The Revision of EMS in New Jersey

As some of you may or may not know, I got my start in EMS in the state of New Jersey, and more specifically at the Jersey Shore.For the first 8 years or so I was an active member with two different Squads servicing Ocean County.I still have family and friends in the area who are very active in the EMS Community.

New Jersey possesses some unique issues when it comes to Pre-Hospital Care.A large amount of the system State wide is still Volunteer based at the BLS Level.ALS Services are limited, and must be hospital based or hospital affiliated, and largely participate in prehospital care as non-transporting units.

While there is a State EMS office, it is often rivaled by the New Jersey State First Aid Council which advocates for what it feels should be beneficial changes to the EMS system in the state to keep Volunteer EMS alive.Membership in the NJSFAC is not mandatory, but they expect departments affiliated with them to maintain the minimum standards they set.

As time goes on, more Volunteer departments are having a tough time getting rigs on the road to care for the sick and injured.As a result, many municipalities are starting to turn to paid ambulance services or Municipal Third Service or Police Department affiliated EMS systems.The NJSFAC’s solution in response to this problem though is to lower the required level of care on most ambulances within the state from a mandatory 2 EMT staffing to one EMT and one First Responder/Driver.

Paid ambulance services, municipal or not however, are required to have a minimum of 2 EMTs on each truck.

While speaking with family today, I was told that they had a conversation with one of our New Jersey State First Aid Council representatives who voiced his displeasure for pending state bill S-818, seeing it as something that could potentially destroy the Volunteer EMS system in the State of New Jersey.Intrigued, I decided to take a look at it for myself.

NJ State Bill S-818 was developed in response to a state-wide EMS study that was conducted in 2006 and released in 2007.It is a 150 page document that outlines the accomplishments and short falls in the NJ EMS System.I’ve read it, and I feel that it is a pretty accurate depiction of EMS in New Jersey.State Bill S-818 is designed to fix a lot of the problems outlined by this report.

A few of the major changes that I saw when reading through some of the bill (I have not reviewed the full document yet) is the development of a more structured, accountable EMS system in the State of New Jersey.It calls for the development of response time criteria, more strict training criteria, and increased clinical guidelines developed by state-appointed committees and boards.It also appears to address staffing levels, and requires a minimum staffing of 2 EMTs state wide.Simply put, State Bill S-818 redefines how EMS will be done in the State of New Jersey in the future, and makes a strong attempt to move it forward.

A few of the contested points cited by the NJSFAC are the proposed minimum staffing changes, and more prominently the omitting of the word “Volunteer” from the Bill.I say go for it!Lets break down the barriers between Paid and Volunteer EMS in New Jersey and hold us all to the same professional standards.An EMT is an EMT, and a Paramedic is a Paramedic.The NJSFAC just sees the omittion of this word as a way to galvanize its membership against Bill S-818.

Will this bill have a negative impact on Volunteer EMS in the State of New Jersey?Yes, it potentially will.But it also develops standards for a State that has seen little to no changes in BLS Care and standards in the last 15 years that I have had some involvement in New Jersey EMS.The system is falling apart, and something needs to be done.Throughout the nation, EMS Systems are progressing at all levels.BLS Care is advancing, while in New Jersey, CQI and Chart Review is lacking, documentation is lacking, training standards are starting to slip, the quality of provider is slowly starting to slip, and if the New Jersey State First Aid Council has its way, staffing requirements would probably be reduced even more.

In my opinion, the NJSFAC is overlooking the greater good and doing nothing but looking out for its own organization rather than the communities its Squads provide for.Reducing staffing levels to one EMT and one first responder does nothing but move EMS towards the stone age.While often a patient can be cared for by one individual, both should know the job, and know what to do, and as a result, both should have an EMT Card in their pocket.

Standards of Care is what New Jersey needs, not the mediocre, fragmented system that it now possesses.Having an actual State Agency with the best interest of the people of New Jersey in mind is exactly what they need.It will push for the changes and progression that New Jersey needs to take its Statewide system to the next level, and hopefully let them catch up to the rest of the country.

To read the NJSFAC’s view on the Bill, follow this link.

To read a summary of Bill S-818, go here.

As always, your comments are welcomed and encouraged.What does everyone think?

*** On June 17, 2010, I made some corrections to this post thanks to a couple of observant readers. My comments that the Training Fund was being eliminated were incorrect. It is, in fact, being increased. Thanks to my readers for pointing this out to me! ***

  • Jon

    You are spot on. The training fund is good… and should be kept, if it can be funded.

    I am astounded at the sheer number of volunteer squads, each serving a small town, or a small part of a town, almost always with a yearly call volume below 1000, often below 500… and they have two or three ambulances. A single paid ambulance, with access to PAID mutual aid, could probably replace 5 of these squads with no change in response time or care.

    Speaking of response time – will the statistics count time from dispatch to response, while the volunteers drive to the garage?

    Also, I have always been irritated that when I cross the bridge into NJ, I become a BLS provider, even though I'm a medic in PA. I think that eventually that battle will be won by Cherry Hill Fire… they have a EMS workforce that has a large amount of folks trained as paramedics at this point.

  • Anonymous

    One thing that I have to say is not true per your review is the elimination of the EMT Training Fund. It's not going anywhere, just being renamed, more funding (more than double) will be put into it from traffic offences and motor vehicle registration, and it will be accessible to BOTH paid AND volunteer providers. Also, it has a provision to allow people to go to paramedic school interest free with repayment provisions if they so choose to do so.

    As for Cherry Hill, I don't see it happening. ALS will always be provided by hospital based systems, HOWEVER, this bill is written to be very broad without many specifics which will be left to policies and other enabling legislation. With that, I wouldn't be surprised that the EMT scope of practice is increased to allow EMTs in progressive departments to perform other skills, to intervene until ALS arrives. This is all in the new National Scope of Practice, which this bill, will allow NJ to progress to as it is written right now.

    It's a step in the right direction. I for one can't understand how a private organization has authority over a state government department which REGULATES delivery of medical care, other than those ambulance squads that don't bother to be licensed. Unimaginable, only in NJ.

  • Margaret Keavney

    I worked on the bill as part of the EMS Council's redesign subcommittee. Establishing a uniform standard for every 9-1-1 provider was very important to the group. The law would no do away with the training fund, it would expand it – collecting more money and allowing more people to access it. Why do you think they are doing away with the fund?

  • MedicSK

    My apologies. I just reread some of my sources and my interpretation of the NJSFAC information was incorrect.

    I am REALLY glad that the training fund is remaining. I am definitely in favor of it, and of the changes that this bill could bring to EMS in NJ.

    Thank you both for reading my post, and for correcting my inaccuracy.

    Be safe out there!

  • Anonymous

    Actually (and sadly) the NJSFAC recommendation of one EMT and one First Responder would represent a real improvement (and strain) for many volly squads and departments. I personally know of many squads where the only requirement is a CPR card – mine is one. That should simply not be acceptable.

  • Anonymous

    The standard should be 2 EMTs. I don't understand how the NJSFAC is still balking at this idea, since the redesign committee is giving them 10 YEARS to phase over their members to EMTs. Not to mention, they're even allowing those who have EMS experience but no EMT card to take a "bridge" course to allow them to become EMTs. Oh, and did anyone mention that there is an Online EMT program run by Camden County College that makes it yet even easier to become and EMT. Running out of excuses guys.

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