Apr 11, 2017
Last week, the Asbury Park Press posted a letter to the editor entitled “Letter: Emergency response teams must have volunteers.” The piece was written by John Bendel, a town councilman from Island Heights, NJ; the same Island Heights, NJ where I got my start in EMS more than twenty years ago. John’s letter is a reply to an editorial done earlier in the week called “EMS system deadly hodgepodge” which addressed several the shortcomings of New Jersey’s EMS system, many of which were identified more than ten years earlier by a study done about the state’s slowly dying prehospital care system.
To say the least, Mr. Bendel’s letter sparked a fire in my belly. I wanted to address some of the points that he attempted to make here.
“Sure, it would be nice if every Emergency Medical Technician (EMT) were as qualified as the legislation you endorse would mandate. But if they were, far more would be paid professionals than volunteers. In America where health care still bankrupts families, that’s a big deal. We need volunteers.”
Let’s address the semantics of this statement first. “Health care” is not bankrupting families. Many have begun pointing out that it is health insurance that is doing this. Skip Kirkwood has taken to frequently correcting people telling them that what they are seeing is attempts at health insurance reform, and not health care reform. He’s right.
Now, on to the meat and potatoes of this statement. First, what is the issue with creating more jobs, and putting more money, and insured individuals, into society? Why is it so bad that some would like to see people compensated for the hundreds of initial training and numerous hours of refresher and continuing educational training that EMTs are required to do? Career EMS providers (because professionals can be paid or unpaid) guarantee that someone is going to be there when the tones drop. Volunteers cannot always make that same assertion.
And let’s talk, for a second, about the chain of survival that drives health care. With the exception of bystanders, every other link in that chain is staffed with employed, compensated individuals. Nurses, doctors, dispatchers, people who work in rehab centers, the list goes on and on. Why must prehospital providers, the ones who have the greatest impact on survival in many medical emergencies, be asked to donate their time? Where is the cry to have doctors and nurses volunteer their time in the hospital? That would create a much bigger savings for the economy when it comes to health care.
“But rising state requirements for EMTs are responsible in large part for thinning volunteer ranks. What you suggest would thin them further, putting many squads out of service altogether. Your editorial calls that assessment put forward by volunteer groups ‘questionable.’ But there is no better group to know than the volunteers themselves. Their analysis is not questionable at all.”
Firstly, state requirements often trickle down from national standards. I would assume that New Jersey is no exception to that. The only difference between a person having a heart attack in Massachusetts and one having a heart attack in New Jersey is how the medical community, specifically EMS, responds to it. Our industry is terrible at setting expectations for specific levels of care, but these standards are a start.
One of the biggest issues with the EMS Council of New Jersey, formerly known as the New Jersey State First Aid Council, is that it is largely self-regulated. That is a dangerous road to go down. Why then, does MONOC, a multi-million dollar non-profit company affiliated with many hospitals throughout the state, still have to subject themselves to the requirements and inspections of the State of New Jersey? Why aren’t they able to self-regulate?
The EMSCNJ is an organization that squads throughout the state are not required to join. Why should its members be exempt from state inspections just because they pay dues to this organization? How, exactly, does that make sense? And how is their self-assessment not open to the scrutiny of people who might know a bit more about the industry than they do? Since it is a voluntary organization, wouldn’t over scrutinizing a department risk pushing them out of the EMSCNJ, reducing incoming dues and putting the “safe space” that they have created at risk?
“But assuming we won’t mandate a heart surgeon and orthopedist in every EMS squad, there is a point at which those requirements begin to do more harm than good.”
Let’s first ignore the absurdity of this exaggeration. Can we get a citation to back up the statement that “there is a point at which those requirements begin to do more harm than good?” I would assume that is just the opinion of the author.
Assume for a moment that the state did mandate a heart surgeon and an orthopedist for every EMS service. And let’s further assume that every squad in the state could get those doctors to staff their ambulances. And let’s say that cardiologist grossly misdiagnosed a heart attack as GERD, and mistreated the patient. Would the excuse of “he’s just a volunteer cardiologist” be an acceptable one? I highly doubt it.
“. . . local volunteers often know the people they’re dealing with personally. They’re aware of conditions and sometimes of otherwise routine medical steps that could be harmful.”
Again, citation please! Volunteers knowing who they care for is a double-edged sword. One situation comes to mind where I once responded with a crew of four people to a cardiac arrest in a residence in the town where I lived and Mr. Bendel currently resides. One of the EMTs on the truck had to remove themselves from the situation and was rendered ineffective on the call because the person we were performing CPR on was a friend of theirs.
I can also think of other situations throughout my career where taking care of one of your own, be it friends, family or colleague, results in providers sometimes rushing and things not going nearly as well as they should and could. Turning off the emotions of taking care of someone close to you is a difficult thing to do, even for those who are highly trained.
Take that a step further. I worked for twelve years in Massachusetts, where I did not grow up, and for a time, in a city where I did not reside. I currently work in an area where I do not live. Does that make me a less effective paramedic because I do not have intimate knowledge of the people that I am asked to care for?
Ultimately, what it comes down to is the EMSCNJ needs to pump the breaks on their push for different and often lower standards for volunteers, and people in positions like Mr. Bendel’s need to get a little more information before they hop on the EMSCNJ’s bandwagon. It does not matter what patch a person wears on their one sleeve, whether it says MONOC or Island Heights First Aid or Toms River EMS or any other department in the state of New Jersey. What matters is the patch on the other arm that says EMT. Regardless of the writing on the side of the ambulance, and regardless of whether that person collects a paycheck because of that response or whether they are volunteering their time, the citizens that they serve deserve the same level of care.
That means the providers need the same level of training if they want to keep a card in their pockets and continue to practice medicine on the unsuspecting public. I’ll just throw that quote out there yet again: “your chances of surviving a medical emergency should not be dictated by your zip code.”
If Mr. Bendel would like some education about what prehospital care actually entails and why the system in New Jersey is so fractured, I’d be happy to sit down and discuss it with him. I’ll even buy the first cup of coffee.