LOUISVILLE — Pendleton, Bracken, Owen, Henry and Robertson counties are among 17 rural Kentucky counties lacking advanced life support in their public ambulances, with sometimes fatal results, officials say.

        “It's a problem and a growing concern for a lot of people all over the state,” said Ashley Davis of the Kentucky Board of Emergency Medical Services.

        Rural counties with small populations often lack the tax base to pay the hundreds of thousands of dollars needed for advanced life support. Advanced life support includes hiring a paramedic and equipping ambulances with a heart monitor, IV bags, a drug box and breathing tubes.

        And poorer counties without colleges or technical schools struggle to find and retain paramedics who leave for better-paid positions in urban areas after training.

        “It hurts that you can't get people the level they need sometimes. Our hands are tied because we don't have advanced life support,” said emergency medical technician Dorvin Bush of Powell County.

        Powell County is one of the 17 counties lacking advanced life support. So is Trimble County. Trimble County ambulance director Sharon Law said in one case a couple of years ago, a 56-year-old heart-attack victim might have survived.

        The man was clinging to life as a county ambulance pulled up to his home. But the ambulance wasn't carrying the drugs and breathing tube needed to resuscitate him, nor was there a paramedic trained to use those aids.

        “He was dead by the time he reached the hospital,” Ms. Law said. “If we had a paramedic, we could have saved him.”

        The other counties that lack advanced life support in public ambulances are Bracken, Elliott, Fulton, Hancock, Henry, Lee, Leslie, Menifee, Owen, Pendleton, Robertson, Rockcastle, Todd, Trigg and Wolfe.

        To allow EMTs to provide more services, a bill has been introduced in the General Assembly that would give the state Board of Emergency Medical Services authority to create the classification of EMT intermediate. Such workers would be permitted to give IVs and administer certain drugs. To qualify, the workers would need nine months of training rather than the two years necessary for paramedics under the bill, sponsored by Rep. Jim Callahan, D-Wilder.

        Tommy Bryant, judge-executive of Henry County, said his county spends $200,000 to support six basic life support ambulances. With four hospitals all 20 miles from the county seat of New Castle, Mr. Bryant says not having paramedics is a major disadvantage.

        “It's always been a concern and always will be,” Mr. Bryant said.

        In Harrison County, it cost $125,000 last year to acquire advanced life support for the county's three ambulances, Judge-executive Dean Peak said.

        “We're thrilled to death to have it,” Mr. Peak said. “It was an expensive endeavor, but it was well worth it.”

        Judge-executives in rural counties say tight budgets make service upgrades difficult.

        Trimble Judge-executive Ray Clem said his county recently spent $350,000 just to upgrade from a strictly volunteer EMS to a paid basic life support service.

        “We're always concerned about getting service to people. There have been closer calls than we would have liked,” Mr. Clem said.

        The Board of Emergency Medical Services offers any county seeking to improve ambulance service a matching grant of up to $25,000 a year.

        But experts in emergency health care say the state is not spending enough to help ambulance services in places like Todd County, where there are no hospitals, doctors or ambulances with advanced life support.

        “If you don't have a hospital, you certainly need to have” advanced life support, said Larry Allen, a director at the UK Center for Rural Health. “For some reason, the state hasn't put enough money into EMS.”

        Because of the state budget crunch, the Board of Emergency Medical Services will have its budget of about $2.5 million cut by 5 percent, or $139,000, next year.

        Compared with neighboring states, Kentucky lags in the number of paramedics, whose salaries average $30,000 a year or more — double what EMTs make. The state has 1,400 paramedics, or one for every 2,800 residents. Tennessee has one paramedic for every 1,600 residents, and Virginia has one for every 2,300 residents.

        In addition, Tennessee, Virginia and Indiana already have the EMT intermediate classification, which lets workers provide additional services.

        State and federal efforts are under way to help remedy the problems in rural Kentucky.

        Grants to improve EMS services are available from the U.S. government, and Allen said the Center for Rural Health is working with the state emergency board to increase the number of hospitals equipped to deal with emergencies in rural areas.

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