Doctor to lead Louisville's consolidated EMS
By Robert Davis, USA TODAY
In an effort to save more lives in emergencies, Louisville Mayor Jerry Abramson is revamping his emergency medical system and putting a physician in charge.
In most big U.S. cities, doctors have little authority to make changes to emergency medical services (EMS), even though paramedics work under their medical direction, because emergency services are controlled by the fire department. The result is that a firefighter can have more influence on how a paramedic delivers care than the physician who is medical director.
Louisville is trying to create a new national model of EMS design.
Abramson appointed Neal Richmond, now deputy medical director for the New York City Fire Department, as chief executive officer of the new Louisville Metro Emergency Medical Service. Richmond will report to the mayor and have sweeping powers over other emergency officials, including the fire chief.
Abramson says he was inspired by a USA TODAY investigation that found emergency services in the nation's 50 largest cities were fragmented, inconsistent and slow. Thousands of lives are needlessly lost each year because of failures in these systems. (Related story: Six minutes to live or die)
At the root of the failures are often long-running feuds and turf battles between ambulance medics and firefighters, the investigation found.
Louisville was not included in the newspaper's investigation because at the time it was ranked 66th by population. But when the city and the county merged in 2003, Louisville became the nation's 16th-largest city, bypassing Washington, Seattle and Boston.
"This historic moment of our consolidation of our city and county gives us this opportunity," Abramson says.
EMS would have been changed in some way, no matter what, he says, but the USA TODAY investigation served as a blueprint.
"We want our system to be driven by data, driven by medical focus, and driven by an emergency medical physician," Abramson says.
Life and death is decided within six minutes in most cases of sudden cardiac arrest, so the person who reaches the victim first with a defibrillator has the best chance to save his life. Deadly delays occur when 911 calls are bounced from one emergency operator to the next in big cities where every service has its own dispatch office.
Abramson has removed the ambulance service from the fire department, undoing a merger he had created years ago, although firefighters will still rush to medical emergencies as first responders. And the city is renovating an old bank building to create a single communications center for all emergency crews.
"The mayor and his Cabinet are extremely knowledgeable," Richmond says. "They understand the issues here."
Experts agree, however, that Richmond could face obstacles.
"Some people will be naturally suspicious that a physician will have some operational control over some aspects of the fire service," says Marshal Isaacs, EMS medical director for the San Francisco Fire Department. "Dr. Richmond is in for some challenges."
Dan Danzl, who heads the emergency department at the University of Louisville, where doctors now oversee the city's emergency medical care, agrees.
"He's going to have his job cut out for him," Danzl says. "But I don't see anybody lying low hoping it doesn't work. It looks like everybody is enthusiastic."
Especially the mayor. "This is about saving lives," Abramson says. "It's not about the status quo."