More on New Jersey EMS

To read all of my posts about the New Jersey State First Aid Council, and the struggles of EMS in New Jersey, just click here.

For more information on the NJSFAC click here.

Earlier this month, I had a friend from New Jersey send me the latest information sheet put out by the New Jersey State First Aid Council in regards to State Bills S818 and A2095.  While the bills are slowly gaining momentum with the current vote on Bill S-818 resulting in 21 “Yes” 15 “No” and 4 “Not Voting” as an official for the NJSFAC stated in a recent email, “The fight is not over.”  EMTs and paramedics that live and work in New Jersey need to understand the true fabric and importance of these bills.

The First Aid Council’s intention was to share their views which are in the form of oppositions to many of the amendments that were recently made to the bills.  Here is my rebuttal to a few of their arguments.  Please take a good look at this, especially if you are a New Jersey EMT.

FACT: The New Jersey State First Aid Council opposes the establishment of a new lead agency for EMS. 

For some reason, the NJSFAC opposes this amendment because it would give “. . . complete control over and all facets of EMS in the state including some that are already overseen by other groups. . .”  My question to this is: what’s the issue?

EMS is a fragmented profession, and New Jersey is no exception to this.  In fact, in many aspects the fragmentation of EMS is magnified in New Jersey.  In some states, differences exist in counties.  In New Jersey, the unique setup of each EMS system right down to staffing and equipment varies from town to town and squad to squad.  Rules and regulations vary depending on whether or not you are a volunteer ambulance service or a professional one.  In New Jersey, an ambulance is not an ambulance and an EMT is not an EMT.

Establishment of a lead agency for the state would create one entity for everyone to answer about everything.  Standardization could be developed.  Studies could be done.  EMS could finally be brought up to speed and out of the “roaring 90′s” where it has been stuck for close to fifteen years.

FACT: The NJSFAC opposes the establishment of agency medical directors but wants the scope of practice to be expanded. 

Am I the only one who sees this as a completely contradictory statement?  How can scope of practice be expanded without medical oversight?  How can treatments such as “Epi Pens, advanced airways, Aspirin, CPAP, and blood glucose checks” that the NJSFAC wants so desperately be implemented without someone to tell us how to do it and how well we do it?

A high performance EMS system thrives and grows with the participation of an active, aggressive medical director.  New Jersey lacks that, and it is time for that to change.

FACT: The NJSFAC wants to continue to have their inspections recognized as equal to New Jersey’s DHSS inspections.

This is a complete and total conflict of interest.  How can the NJSFAC be impartial when inspecting one of their member squad’s ambulances?  Why would the NJSFAC ever fail an ambulance from a member squad on an inspection when they are fighting so hard to maintain their position in the state and show that a different standard for volunteer EMS is the way to go?

Having a state agency inspect ambulances is far more appropriate.  They have no preconceived notions based on friendships, mutual aide agreements or hidden agendas like an inspector from the NJSFAC might have.

FACT: The NJSFAC opposes the mandate that there be two EMTs on every ambulance.

They oppose this, but only for volunteer crews.  Apparently, to the NJSFAC, a paid ambulance staffed by less than two EMTs or one staffed by an EMT and a paramedic is considered to be unacceptable.

An argument can be made that “there is only one EMT in back with the patient anyway” but there is a reason that these standards have been established elsewhere and in the state of New Jersey for paid services already.  The first time an EMT is forced to do a call with someone who is not adequately trained, they will realize what I am talking about.  Splinting, care, stabilization and packaging of a patient is ultimately two person jobs.

A non-EMT, based on the parameters set forth by the NJSFAC (driver’s license, EVOC class, and “complete review of the squad’s equipment”) lacks the training to assist an EMT.  Nowhere in there is training on how to interview a family, collect medical history, what information is important and what is not, how to properly restrain a patient, or how to hold C-Spine and rapidly extricate someone in a motor vehicle accident.  Any EMT instructor will tell you that skills such as using a KED and putting on a HARE traction splint require two trained providers, not one.  All of these activities are extremely important when operating as part of a team at the scene of a medical emergency.  You cannot expect one person to have to manage all of this.

