician and one paramedic or, rarely, two paramedics. There is also at least one "Chase car" staffed with a paramedic at any given time. Additional Chase-cars are staffed as need dictates. 2010 policy revisions state there must always be one supervisor per operations division but currently no more than two are ever on duty simultaneously. This leaves at least one division without a supervisor on a recurring basis.

Equipment

Ground transportation

LMEMS utilizes a fleet of modular ambulances manufactured by Lifeline Emergency Vehicles from Sumner, Iowa[9] and Ford Explorer response vehicles called chase-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. The newest (post-merger) ambulances retain the straight-side feature of the former LFD type and are taller, longer, and heavier. The new design includes a more powerful, greater torque-producing engine (Navistar turbo-charged diesel), and a more spacious patient compartment (6 foot ceiling).

In 2012, Ford Motor Company announced they would no longer manufacture the Econoline van ambulance prep package and subsequently LMEMS has opted to begin procuring Type I vehicles based on the F-450 pickup truck chassis. The first delivery of Type I ambulances occurred in 2013.

Most LMEMS response vehicles, including all ambulances, are fitted with satellite transponders that constantly track the exact location of the vehicle, map the potential route to a call, and determine which unit is closest to the emergency.

All ambulances are stocked with a full complement of advanced life support equipment including LifePak 15 cardiac monitor–defibrillators, oral and intravenous medications and fluids. Each ambulance can transport up to three fully immobilized patients. All crew members are trained and equipped with protective gear to treat patients potentially contaminated with hazardous materials.

All charting and patient care information is collected and distributed electronically, eliminating paperwork and reducing the possibility of patient privacy compromise. Electrocardiographs (EKG) can be transmitted wirelessly from the cardiac monitor to the receiving hospital in the advance of the patient's arrival.[10]

Aeromedical Services

Due to hospital proximity and the numerous excellent highways within Jefferson County air ambulances are rarely requested by LMEMS as ground transportation can usually be faster and more effective. As such neither Louisville nor Jefferson County governments have ever maintained a helicopter for air ambulance use. However it is worth noting that the medivac concept, proven effective during the Vietnam War, was provided in the 1970s by the United States Army Reserve on an "as available" basis for non-military use in the Louisville and surrounding areas. 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 1998 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. AirMethods now provides most of the aeromedical services in the region.

Area of responsibility and divisions

Louisville Metro EMS has the largest area of geographical responsibility of any Louisville Metro public safety agency. It is the sole provider of emergency medical services to 96.5% of the 399 square miles (1,000 km2) of Louisville-Jefferson County. The cities of Anchorage and Jeffersontown maintain their own EMS providers, however, LMEMS will always ensure a response if these providers are unable.

Divisions of Louisville Metro EMS
Division One St. Matthews (Medic 211), Middletown (Medic 112), Lyndon and Graymoor-Devondale (Medic 113), Berrytown-English Station (Medic 119), Downtown (Medic 151), Camp Taylor and Germantown-Schnitzelburg (Medic 161), Clifton-Crescent Hill (Medic 162), Buchertown and The Highlands (Medic 277), and Douglass, western Hikes Point and Bowman Field (Medic 175), Okolona (Medic 121), Highview (Medic 123), Newburg, Watterson Park (Medic 225), Buechel (Medic 127), and Fern Creek (Medic 126).
Division Two Beechmont(Medic 163), Iroquois and Auburndale (Medic 267), University of Louisville (Medic 274), Smoketown (Medic 255), Pleasure Ridge Park (Medic 131), Valley Station (Medic 132), Fairdale (Medic 135), Shively (Medic 137), Shawnee (Medic 141). Russell (Medic 243), Portland (Medic 145), and California (Medic 147).

Continuity of coverage

Not all locations have ambulances on station at all times. Alternatively, response cars may be placed with a single paramedic or technician instead of an ambulance. All response units use a three-digit radio identification number. The first number denotes the type of resource ("1" ALS ambulance, "2" BLS Ambulance, "3" BLS response car, "8" special detail unit, or "9" ALS response car). The second number identifies the unit's assigned division within the computer-aided dispatch (CAD) system and the third digit is the unit's area of responsibility/beat within the division. Ambulances are prefixed as "Medic" and response cars as "Car."

Communications

All LMEMS resources are dispatched and tracked by MetroSafe, a unit of Metro Government within the Emergency Management Agency that handles all public safety communications. Previously many separate dispatch centers existed staffed by the individual agencies they served. MetroSafe puts, for the first time in area history, all emergency call-taking and radio dispatching under one roof. In addition to radio telecommunications MetroSafe is the primary answering point for all 911 calls placed inside Louisville-Jefferson County. Since April 2010 all government agencies are transitioning to the long-awaited MetroSafe phase III radio system. All the major public safety agencies, of which LMEMS was the first to do so, have now implemented full operational use of the new 800 MHz trunked radios.

Radio codes

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, however LMEMS does not share its radio channels with any other organization or department. While the use of 10-codes is discouraged by LMEMS policy, the use of coded radio traffic continues and is widely tolerated.[11]

Online medical control

Many advanced procedures and medication administration require direct orders from a physician before being performed. All on-online medical control is performed by two-way radio with the attending and resident physicians at University of Louisville Hospital for adult patients, and Kosair Children's Hospital for patients under the age of 18.

Two-way radio

The current Louisville Metro public safety radio system is a Motorola Project 25-compliant trunking system. Voice encryption is used for many channels including all those used by LMEMS, thus radio traffic cannot be received using a scanner. By using voice encryption the chances of protected health information (PHI) being compromised by unauthorized monitoring is greatly reduced.

Each LMEMS division has an assigned talkgroup, or channel, for operations (MED channels 1 and 2) and a secondary talkgroup for official communication of non-response natures (TAC channels 1 and 2). Car-to-car talkgroups are used for informal communication. Online medical control is conducted with physicians on talkgroups Hospital 1 for University of Louisville Hospital (adult patients) and Hospital 2 for Kosair Children's Hospital (for pediatrics). Additionally, all of the serviced hospital can receive report from the crews in the field via radio when necessary. Real-time availability of "non-system" conventional frequencies allow communications with agencies and responders outside of Louisville-Jefferson County using Project 25-compliant radio equipment.

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 an additional ambulance (or, if available, a chase-car) containing a paramedic is also dispatched.[12] 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. The decision to use, or not to use, lights and siren en route to the hospital is at the sole discretion of the crew.

Area Hospitals

Current hospitals served by Louisville Metro EMS include:

Patient transports to hospitals outside of Louisville-Jefferson County are infrequent and some destinations require supervisor notification and assent.

See also

Notes

References

  1. ↑ 1.0 1.1 Louisvilleky.gov - EMS Staff
  2. ↑ 2.0 2.1 The Encyclopedia of Louisville By John E. Kleber (University Press of Kentucky 2000) page 610 ISBN 978-0-8131-2100-0
  3. ↑ Louisville Metro EMS To Enhance Medical Response
  4. ↑ National Registry of EMTs
  5. ↑ Louisville Metro EMS
  6. ↑ American Heart Association 2005 Guidelines for CPR and ECC
  7. ↑ Anchorage EMS
  8. ↑ Louisville Transportation Company - Ambulance
  9. ↑ Life Line Emergency Vehicles
  10. ↑ EMS Builds Hospital Network to Speed Heart Attack Care - 2009 - LouisvilleKy.gov
  11. ↑ NIMS FAQ :: NIMS Online :: Serving the National Incident Management System (NIMS) Community
  12. ↑ Target 32: Louisville's EMS Service Facing Challenges - Target 32 News Story - WLKY Louisville

External links