Louisville Metro EMS

Louisville police officers transported patients for many years until Louisville EMS (LEMS) was created in 1974. The Park-Duvalle Neighborhood Health Center In 1968 provided ambulance service first to just patients with in their service area,then eventually to the city. The service was taken over by Louisville government. The program was operated by the city and Robert Shaver PhD was recruited as its founder and first Director, as well as Director of Public Health, and disaster planning, and was the first EMS service provided in Louisville. Dr. Shaver created a unique first response system staffed by registered nurses who were housed in Medi-cars and operated under the guidance of advanced medical directives. 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 EMS had its 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.

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.

In February 2015, with the departure of Dr Neil Richmond, the agency's first executive head, Metro Government combined the emergency medical services with Emergency Management Agency to create "Louisville Metro Emergency Services." Emergency Services combines 911 call-taking, all radio dispatching, and LMEMS into a single agency. The new agency, despite its inclusive name, does not include the police or fire department which remain entirely separate. The job of chief executive officer, heretofore both the agency director and the medical director, was eliminated and the jobs again separated. The executive assistant director of Emergency Management Agency was given ultimate charge of LMEMS and a part-time physician hired to perform medical direction.

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 independently 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.

LMEMS is a subordinate entity of an umbrella organization called Emergency Services. LMEMS is headed by the director who serves as the agency head (much like a commissioner). This organization follows the structure of the United States Military. When wearing EMS uniform the director wears the silver eagle of a US army colonel. Under the Director of Emergency Services is the top uniformed officer holding the job of 'Assistant Director, the title of Deputy Chief and the rank of colonel (with gold eagle to indicate subordinate position to the director). This officer 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." Under the Assistant Director are several officers with the position of Assistant Director of Operations wearing the silver oak leaves of a lieutenant colonel. The operations officers, wearing the gold oak leaves of major oversee all day-to-day operations including scheduling and may be drawn upon to provide additional manpower. Other personnel that act in positions of authority wear varying grade insignia such as captain, lieutenant and sergeant.

The collar insignia of LMEMS is as follows:

Title	Insignia
Director of Emergency Services
Deputy Director (Chief of Service)
Assistant Director
Operations Commander
Operations Executive Officer
Operations Field Officer - Paramedic
Operations Field Supervisor - Technician

• Regardless of collar rank an employee's skill level is denoted on the bottom edge of the right sleeve patch, either "Technician" or "Paramedic." A patch reading "Supervisor" was envisioned but never produced.

LMEMS is a long-established "union shop" and all employees beneath the rank of lieutenant colonel can become members of the International Brotherhood of Teamsters (IBT) Local lodge #783, but all employees are required to pay a "Fair Share" contract support fee. 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.

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.[5] 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.

Several other ambulance services exist within Louisville-Jefferson County such as Anchorage EMS.[6] 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.[7] 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.

LMEMS utilizes a fleet of modular ambulances manufactured by Lifeline Emergency Vehicles from Sumner, Iowa[8] 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. 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. The ambulances have emergency lights and sirens along with air horns to help them warn motorists to move over. They also have radios to communicate with other units as well as the dispatcher.

All ambulances are stocked with a full complement of advanced life support equipment including LifePak 15 cardiac monitor–defibrillators, LUCAS II mechanical chest compressors, and 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.[9]

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, Jeffersontown, and St. Matthews[10] maintain their own EMS providers, however, LMEMS is required to ensure a response if these providers are unable.

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.

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.

Current hospitals served by Louisville Metro EMS include:

• the five hospitals and a pediatric outpatient medical center owned by Norton Healthcare
  • Norton Children's Hospital (downtown Louisville)
  • Norton Children's Medical Center (Springhurst, Louisville)
  • Norton Women's and Children's Hospital (St Matthews, Louisville)
  • Norton Hospital (downtown Louisville)
  • Norton Brownsboro Hospital (Springhurst, Louisville)
  • Norton Audubon Hospital (City of Audubon, Louisville)
• the hospitals of UofL Health
  • University of Louisville Hospital, the region's level 1 trauma center.
  • Saints Mary and Elizabeth Hospital (Beechmont, Louisville)
  • Jewish Hospital (downtown Louisville)
  • Jewish Medical Center-East (St Matthews, Louisville)
  • Jewish Medical Center-Southwest (Valley Station, Louisville)
  • Jewish Medical Center-South (Brooks, KY)
  • Jewish Hospital-Shelbyville (Shelbyville, KY)
• the hospitals of Baptist Healthcare
  • Baptist Health - Louisville (St Matthews, Louisville)
  • Baptist Health - LaGrange (LaGrange, KY)
  • Baptist Health - Floyd (New Albany, Indiana)
• The U.S. Department of Veterans Affairs Louisville Medical Center (Clifton, Louisville).