Finally, I found this statement to be interesting:

“. . . we would like to emphasize that volunteer EMS has many EMT members who are employed in paid services.  We know that many continue to volunteer so the existing volunteer EMT training fund pays for their training.  If they were able to obtain their training without being a member of a volunteer agency, we believe strongly that there would be a significant number who would leave their volunteer squads thus adding to staffing problems already being experienced by the volunteer EMS community.”

I interoperate this to say that the NJSFAC hopes to strong arm paid EMTs into continuing to volunteer when they may or may not want to with a promise of free training.  The state, however, wishes to attempt to establish funding for all EMTs regardless of who they work for.

Imagine that: free training for everyone.  Not during the NJSFAC’s watch.  They oppose this.

How should volunteer organizations bring in paid EMTs?  How about by improving their organizations, or those organizations that represent them.  Back in the 90′s when I did EMS in Ocean County, both of the squads that I was a member of (Island Heights First Aid and Toms River EMS) were very highly regarded.  We had people from paid services that rode with us, but they were there because of the pride that they had in the service, not for free training.  I still have a lot of love for both of these departments and would gladly step back onto a truck in either service if I still lived in New Jersey.

The NJSFAC should work with volunteer services to help reinstate that feeling of pride its members had.  They should be working towards improving the quality of care performed by EMTs and the training that they should have.  They need to stop trying to lower the standards for ambulance staffing and participation in EMS.

Ultimately, it is time to move away from the volunteer vs. paid debate in New Jersey.  It is time to stop looking at their department patch on one shoulder and time to focus on the EMT patch on the other shoulder.  The EMS system in New Jersey has failed, and it is time to scrap it and start from scratch.  These bills are the first step towards doing that.

I am not opposed to volunteer EMTs, what I am opposed to is the establishment of different standards, practices and governing entities based on the type of department a person is affiliated with.  The NJSFAC stands behind principles that promote that.  They can blame the DHSS for failing to advance practices in EMS, and I agree with them that some of the blame rests with them, but the fact is, with their opposition to the currently proposed amendments, the NJSFAC is doing nothing more than holding EMS back, and I refuse to stand for that.

If you are a member of a volunteer service in New Jersey that is a member of the NJSFAC, let your squad know that you oppose their actions, and you feel that S818 and A2095 need to be pushed forward.  If you are an EMT or paramedic in the state who is not affiliated with a volunteer service, ask your employer what you can do to help support the bill or speak out to your local state senator or representatives whose hands the decision ultimately falls in.

Let’s stop the nit picking and the infighting and strive to move EMS in New Jersey once and for all.

  • Bucky

    Scott-
    Well stated, and THANK YOU for clearing up some of the propaganda that the Policital Action Group known as the NJSFAC is spreading. They hopefully are digging themselves right into the grave at this point. ONE voice, for the Patient in mind, and realization that one-size wont fit all is known. However, let the process work without scare tactics. This is needed… for EMS to survive as one!

  • http://twitter.com/MedicSBK Scott

    Bucky –

    Thanks for your feedback. I think many would agree that it is time for the NJSFAC to put aside their organization’s agenda and take a hard look at how patient care is being provided in NJ.

  • Roger

    Thank you for your obje give and insightful commentary.

  • Joyzgirl

    Well said, well written, well meant, Scott. Kudos!

    I was a volunteer at a Monmouth County squad in the early 80′s before becoming a MONOC Paramedic in 1986. I went on to become a Flight Paramedic and had an amazing and rewarding career in EMS. It’s hard to digest that some of the same problems and frustrations with the NJSFAC and the volunteer squads I had back then, continue. It is way past the time to end their political influence when done for the wrong reasons, power and money for their squads. I haven’t worked in NJ in a long time, but most of my family lives in NJ. It has always been a concern that the care that they might get depends on where they enter the EMS system; the inconsistencies between jurisdictions is frightening.

    As the conversation moves to a national EMS department with nationalized standards and a voice in the federal government at the national leve. so too does the conversation need to be moved towards state wide systems. The current, fragmentized systems and protocols in NJ do not best serve our patients. It’s time to move forward and this bill is an important first step in the process. Thank you for continuing to care about NJ EMS, Scott, many of my loved ones count on that.