is accessible through the 9-1-1 system. LMEMS employs an entirely full-time workforce of Kentucky-licensed Emergency Medical Technicians (EMTs) and paramedics (also known as EMT-Ps). Most employees maintain optional certification by the National Registry of EMTs, a national EMS accreditation association. LMEMS provides transportation to the emergency department of the chosen hospital. LMEMS does not return patients home nor does it offer transportation to immediate care centers or hospitals without emergency departments. All scheduled ambulance service and inter-facility transports are handled by private ambulance companies retained by the patient. Only under exceptional circumstances will LMEMS provide hospital-to-hospital transfers. Skills Louisville Metro EMS utilizes two levels of care providers. EMT-Basics (referred to as technicians or EMTs) and EMT-Paramedics (usually just called paramedics) have drastically different scopes of practice but all exist to provide care and transportation to the sick and injured. A technician specializes in ambulance operation and basic life support care as well assistance to advanced providers. Most technicians have an initial six months of training receiving at least 110 hours of formal classroom training, often reaching or exceeding 120 or 168 hours, with some training institutions requiring initial unspecified numerous clinical hours within a hospital. Basic Emergency Medical Technicians are required to pass skills training and are required to challenge the National Registry of Emergency Medical Technicians exam to become NREMT certified. Paramedics use complex diagnostics, perform medical procedures, and administer medications and additional advanced care that would otherwise only be provided by an emergency physician. Paramedics in Kentucky generally have three years of initial training including at least 750 hours of internship and clinical instruction in addition to about 1200 hours of formal, classroom instruction. An increasing number of paramedics possess at least an associates degree, many have bachelor's degrees. Technicians are trained to operate independently of a paramedic, and when such situations arise they are capable of caring for and transporting any medical emergency to the hospital on their own. Although the Kentucky Board of Emergency Medical Services allows for the use of EMT-Intermediate providers, LMEMS does not utilize this mid-level of care provider. Structure Ranks LMEMS is a subordinate entity of an umbrella organization called Emergency Services. LMEMS is headed by the director who serves as the agency head (much like a commissioner). This organization follows the structure of the United States Military. When wearing an EMS uniform the director of emergency services wears the silver eagle