Kentucky introduces the EMT-Intermediate
First classes expected to graduate in December 

By JOHN HULTGREN
Kentucky EMS Connection

FRANKFORT — Only a few knew that one of the biggest changes in Kentucky EMS in a quarter-century would take place today.

The Kentucky Board of EMS approved a pilot project this afternoon that creates the Emergency Medical Technician-Intermediate.

"This is a program that has come to us by the [Kentucky state] legislators and they want to see us do it or they will do it next year," said KBEMS board chairman Mark Bailey. His words were echoed by Kentucky Ambulance Providers Association president Mike Swift, also a KBEMS member, who said "If we don't take a step to do this, then the next session of the legislature will do it and it will be done under statute."

"We have identified a great need for an EMT-Intermediate program in Kentucky," said KBEMS' staff member Charles O'Neal who then explained plans for a pilot program that would train two to four classes using the United States Department of Transportation EMT-Intermediate curriculum and KBEMS staff as adjunct faculty.

The initial classes would complete their training and test in December. A critique of the pilot program would be conducted next January and "we hope to have state-wide implementation in the first quarter of 2003," O'Neal said.

KBEMS executive director Brian Bishop said that each class would have 25 students.

O'Neal said that the location of the first pilot classes have not been determined yet.

"We are looking for agencies that have the equipment and instructional staff," O'Neal said, although Louisville Fire and Rescue, Madisonville, and KCTCS were identified as possible candidates.

Before the pilot program was approved, KBEMS board member Lee Brown said "I'm looking over this list of medications and skills, and I don't see a lot of difference between EMT-Is and the paramedic as we know it now."

But board member Dr. Eric Bentley explained that "This goes hand-in-hand in expanding paramedic scope of practice."

The cost of the training also has not been determined yet. "Once the four entities are identified, we want to make sure that the cost is all equal," O'Neal said.

The board approved the program unanimously.

"We're taking a very historic step in the history of EMS in Kentucky," Swift said.

With the adoption of the EMT-Intermediate classification, Kentucky is now lacking only the Emergency Medical Dispatcher and EMS Education Instructor from the U.S.D.O.T. lineup. Kentucky already recognizes the U.S.D.O.T. EMT-First Responder, EMT-Basic, and EMT-Paramedic.

Medicaid considers care provided by an EMT-Intermediate to be an advanced level, just like the paramedic. Therefore, ambulance services that use the EMT-Intermediate will get the same reimbursement rate as they do for using paramedics. This has caused some paramedics to worry that their cost-conscious employers will replace them with intermediates and lower the standard of care for their community.

A Louisville Courier-Journal report last month found that 17 rural Kentucky counties lack paramedics and advanced life support equipment. That report noted that rural counties with small populations often lack the tax base needed to support hiring paramedics and providing the advanced equipment. Poorer counties without colleges or technical schools struggle to find and retain paramedics who leave for better-paid positions in urban areas after training.

The 17 Kentucky counties that lack advanced life support are: Bracken, Elliott, Fulton, Hancock, Henry, Lee, Leslie, Menifee, Owen, Pendleton, Powell, Robertson, Rockcastle, Todd, Trigg, Trimble and Wolfe.

But the paramedic shortage isn't limited to rural areas. As of last year, Louisville Fire and Rescue had 33 paramedics assigned to ambulances -- 16 fewer than their plans called for.

''There's a shortage of paramedics in general,'' Jefferson County EMS Major Randy Jackson told the Courier-Journal. ''There are plenty of places to get training, but people aren't doing it. We have continual openings.''

Although most agree that Kentucky does have a paramedic shortage, many field paramedics blame that on low pay and a lack of recruitment or retention efforts by the state and the ambulance services. Some of those paramedics also blame poor education programs and resources, and question whether an EMT-Intermediate program is really a solution or just a way to lower operating costs at a time when many ambulance services are facing a financial crisis.

And a recent move to allow paramedics to work in hospitals and other non-traditional areas, which may be able to offer the paramedic a higher wage and better benefits and thus compete with ambulance services for the paramedic, may worsen the paramedic shortage.

In neighboring states, Tennessee, Virginia and Indiana already have an EMT intermediate classification.

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