Then the state tosses them out and all that money, knowledge and experience goes with them.

That's the career path for Emergency Medical Service workers, according to Tommy Sampson, who leads a service in Shelby County so respected that other counties send their EMS workers here to train.

"You can have your chosen vocation, but once you can't get out there and pull and tug victims out of a wreck, you're out," Sampson said. 

"You could use your years of experience and knowledge for another 20 or more years," he said, transferring those life-saving skills to hospital emergency rooms or industrial health services.

Current law, however, doesn't allow emergency medical workers to do that and a major EMS reform law now making its way through the state Legislature fails to take the issue on.

"It's a shame because it's a waste of money and talent," Sampson said.

House Bill 405 addresses some of the growing pains of EMS, he said, including consolidating many of the administrative functions of the current system under one 15-member Board of Emergency Medical Services. Currently, the responsibilities for regulating the system and the practices of paramedics, emergency medical technicians, first responders, dispatchers, ambulance services and training institutions are spread out between a board like that proposed in the bill, the Cabinet for Health Services, the Kentucky Board of Medical Licensure and other agencies.

The bill also attempts to require reimbursement rates for services to at least equal what Medicare pays and requires both health and automobile insurance companies to reimburse EMS for medical services and supplies when they are needed by their customers.

As of Wednesday, the bill has passed a first reading in the Health and Welfare Committee in the state House of Representatives and has been sent to the Appropriations and Revenue Committee.

"What they're trying to do is put everything under one roof," Sampson said, and provide for service reimbursements that are either non-existent now or paid at too low a rate.

For example, the way it works now, if Shelby County EMS helps extract a victim from a car wreck, provides initial medical care and then puts the victim on a helicopter for a hospital in Louisville or Lexington, the transporting agency like the helicopter's company gets paid for the materials and supplies they use on the way to the hospital. Shelby County has to absorb the costs of the bandages and drugs they used on the patient, he said.

While the bill will address major problems with the existing system, Sampson said, it still makes it hard to recruit and keep people to do a dangerous and stressful job.

"We would have liked it added in where you could continue your occupation after you can't do the street work anymore," he said.

About three years ago, EMS personnel became eligible for hazardous duty retirement after 20 years of service, according to Sampson, but only those who began their service in their very early 20s can hope to make it to retirement.

"You have to perform in the situation you are in," he said, and that has led to debilitating back injuries, other physical injuries  and exposure to all manner of contagious diseases.

It used to be that firefighters were considered to have the most hazardous jobs, but now it is EMS, Sampson said.

EMS workers are expected to work in uncontrolled situations with lots of unknown elements and make quick, life and death decisions.

"We pick them up in auto accidents and we may be swirling in a pool of blood, and we don't know," Sampson said.

"It's a tough job mentally, it's a tough job physically," he said.

Because the EMS concept is only about 20 to 30 years old in Kentucky, it has grown and evolved and only now is it being studied for how it affects those who do it.

"They're just beginning to learn things that are needed," Sampson said.

Training is continuous, but unlike police and firefighters, who get monetary incentives to continue their training, EMS personnel do not.

"I don't think it's a fair situation," he said, and it is because Fiscal Court is interested in maintaining a well-respected service that his people get the training they get now.

"No doubt we're very fortunate here, compared to some other agencies in getting training," Sampson said.

But it is the same here as it is anywhere in Kentucky. If a 40-year-old paramedic hurts his back helping someone, that's the end of his career.

"He's 40 and this is all he's ever done," Sampson said, and suddenly he can't do it anymore.