EMS in New Jersey – A Call for Action

Almost a year ago, I wrote a post about NJ State Bill S-818 which was set to change the landscape of EMS in New Jersey.  In the year since that article was written, the bill and a second one also making its way through the New Jersey legislature have been revised, but the opposition has remained.

I got my start in EMS at the Jersey Shore on a small volunteer first aid squad.  We ran, on average, around 400 calls a year, pretty busy for a town of our size.  Often times, it was not uncommon to have two or three, or sometimes even four EMTs standing in your living room in my town ready to render you emergency care.  The communities around us were no different than we were.  We all took pride in what we did, and knew that we could deliver better service than any paid provider who came into the area because we held ourselves to a very high, very professional standard.

To this day, I am still proud of my accomplishments as a volunteer.  I was an active member of two excellent services, and the staff of those services taught me to be the caring, compassionate, knowledgeable provider that I am today.  My roots in New Jersey run deep, and I have been very troubled by what I have been reading lately.

As time has progressed, and the political and economic climate in this country has changed, volunteer EMS has taken a turn, and is not as prominent as it was even ten years ago.  Families are working harder to support themselves, and the call volume and expectations of care have grown and evolved.  Some might say that these factors spell the end of volunteer EMS, and I hope every day that it isn’t the case.  It’s not the time to expect less from our volunteers; it’s time to expect more for our patients.

Sadly though, the New Jersey State First Aid Council seems content with the past.  Their staunch opposition to Bill S-818 has taken the focus off of where it needs to be: the patient and put their stress on what EMS is about on the provider.  The argument of “you should want us to do the job because we do it from the kindness of our hearts” just doesn’t really fly for me anymore.  There are people’s lives at stake, and they deserve the best.

I took some time today and checked out a few websites, the first, of course, being the most recent revisions to the two bills relating to EMS in New Jersey: S-818 and A-2095.  As I stated in my previous blog, this bill is a direct result of the study done in 2007 which showed many of the flaws in the New Jersey statewide EMS system, and made suggestions on how to fix it.  Over the course of the last year, this bill has undergone many changes in an attempt to please its opposition and get it passed.  Some of these revisions are good, such as the requirement of background checks for prospective EMTs, and some of them, well; they’re not so good, like the reduction of minimum ambulance staff to “at least one Emergency Medical Technician.”  That’s right, an ambulance with an EMT, and a driver.

My focus then turned to the State First Aid Council’s website, and their interpretation and opposition of the bill.  Certain arguments seem a bit strange to me.  They seem more concerned to maintain the status quo, and are content with regressing to BLS care that was provided twenty years ago, instead of progressing forward, and expecting the best out of their EMTs.

A governing body, statewide standards for patient care, medical oversight in the form of a medical director for each and every service in the state, technology to help dispatchers make sure the closest unit is being dispatched to an emergency, and background checks for EMTs.  I fail to understand how any of these would do anything except for improve patient care and make sure that we have the best possible EMTs on the streets.  The only argument that the NJSFAC seems to keep putting out there is “unfunded costs” and concerns about money for volunteer services.

How about it, New Jersey?  What is truly important?  As I perused the State First Aid Council’s position statement on S-818, I noticed something interesting: the word “patient” is mentioned three times in the entire document.  Each instance of the word has to do with the rationale behind having one EMT instead of two caring for a patient.  There is no mention of putting the patient first, or any documentation on how the State First Aid Council’s oppositional statements would improve the care provided to the sick and injured of New Jersey.  As a matter of fact, the phrase “patient care” appears only once in the entire document:

. . . we recommend that at a minimum, a volunteer crew consist of 1 EMT who will be responsible for patient care and 1 certified driver.”

That’s it.  They recommend less trained providers care of the sick and injured of New Jersey.  The intentions of these bills are to improve EMS in the State of New Jersey.  How exactly does having less trained responders improve patient care?  Their intentions are made clear though, they are concerned about a potential decline in the number of volunteers state wide.  That’s the PC way of saying “we are putting the providers before the patients” and that really upsets me.  Instead of going out in search of high quality EMTs and providers to serve in their systems, the NJSFAC is content with saying that they can do the same job they did ten years ago with less man power, and less training.  Translation: they are moving backwards.

The time is now to raise standards and demand more out of the potential care that could be provided and bring New Jersey’s EMS system more in line with other systems around the country.  I’m shocked that more volunteers are not coming out in support of these bills.  Part of being in EMS is having a degree of passion that enhances one’s selflessness.  Doing this job out of the kindness of your heart requires that.  It requires a person to put the needs of themselves and sometimes their family aside for someone who might be a complete stranger.  It’s supposed to be about the patients.

When my loved ones are in their time of need, I want the best possible providers to be there caring for them.  Great patient goes beyond the patch on someone’s shoulder; it has more to do with the person that is providing the care.  That person might collect a pay check for what they do, or they might just be doing it out of the kindness of their heart, but in order for that person to be capable of doing that job, they need standards, they need regulation, and they need medical direction.

Do you agree with me?  Let me know!  Do you disagree?  That’s fine too, I want to hear why.  Please share your comments below.

Websites related to NJ Bills S-818 and A-2095:

www.supportnjems.com
www.njsfac.org/s818.shtml
www.supportnjems.com/assets/docs/A2095-021210.pdf
www.supportnjems.com/assets/docs/S818-011210.pdf

Finally, show your support for NJ Bills S-818 and A-2095.  Put the patients first:

www.supportnjems.com/takeaction.cfm

  • Joey Rubba, MICP

    Scotty…New Jersey is, as a whole, a very progressive state within our various industries to include medicine. I ask the voters of New Jersey why you would advocate allowing an inferiorly skilled technician enter your nightmare and not have the skills needed to appropriately treat you? More so, why isn’t the commissioner of health interceding to protect the citizens of New Jersey?

