Pressing Issues: Q&A with D. Randy Kuykendall

A core function of a state EMS office is to protect the health and safety of the public by handling regulations and enforcing rules regarding EMS.

But D. Randy Kuykendall sees state EMS offices as more than that—they’re a voice for EMS at the state level and an advocate for the needs of the profession and its providers. “We’re a regulatory agency that also needs to function as the profession’s cheerleader,” Kuykendall says. “We feel it’s our job to do both those things.”

Kuykendall responded to his first 9-1-1 call on Christmas Day in 1974 while working as a volunteer firefighter in Las Cruces, NM. In 1981, he became the first state EMS training coordinator for the newly formed New Mexico Office of EMS and served as president of the Council of State EMS Training Coordinators during much of that decade. In 2004, he was appointed chief of the Emergency Medical and Trauma Services Section of the Colorado Department of Public Health and Environment. He was recently promoted to deputy division director of the Health Services and EMS Division, a role that includes regulating hospitals, ambulatory surgical units, dialysis and home healthcare agencies. Kuykendall is also in his second year as president of the National Association of State EMS Officials (NASEMSO).

Kuykendall recently spoke with Best Practices about the role of state EMS offices and where he sees the profession headed. The following excerpted interview can be found in its entirety on the Best Practices in Emergency Services website at

As president of NASEMSO, what do you see as the most important issues facing EMS?

At the top of the heap is the financing of EMS systems at the local level. Every state EMS director is constantly working to find ways to augment the reimbursement system, particularly in our rural areas, so we can keep services out there and find mechanisms to ensure that we have adequate resources to provide high-quality care and transportation.

The second thing is ensuring that we continue down the path of a standardized national system of care in EMS, including standardization of certification levels and scopes of practice and working continuously to have some level of consistency in medical direction and interoperability of communications.

The third issue is managing human resources. Do we have enough people? Do we have them in the right locations, and do they have the right training? You have to measure that against what the job is today, what it will be in the future and how EMS will fit into a changing healthcare system.

What would you say to people who accuse state EMS directors of being bureaucrats who are out of touch?

Those kinds of comments are not uncommon and tend to be easily aimed at public servants. Across the country, state EMS directors are a very interesting mix of highly educated, and in most cases, field-experienced people. When people make that accusation, they need to stop and ask themselves whether they are connecting to their state office. It’s a two-way communication. We are responsible from a regulatory standpoint. By the same token, the regulated community has a responsibility to be participatory in the regulatory process.

Community paramedicine is emerging as a hot topic. Where do you think this is headed?

It’s taken us a couple of years to get our head around what a community paramedic is, from a state and regional perspective. I think there is some real efficacy to it, if we are careful and thoughtful about how and where EMS is used in a home healthcare environment.

What’s your opinion about EMS training vs. education? Is EMS a vocation that requires the ability to do specific skills or a profession that requires broader knowledge and thinking skills?

Training is great for entry-level EMTs, but it’s not enough for paramedics. The most significant steps we as an industry have taken in the past two decades is to require paramedic program accreditation. As of January 2013, to sit for the National Registry paramedic exam, you have to demonstrate you have graduated from an accredited program. That is going to move our paramedic-level education into the world of education. In the 30-plus years I’ve been in the industry, it’s a huge positive step to improve and increase the level of education and to provide a truly rounded practitioner at the paramedic level.

Jenifer Goodwin is an associate editor for Best Practices in Emergency Services.