Medical director requirements strengthened

By JOHN HULTGREN
Kentucky EMS Connection

FLORENCE — After hearing pleas from the medical community, the Kentucky Board of Emergency Medical Services voted to strengthen medical director requirements but passed on the opportunity to extend hospital diversion plans.

Kentucky Medical Association attorney Bill Doll addressed the board this afternoon at the Cincinnati/Northern Kentucky Airport. Today's board meeting was the first held outside of Frankfort.

Doll told the board that there are inconsistencies in the current regulations regarding the education requirements for medical directors of ambulance services.

Doll and Dr. Reynolds, president of the Kentucky Chapter of the American College of Emergency Physicians, encouraged the board to strengthen those requirements in the permanent regulations that are waiting for board approval.

Kentucky's current regulations, which exist as emergency regulations and are awaiting permanent status, state that an ambulance service's medical director must be a Kentucky licensed physician who holds, or is in the process of obtaining, successful completion of an American Heart Association Advanced Cardiac Life Support provider course.

Both Doll and Reynolds suggested that a medical director be required to be a Kentucky licensed physician who is board certified in emergency medicine or who has successfully completed an Advanced Cardiac Life Support course, Pediatric Advanced Life Support course, and an Advanced Trauma Life Support course. Medical directors who have not completed these courses would be required to complete them within six months of assuming the medical director position.

Patricia Bausch, legal counsel for the board, explained that the board's regulations committee felt these strengthened requirements would not be practical in some areas of eastern and western Kentucky.

Dr. Eric Bentley, a board member who represents trauma surgeons, and Dr. Julia Martin, a board member who represents emergency physicians, took issue with that claim.

"I don't think it's too much to ask your physician to have the same knowledge" as the EMS providers they supervise, Martin said.

"We will be going backward from the previous standard if we don't do what is before the board today," Bentley said.

Both Bentley and Martin said increasing the requirements would not create a shortage of medical directors for ambulance services in rural Kentucky.

And, in case there does prove to be a shortage, Bentley said "I'll serve as medical director for any service who can't find one, and I'll do it for free."

The board voted unanimously to increase the requirements as recommended by KMA and ACEP. Bausch said the language will be given to the Kentucky Legislative Research Commission to include in the permanent regulations that the board will vote on at a special meeting on August 6.

"I really believe the quality you are concerned about will go up," Bentley said.

The hospital diversion language, however, will not be changed.

Dr. Daniel Varga, chief medical officer for Norton Healthcare and representing the Kentucky Hospital Association, asked the board to extend regulation language on diversion.

The board had previously approved a diversion plan, that they call "permissive," which would require ambulance services to have a transport protocol but giving them the option to include a diversion plan in that protocol if they choose.

Varga asked for language that required that the transport protocol be developed by local medical officials and include any existing diversion plan.

"I don't think it's a board issue," said KBEMS chairman Mark Bailey. "It's a local issue that needs to be worked out at the local level."

No motion was made to change the regulations.

In other action:

• The board voted to begin their calendar year on September 1. The board will elect their chair person during the first meeting of their calendar year.
• KBEMS executive director Brian Bishop reported that all Senate Bill 66 ambulance grant money for the 2000-2001 fiscal year has been dispersed.
• The board agreed to look at how ambulance grant money will be distributed for the 2001-2002 fiscal year. Some counties that have multiple ambulance services, where one ambulance service does a larger percentage of runs, have questioned the appropriation process.
• The board postponed voting on emergency grant requests because the items were not on the agenda. This included a request for $25,000 from the Crittenden County judge executive for money to replace an ambulance and equipment damaged recently in a wreck.
• Martin reported that the EMS-C committee will need to meet again before they can make a recommendation for an EMS-C program coordinator.
• Bishop reported that the board still does not have an exact figure that they must cut their budget by, but that they will probably know by September. "This is the first cut," Bishop said, explaining that an additional budget cut may be required by the state in the Spring. Bishop, who is trying to protect a cut in ambulance grants by allocating the full budget cut to operational expenses, still does not know if he will be allowed to protect those grant funds.
• Bishop reported that the EMT testing contract had been awarded to the Kentucky EMT Instructors Association without going through a bid because they were a sole testing source. "We have since found out that KEMTIA is not a sole source" so KEMTIA is currently testing under an emergency process until the contract can be bid and awarded.
• The board postponed until the August 6 meeting a motion to support a request by Carter County EMS that has been made to AdminiaStar and the Health Care Financing Administration. Carter County EMS is requesting that Medicare pay for ambulance transports to clinics since they do not have a hospital in their county. "I don't want to be perceived as supporting transporting patients to clinics rather than a hospital," Bentley said.
• The board agreed to conduct a full hearing on paramedic license 1714 and EMT certification 19866, which were revoked at a previous meeting.
• Bishop announced that KBEMS has a new Internet site that will be operational at 4:00 p.m. tomorrow. The address for the site is www.kbems.org
• Bailey announced that Kyle Faulkner has resigned from the board. Bailey said that Faulkner "got out of the ambulance business." 

There are also two other board vacancies that were identified by Bailey as the first responder representative and the hospital administrator representative. Joseph Atwell of Fulton is the first responder representative, and Connie Smith of Bowling Green is the hospital administrator representative. The roll call for the meeting did not include either of their names.

Absent from today's meeting were James Cornelison, Mary Guidugli, and Anthony Stratton.

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