    In the era where acute onset of congestive heart failure is treated in your home and patients are significantly better upon arrival at the hospital of THEIR CHOICE, when the new EMT-B criteria being piloted now was actually the standard when I took my first EMT-A class in 1981, and when ambulance manufacturers are creating safer patient compartments, why would the NJSFAC lobby for digression? For your readers who are not familiar with the most recent of these acts; the EMT-B recertification period was changed from 3 years to 5 years! In addition, A-2095 will permit NJSFAC the right to inspect and certify it’s own member’s ambulances and every other agency will need to be inspected by the current overseer, NJ OEMS. So A-2095 will allow a political coal-fueled engine who is advocating archaic medical practicies through it’s lobbying efforts, to self-inspect the safety of their members ambulances. Am I the only one missing the objectivity.

    What concerns me even more is that NJ OEMS is considering changing the EMT-B scope of practice to include an alternate airway (LMA or KING Tube) and administration of medication, above and beyond epi-pens, which, if not screened appropriately by a skilled provider, will cause significant harm to a patient. You yourself attested that you and your family are from a small community with a relatively small call volume. The big question is where the skill proficency will be with such infrequent exposure like you had growing up?

    Scott, I can rant on-and-on but the real fact of the matter is that a handful of unsuspecting politicians votes were able to influence to accomodate a political agenda which is nothing new, just new to our slice of the world. New Jersey Legislator needs us to help educate them to our system and what the national standards are and how the current course of this bill will have almost certain negative impact on their constituents. Instead of complaining, I will offer an avenue for a solution. Educate your legislator or their assitant and tell them how you feel about S-818 and A-2095 by going to http://www.njleg.state.nj.us/members/legsearch.asp

    As you do, I welcome opposing as well as supportive comment but have your facts and figures ready to go and please educate me, not tell me the error of my ways

    Joey

  • Margaret

    Joey, where in the bill do you see that NJSFAC will substitute for OEMS inspection ?

  • http://medicsbk.com Scott

    Hi, Margaret. In the past, my personal interaction with the NJSFAC has painted them in a light where they act as a buffer between a First Aid Squad and the NJOEMS. Other than the occasional regional meeting that I’d attend, I would see the NJSFAC when they would come to our squad to do their annual inspection which paled in comparison to what I’ve seen from organizations in other states.

    The entire pitch by the NJSFAC is to substitute themselves for OEMS in an attempt to preserve themselves and the volunteers that they serve. I fear though that patient care will suffer as a result. That’s what happens when you put the preservation of the provider before the well being of the patients being served.

  • Tony

    Having participated in one of the focus groups as part of the study and sitting on the committee that crafted the proposed legislation I have some perspective on this legislation.
    The legislation if passed will be an improvement for the patients and stakeholders in NJ, though it could be better.
    I believe this legislation needs to be marketed broadly, not just to EMS personnel but end users like senior citizens. In hindsight we should have held town hall meeting around the state and on the web to have open discussions on this proposed bill. It is still possible to do.
    What disappoints me with the First Aid Council is, it appears they don’t realize their organization will continue to dwindle if they don’t take some modern steps to provide leadership to their member agencies and medical service to their communities. Having an active role in managing a volunteer agency in NJ,I have taken time to find out what the common themes and trends are the keys to success in a volunteer organization. It is good leadership, positive human resource development, partnering with other organizations to share responsibilities and looking for innovative ways to deliver service. The models for these types of organizations can readily be found in the volunteer emergency services world, as well as organizations like the Red Cross. None of these models advocate status quo. I have spoken a few times to the NJFAC leadership on this issue. We respectfully agree to disagree on some items, but we actually have a lot of common ground.
    I believe it is still time to have a open dialogue within our state to move this legislation to the next step. We need to get out in the open the specifics to how this legislation will benefit the end users and taxpayers, as well as have those concerned with this document to provide the specifics to how it will hurt their organizations.
    To move this legislation forward, we need to make sure it will encourage EMS to move forward and morph to continually provide better EMS service to our constituents, in a cost effective manner. Billing a ALS pt. $1800.oo is a not very cost effective. Cost effective is putting CPAP and nebs. on BLS units.
    Additionally, as part of this bill we need EMS to be recognized as a true profession, with commensurate pay and benefits. The key to this is to demonstrate how EMS provides a Outstanding Return on Investment for those paying for the service.
    Scott it is a shame you now only have 4 posts on your blog. It is important that we, the EMS community make this a prime discussion at every event we participate in, to vette out the pros and cons. This will also allow us to create a larger network to get involved with this legislation. Quite frankly moving or getting this bill killed is all about relationships and right now the NJFAC has done a great job connecting through their relationships. During national EMS week this should have been and still can be the major topic of discussion, directed to the public at large.
    I also believe the various blogs from NJ EMS to share and connect. I would recommend you go to: http://theemsblog.com/ to read their messages and share your concerns and recommendations for improving NJ EMS.
    I just spoke to our state senator last night on this very topic. She listened intently, but the NJSFAC took their time to sit down with her early to get their points across and build relationships.
    It’s time the rest of the EMS community did the same.

  • Rich Neurouter MICP 1838

    Well Put!

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