Emergency Physician To Lead Louisville EMS

At a time when EMS services across the country are being absorbed by fire departments, the mayor of Louisville, KY, has taken a bold step in the opposite direction by removing EMS from the fire department, creating a stand-alone third service and putting an emergency physician in charge.

The process started back in the year 2000, when the city of Louisville and Jefferson County voted to merge their two governments, moving Louisville from the 64th largest city in America to the 16th, says Mayor Jerry Abramson.

“When the merger took effect in January 2003, I was like Noah—I had two of everything,” says Abramson. “I had two fire chiefs, two police chiefs and two EMS directors. Over the past 20 months, we’ve been creating a new city and consolidating our departments, which, as I saw it, was a good time to look around the country at the more modern, future-focused departments that were delivering the best medical services to their respective communities. After looking around, meeting with the chair of the Emergency Department at the University of Louisville and with the heads of several EDs here, and reading a series of newspaper articles, I determined that the best way to deliver services to a community is with a third, stand-alone service with an emergency medicine physician in charge of the entire operation and a COO to oversee the day-to-day operation.”

Abramson admits he was initially influenced by a USA Today investigation of the nation’s 50 largest cities that found EMS was fragmented, inconsistent and slow, and thousands of lives were being needlessly lost. The merger of Louisville’s city and county governments presented an opportunity to make some changes. Abramson subsequently appointed Neal Richmond, deputy medical director for the Fire Department of New York, as chief executive officer of the new Louisville Metro Emergency Medical Service. Dr. Richmond will report to the mayor and have authority over other emergency officials, including the fire chief. Firefighters will continue as first responders, says Abramson, and suburban fire departments have begun to merge, bringing the total number of departments down from 21 in January 2003 to 15. The new CEO was expected to be on the job by November 1.

“He’s coming in from time to time, meeting with the transition group and working through issues regarding structure and location of the new headquarters,” says Abramson. “We have a checklist of all the things that have to be worked through and a time-line. All that we’ve been missing is the executive director, and now we have him.”

And how have EMS and fire personnel reacted to the proposed split and new medical authority?

“When I merged the EMS and fire departments in the ‘old’ city, EMS was excited about it, because, at the time, the only way they could get a hazardous-duty pension from the state was to be part of the fire department, and it meant a significant increase in their pension and health benefits,” says Abramson. “The firefighters thought it was a great idea because their union took on a whole new group of members.” Unfortunately, he adds, the changes have again removed EMS from the firefighters’ union; the Teamsters, who represent EMS, and the firefighters’ union will vote within the next two months to see who will represent the new third service.

“It’s never going to be easy,” says Abramson, “but we’re very excited about Dr. Richmond and the structure he’s putting together. I really believe that being medical data-driven is the way to ensure successful delivery of a service, and that’s what we hope to prove. We want Dr. Richmond to take this slab of clay and mold it into what we hope will be one of the best departments of its kind in the country.”

—MN