SB 66 grants may be released within 2 weeks

By JOHN HULTGREN
Kentucky EMS Connection

FRANKFORT — Senate Bill 66 grant monies may be in the mail within the next two weeks.

The Kentucky Board of Emergency Medical Services, at their board meeting this afternoon in Frankfort, approved a deescalating system where smaller services would get a larger percentage of their requests than others.

This is because requests for grants may exceed the available money.

KBEMS has $1.3 million in grant money available. According to Judge Anthony Stratton, a total of $2.1 million in aid has been requested.

However, the Budget and Finance Committee failed to adjust this figure where ambulance services requested more than the law allows. Since some of these requests exceed allowable limits, it's possible that there may be enough to fund all requests.

Anticipating a shortfall, the board approved a system that they call a "reverse pyramid" that will be based on county population as determined by the 2000 census.

Judge Stratton scheduled a meeting of the Budget and Finance Committee last week to review the grant applications but no other members showed up to join him. Another meeting has been scheduled for next Wednesday.

KBEMS' chairman Mark Bailey said that he will call a special meeting of the board to ratify the committee's recommendations within the next two weeks.

"This is something that didn't occur, and we need to get it out," Bailey said. "I think it's ludicrous that the money is sitting in the office."

The Senate Bill 66 grant application process ended April 2. If the money isn't awarded by the end of next month it will be lost.

Board members devoted much of the lengthy meeting amending the current emergency administrative regulations.

Public hearings were never held on the EMS administrative regulations because "not enough people requested it," said board attorney Patricia Bausch. Written comments, however, were received and have been reviewed by the Administrative Regulations Committee.

Although they had been told that there were no substantive changes, board members Dr. David Bentley and Dr. Julia Martin expressed reservations about voting on the recommended changes without being given time to adequately review them. A 15-minute recess was called to allow board members to review the changes. After the recess, the board decided to specifically review each recommended change.

Advanced Life Support Regulations 

Most board discussion centered on the Advanced Life Support regulations.

Dr. Bentley explained that the regulations, as currently written, use the U.S. D.O.T. EMT-Paramedic Training Curriculum and medical protocols in a way that limits what a paramedic is allowed to do.

Dr. Bentley asked the board to replace the term "protocol" with the term "standing orders," and then require ALS medical directors to issue standing orders that meet or exceed the standards of a collection of standing orders that will be provided by KBEMS. 

Dr. Bentley also asked that skills, which are commonly described in detail in medical protocols, not be included in the standing orders.

"This opens the door for paramedics who want to work" outside of EMS, said Bailey.

Dr. Martin also raised concerns about medical director requirements in the new regulations. She said that, under the new regulations, medical directors only need to be a licensed physician who holds an ACLS card.

"The medical director who oversees a paramedic should have at least the same level of knowledge," Dr. Martin said.

Judge Stratton replied "I don't want to have so many restrictions on them [medical directors] that they [ambulance services] shut down. We're supposed to be helping them."

Dr. Bentley explained that physicians are required to obtain 60-hours of continuing education every two years and said he did not find it unreasonable to "require the physician to have an education that is compatible with the position."

"There are medical directors throughout the state that only provide a signature on a piece of paper," Bentley said. "If you can't get a medical director that wants to act like a medical director, then maybe that's a good thing."

Mayor Dodd Dixon asked "Do we have the authority to do this?"

According to Bausch, language in the old regulations wasn't a problem because the Kentucky EMS Branch was operating under a contract with the Kentucky Board of Medical Licensure. KBML has the statutory authority to regulate physicians, but KBEMS doesn't.

A solution offered by Bausch would place the legal requirement directly on the provider, requiring the provider to hire a medical director that meets the requirements.

The board eventually voted to keep the medical director requirements from the old regulations.

Ambulance Regulations 

Another regulation change addressed hospital diversion.

The board voted to remove all previous references to hospital diversion from the regulations and substitute language that says EMS providers shall transport patients according to the provider's transport protocol. Providers, however, may choose to incorporate hospital diversion plans within those protocols.

Reportedly this change was recommended following meetings the board recently had with the Kentucky Medical Association and the Kentucky Hospital Association.

Basic Life Support Regulations 

In recent weeks it was discovered that a section of the regulations intended to specify who is approved to instruct EMT continuing education had been left out of the emergency regulations.

The board approved language that authorizes a physician, registered nurse, paramedic, or EMT-Instructor to teach EMT-Basic continuing education. In addition, anyone certified by a Kentucky, other state, or a federal agency to teach a qualifying course, or persons uniquely qualified by experience or education, will also be approved to instruct EMT-Basic continuing education.

Medical Standards Committee

The board approved the following requests by the Medical Standards Committee:

• Hebron Fire: protocol, medical director, and upgrade to ALS
• Gallatin County EMS: protocol (with deletion of Romazacon use), medical director, and upgrade to ALS
• Simpson County EMS: medical director. Protocols were sent back because they lacked a determination of death section.
• Powell County EMS: medical director, protocol (with deletion of Romazacon use)
• Dry Ridge Fire: protocol (with deletion of Romazacon use), medical director (contingent on BTLS certification), and upgrade to ALS
• Boyle County EMS: protocol (with deletion of hyperventilation in head trauma)
• Jessamine County EMS: medical director
• Casey County EMS: medical director
• Marcum and Wallace (as ALS first responders): medical director
• NET Care Ambulance: medical director
• LaGrange Prison: waiver of pediatric immobilization devices

Some protocols submitted to the board apparently never received a review. It appears that the board's only copies were forwarded to committee reviewers who never attended the committee meeting.

"Obviously the process must be improved," said Dr. Bentley.

The board also discussed some confusion with the approval process as defined in the new regulations. Class I ground ambulances are required to have protocols reviewed only, while Class III and ALS First Responders must have protocols reviewed and approved.

And there apparently is nothing to prevent a program from using protocols that are not approved, or for not making changes dictated by the board.

"There is no requirement for them to make that change," Dr. Bentley said, "but if they don't then they don't have the board's approval anymore." Without board approval, a program could subject themselves to greater liability if faced with a lawsuit.

Other business

In other business:

• the board voted to allow Lee Brown to review paramedic course applications. Those that meet the standard will be approved by KBEMS and later ratified by the board.
• the Search Committee reported that they had interviewed several physicians for the medical advisor position, but apparently a salary has not been approved by the board. The board indicated that they would take up this matter during an executive session at the end of the meeting.
• announced that KBEMS can no longer provide free Kentucky EMS run forms to non-municipal services. Bausch explained that this practice is in violation of the state constitution. The board does allow alternative mechanisms for submitting run information.
• approved contracts with the University of Kentucky Center for Rural Health, Health Department for regional inspector/advisors, and the Kentucky Emergency Medical Technicians Instructors Association for BLS testing.
• Bailey reported that KBEMS will remain housed at the Health Services Building until August 1 unless a permanent building is available earlier.

Board member Dr. Mary Fallat did not attend today's meeting because she was out of state. The board will decide at the next meeting if this will be considered an absence. Board member Dodd Dixon left the meeting early at 2:45 p.m. to attend a sporting event.

The next board meeting is scheduled for June 7 at 1:00 p.m. EDT. The location is tentatively scheduled for Room 111 in the Capitol Annex.

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