KAPA plans rally at Capital on Tuesday
EMS providers are asked to 'come defend your profession'

By JOHN HULTGREN
Kentucky EMS Connection

LOUISVILLE — The Kentucky Ambulance Providers Association Legislative Committee plans to hold a rally of EMS providers at the state capital on Tuesday, August 13, at 10:00 a.m. EDT to show support for EMS at an administrative regulations committee meeting.

At that time, the Administrative Regulations Review Subcommittee will hold a hearing in Room 149 of the State Capital Annex on a hospital regulation, 902 KAR 20:016, that is being amended to allow paramedics to triage in the emergency department.

Testifying in favor of the amendments will be:

• Brian Bishop, executive director of the Kentucky Board of EMS;
• Judge Anthony Stratton, chairman of the Kentucky Board of EMS and also representing the Kentucky Association of County Judge Executives;
• Michael Swift, president of the Kentucky Ambulance Providers Association; and
• Nancy Galvani, representing the Kentucky Hospital Association.

The Kentucky Nurses Association is expected to oppose the amendments and has asked their membership to show up in support of their opposition. 

Nathan Goldman, the attorney for the Kentucky Board of Nursing, said today that the KBN has no official opinion on the amendment and has no plans to make one. Goldman said the law clearly allows paramedics to perform any skill included in the U.S. D.O.T. paramedic curriculum.

KAPA legislative committee chair James Ritchey has asked all EMS providers to "come and defend their profession."

Ritchey said that House Bill 469, which was passed in April and signed into law by Governor Patton, clearly states that a paramedic's "scope-of-practice is defined by national curriculum," and that this includes triage.

The issue has already been "debated on the Senate and House floor," Ritchey said, passing the Senate by a vote of 36 to 1 and also passing the House by a vote of 97 to 0.

KNA recently issued a "legislative alert" to their members, saying that "KNA is adamantly opposed to paramedics performing triage in the hospital setting." The reasons quoted by KNA for this are: 

• Patient Safety — Paramedics are trained to perform “in-field” triage, emergency treatment and transport to an emergency room. Their training does not provide for the depth and breadth of knowledge needed by triage nurses in the in-patient setting. 
• Loss of Emergency Services in Counties -- With this expansion of practice, more paramedics will be leaving the emergency services arena, which may well decimate some counties EMS services. KNA is concerned with the provision of healthcare in all settings for the citizens of the Commonwealth.
• Expansion of Scope of Practice — The addition of triage language to this regulation expands the scope of practice for paramedics without defining that practice. This needs to be done before the use of only one aspect of practice is placed in any regulation. 

KNA also wrote, "We are also asking that nurses who are available and willing to come to Frankfort on the August 13 to STAND AND BE COUNTED. You may speak against this issue if you are comfortable doing so, or you can be there to show your support."

In the current issue of Kentucky Nurse, a KNA publication, KNA president Barbara Hawkins wrote:

The RN is essential in the provision of the best quality health care. We argue the point with health care administrators who decide the best way to reduce costs is by reducing staff. We've dealt with, and continue to deal with short-sighted, ill-conceived staffing methods that include reducing RN's [sic] with less skilled staff, like paramedics, in areas that require the assessment and triage skills of the RN. And, we work very hard to inform the health care consumer about the potential consequences.

Another section of Kentucky Nurse, discussing the last legislative session, included the following:

HB 469 amended the paramedic's scope of practice allowing them to work in hospital emergency rooms. Individual hospitals will be responsible for developing policies detailing exactly how the paramedics will function in their facility. Paramedics will function only under the orders of a physician, physician assistant (PA), or an ARNP, or as delegated by a Registered Nurse. Expect to see this group back asking for increased responsibilities in the hospital setting.

In the Personal Opinion section of the current Kentucky Nurse, Kathy Hager wrote:

It recently came to my attention that our KNA President Barbara Hawkins went to the legislature, trying to support the Mandatory Overtime Bill. One of its opponents quite adeptly asked how many nurses Barbara represented. Her answer was that the Kentucky Nurses Association represents all nurses practicing in Kentucky. That opponent asked then just how many nurses practice in Kentucky. Barbara answered that there are around 49,000. And then the opponent asked how many of those 49,000 belonged to the Kentucky Nurses Association. Barbara had no choice but to reveal the ever-so-sad answer that there are about 2,000 nurse members. And quite honestly, that answer today, March 18, 2002, is 1,984, about 4% of the total nurses practicing in Kentucky. Based on that sad statistic, any opponent to any nursing issue can easily refute our right to claim that we know or support what is best for nursing, wouldn't you say?

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