It's a graphic illustration of the problem that Boyle County has had to face in finding a way to keep its EMS fully staffed.

On Tuesday, the county brought salaries here to more competitive levels, setting the beginning salary for EMTs at $19,000, up from $17,500, and the beginning salary for paramedics at $24,500, up from $21,500. Salaries of current employees were adjusted to reflect the increases.

"It's not an easy process to deal with -- the changing EMS field," Judge-Executive Tony Wilder told the Fiscal Court. "Part of it is having people with 24-hour shifts. Paramedics are a precious commodity."

The court also approved changes in rates to reflect changes in Medicare coverage.

One benefit that EMS, as well as the jail, sought won't be forthcoming. That is hazardous duty retirement, which costs more to be part of but allows employees to retire after 20 years at higher retirement pay. Hazardous duty retirement would cost the county about $53,000 a year for EMS employees and $82,000 for jail employees.

The pay raises approved unanimously Tuesday for EMS will cost about $26,000 from January through June, the end of the fiscal year.

Wilder said the salary increases, which were approved Dec. 15 by the personnel committee, bring EMS salaries to levels comparable to other counties similar in size and EMS service.

EMS has lost employees to other emergency services that have raised salaries to keep up with demand. Wilder said EMS had employees go to the Danville Fire Department, where salaries were upgraded in July.

"We don't have much choice," said Magistrate John Caywood. "We need to have good trained people or not have EMS."

He expressed regret that the increases are wreaking havoc on the pay schedule adopted last year.

In addition to increases recommended by the personnel committee, Fiscal Court agreed that the salaries of three paramedics who have been with the service for just over a year should be raised $600 a year to bring them above the entry level salary. After six months of probation, employees receive a 5-percent increase in pay. That 5-percent increase would have put the salary of new paramedics above that of those who had been with the county for a year.

As of Jan. 1, the county will no longer be billing just for basic life support service or advanced life support service. When a paramedic was on board and the patient had life-threatening problems, the run had been classed as an ALS run.

New federal regulations call for runs to be broken into one of six categories: non-emergency BLS, emergency BLS, non-emergency ALS, emergency ALS, ALS-2 and specialty care. Specialty care would likely be a run to Lexington when a registered nurse and paramedic had to go with the patient. A non-emergency transport could be taking a bed-ridden person to a doctor.

The new rates reflect the fact Medicare will pay 80 percent of that amount. Gail Bowling, billing clerk, said private insurance typically go along with rates set by Medicare.

Current rates are $275 for an ALS run and $125 for a BLS run. Those rates have not changed since Boyle started EMS in July 1994. New rates will range from $150 for a non-emergency BLS run to $450 for a specialty care run.

The new rates will increase yearly revenue for EMS by about $94,138.

Other changes in the handling of Medicare claims are coming, primarily in the way patient problems are reported and the codes used to denote service that is provided. Bowling said the new rates had to be approved by Jan. 1 or the county could not collect them during 2000. She said one problem is more stringent guidelines.