Confusion remains on need for scope of practice amendment

By JOHN HULTGREN
Kentucky EMS Connection

LOUISVILLE — The debate over whether Kentucky needs Floor Amendment 1, attached to House Bill 178, continues.

Floor Amendment 1 was added to House Bill 178 on Tuesday and would require the Kentucky Board of EMS to define the scope of practice for all EMT levels after input from the Kentucky Board of Medical Licensure and the Kentucky Board of Nursing.

The Kentucky Ambulance Providers association yesterday asked EMS providers to support the house bill but voice opposition to the amendment.

Today, the Kentucky Chapter of the Association of Air Medical Services called on EMS providers to do the same.

Marc Manley, president of KyAAMS, said the amendment "would drastically change or even take away the expanded scope of practice for the EMT-First Responder, EMT-Basic, and paramedic."

"The expanded scope of practice for paramedics in Kentucky is integral to the advanced level of patient care that is provided by air medical service providers based within the Commonwealth," Manley said. "Kentucky AAMS strongly opposes this amendment. You are urged to call your representative in support of House Bill 178 but in opposition to the amendment."

But not everyone agrees that the amendment is as bad at it is being perceived, and not everyone agrees whether the amendment is actually needed.

James Ritchey, who was identified as the force behind the amendment, wrote that "I think some EMS folks, led by Brian Bishop, are painting my intentions wrong. I am for full advancement of EMS practice at every level. I have always been for a very aggressive expanded scope of practice. KBEMS nor KAPA are leading in that direction. The amendment would allow movement in a positive direction. House Bill 178 is a very good piece of legislation. The amendment was only intended to enhance the bill and hopefully the profession as a whole."

Ritchey used to sit on the old EMS Council and has been a KAPA board member and was chairman of KAPA's legislative committee before his retirement from EMS last year.

Ritchey also wrote in the Kentucky EMS Discussion Forum last night that the amendment offers "an opportunity for EMS practice at all levels to be expanded by the Kentucky Board of EMS at any time the board saw a need to expand without having to be held hostage by any national standards that are often slow to change and often times not written with a definitive meaning easily adhered to by local health care providers."

It would also allow the board to set a standard of care that first responders, EMTs, and paramedics could offer the citizens without being held back by a local medical director who fails to allow those certified and licensed professionals to render the best possible care to every patient that is treated in Kentucky," Ritchey wrote.

"The amendment does not say that their [KBML and KNA] approval is required, only that they are consulted," Ritchey wrote. "If you have worked on any EMS legislation or administrative regulation you well know that they KNA, ENA, PAs, KMA, and a whole host of other groups all want input into any EMS matter. We have to deal with them on every issue, so why not include them from the start and avoid the fights?"

Ritchey, and Rep. Robert Damron, who introduced the floor amendment, both say that EMS is the only medical profession in Kentucky without a defined scope of practice regulated by their governing board.

However, there are already laws that address scope of practice in EMS.

KRS 311A.170 says that a paramedic may perform any procedure specified in the most recent U.S.D.O.T curriculum and any additional procedure specified by KBEMS through an administrative regulation.

202 KAR 7:701, titled "Scope of Practice Matters," establishes a scope of practice for EMT First Responders, EMT Basics, and paramedics.

Brian Bishop, the executive director of KBEMS, reports today he has been told that Rep. Damron will pull the amendment. However, the Legislative Research Commission told the Kentucky EMS Connection at noon that this has not happened yet.

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