According to Reeves, Louisville Fire & Rescue has replaced a number of advanced life support (ALS) units with basic life support (BLS) units because a shortage in department paramedics has created an extreme workload. Reeves' concern is that LFR's new policy is to now dispatch ambulances based on the ambulance's capabilities rather than their closeness to the patient. Reeves said that this has resulted in BLS ambulances being dispatched from the other side of the city when other ALS ambulances were closer -- as much as 6 miles closer. 

LFR is currently 15 paramedics short of their authorized strength. 

Reeves said that he decided to speak to the aldermen after hearing a run in his neighborhood given to an ambulance on the other side of the city when another closer ambulance was available in his own area.

Fire Chief Gregory Frederick told the aldermen that the bulk of their EMS runs do not require a paramedic and that this new system will reduce the number of runs to which paramedics have to respond. Frederick provided EMS run statistics from the last 10 days showing that of 867 EMS responses, 79% had been coded by their dispatchers as BLS responses. Frederick said that of 530 runs transported by the department during this period, only 17% were transported either emergently or urgently.

Twelfth Ward Alderman Paul Bather said that the changes implemented by the fire department were learned of by the aldermen "through the grapevine" and that changes such as these should be made in public. Bather also requested that Chief Frederick supply the aldermen with a memorandum detailing the changes that the department has made.

In a memo to Louisville Director of Public Safety Ronald Ricucci dated Nov. 23, Frederick explained that LFR currently has 33 paramedics but that three are off injured or on light duty. To continue to "fully staff the nine units we have, that are reduced to seven plus one BLS at night, we need about 45 paramedics, so the open slots are hired with overtime, then [if overtime positions cannot be filled, paramedics are required to work] mandatories." 

Frederick stated that because of mandatory overtime policies, paramedics were being required to work as much as three 16-hours shifts per week. (LFR paramedics are normally scheduled to work 8-hour days 5 days a week.) 

The new changes have reduced the number of ALS ambulances to six and created four BLS ambulances each day. 

Prior to Louisville EMS being absorbed by the fire department in 1995, Louisville EMS staffed 8 or 9 ALS ambulances each shift, and BLS ambulances were usually only created when there were extra personnel or special events. Therefore, the new plan does put one or two additional ambulances on the street, but also has reduced the number of ALS ambulances available to respond to runs and in some cases increases the response time. 

Frederick blamed their shortage of paramedics on their heavy run volume and workload and Kentucky's slow and complicated paramedic certification process.

Frederick said the department would like the Board of Aldermen to lobby the Kentucky General Assembly to change the paramedic certification process. Frederick cited difficulty passing the paramedic exam, saying that Kentucky is one of the toughest states in the nation in which to certify as a paramedic. The aldermen present agreed that this would be a good course of action. 

In certifying paramedics, Kentucky uses the National Registry of Emergency Medical Technicians' (NREMT) certification standards and tests, plus a Kentucky required oral examination. According to NREMT's Internet site, NREMT registration services are part of the licensure process for EMTs (which includes EMT-Basic, EMT-First Responder, EMT-Intermediate, and EMT-Paramedic) in 39 states. Currently there are approximately 155,000 EMTs who have met the NREMT requirements.

Frederick also announced that LFR will be starting a paramedic class Feb. 3.