Legislators heard again this week about the struggle communities face in training and retaining vital emergency medical services personnel, a top legislative priority for cities. Kentucky’s Emergency Medical Services Task Force (EMSTF) met Tuesday in Frankfort and heard from a group of experts in the field.
Chris “Blue” Bartley is a retired Lexington firefighter and paramedic who serves as state policy and legislative representative for the International Association of Fire Fighters. He told the EMSTF of staffing issues that plagued EMS organizations before the arrival of COVID-19. He said the pandemic only exacerbated the situation. “There have been abrupt closures of EMS agencies nationwide, and when these organizations close, the fire service has been there to fill the gap,” he stated.
Bartley said 97% of the 200 most populated communities in the U.S. use fire-based EMS, and nearly all firefighters have some level of EMS training.
Kelsie George, a policy associate with the National Conference of State Legislatures (NCSL), said 49% of ambulance services in the U.S. are fire-department based. In Kentucky, 26% of ambulance services have private ownership, and 25% are fire-department based. She said Kentucky has a higher rate of community-based and nonprofit ambulance services than the national average.
George said finding workers is difficult in the emergency medical field, and turnover ranges between 20% and 30% annually. Compensation is one of the top reasons emergency medical care (EMC) clinicians leave their jobs. Nine states have lowered licensure age requirements for emergency medical technicians (EMTs) to 16 or 17 years old. Three states allow individuals to attend emergency medical responder (EMR) or EMT training courses or apply for a training permit. EMSTF co-chair Senator David Givens (R-Greensburg) asked George what position NCSL takes on lowering age requirements. She said the organization has removed its age requirement and now defers to states.
Paul Phillips, a paramedic who serves as regional director of Global Medical Response (GMR), said Kentucky Medicaid Ambulance transport rates had remained the same for more than 10 years, and Kentucky struggles to keep up with surrounding states. He said EMS receives payment for transport, not treatment, and there is limited to no reimbursement for readiness, response, treatment without transport, and patients who refuse care.
The costs of providing ambulance services have increased significantly over the past two years with high fuel and vehicle costs, wages, and other expenses. According to Phillips, Medicare and Medicaid reimbursements are fixed-fee schedules, and reimbursement has shown to be less than the service cost.
The EMSTF meets again on Sept. 20 at 3 p.m. EST.