Eastern Kentucky University was one of the first schools in the country to have an accredited paramedic program. The students they graduate leave to become paramedics all over the state. They train with real-world equipment on mannequins to learn proper techniques and standards. Because they know, practice isn't reality. And when real people are hurting, pressure is the biggest test they'll take.

In Powell County, a family sits around a kitchen table. One chair is empty. "Just a piece of my heart is missing," Elizabeth Hamilton told WKYT's Miranda Combs. Elizabeth's brother, 28 year-old Robert Hamilton, died last December. "He was my best friend."

Robert Hamilton was living and working in Powell County, but on December 6, 2016 he started having chest pains. A neighbor called 911. Medical reports state the Powell County paramedic that showed up let Robert walk to the ambulance, rather than on a stretcher. "If he'd had the proper attention, the paramedic would have never let him walk out of the house," Robert’s grandmother Marlene Hamilton said.

His grandparents met the ambulance on the side of the road. "The ambulance worker came back just shouting, 'Ma'am, is your grandson on drugs? Is he on drugs? Please tell me. This is no time to lie,'" Marlene claimed.

Robert’s grandfather, James Hamilton, said, "They were asking me if he done drugs, and I told them, 'No, he didn't do drugs. ' And they said, 'This is no time to lie,' that they wasn't the cops."

"They just assumed that it's going to be another overdose," Elizabeth, Robert’s sister said.

Robert died a short time later. Autopsy results showed no drugs in his system. It did show a blocked artery, which caused his death. His family said EMS messed up. "I feel like they was just treating him for the wrong thing," James Hamilton said.

"They're under-trained. They deserve whatever is going to happen to them," Elizabeth Hamilton said. "Something needs to be done."

The Hamiltons filed a wrongful death lawsuit. It names the paramedic that responded to Robert that day, and the Powell County Fiscal Court, which runs the county ambulance service. Attorney for the Hamiltons, Gerry Calvert, said, "It really raises the question whether EMS services across the state are taking the necessary steps to ensure adequate care when they call 911."

So WKYT took that concern back to EKU's paramedic program, and Dr. Sandy Hunter, a professor and expert in emergency medical care. "What I think is that there are a combination of issues," Dr. Hunter explained. "One is that these are people that are well-meaning who are not provided access to the best tools, the best education. That, plus once they get that initial license or certification to keep it up, it's difficult to do because there's little incentive and it costs money."

Dr. Hunter said every paramedic has to pass a national test to get certified to do the job. After that, besides required hours that are obtained every two years, it's basically up to each service to keep up to speed. But counties or the individual paramedics have to foot the bills for extra training at a time when county budgets are tight. "So any paramedic that has a license to practice should be at least minimally competent to not hurt you and to do the things they should to make you better," he said.