EMS System in NJ

With permission – the following is an email from a paramedic with whom I have a great deal of respect for. á He and I have had conversations regarding the state of EMS in New Jersey. á Fear of reprisals from his employer is the reason his identity having been removed from this email. á This Paramedic has also discussed the number of other New Jersey paramedics with similar frustrations. áWe have also discussed the issue of this individual coming on-board under an alias and using this blog as a conduit and public forum to help institute change to a very broken system.

This paramedic’s email follows:

Hey Jordan,

I thoroughly enjoyed reading your blog. áI can certainly understand your frustrations with the system since you are a direct recipient of the final product as the squads roll into the ED each and every day. áI myself am appalled by the way things are run, particularly in clinical oversight, education length and quality, as well as policies and procedures. Unfortuneatly, there is nothing, you, I, nor anyone at the Department of Health level can actually change, due to the restrictive legislature that gives us the authority to operate is antiquated and limiting in it’s wording, rather than being enabling and progressive.

What really blows my mind is that the system we currently operate in does not mandate any minimum standards for providers (mainly BLS, as ALS is in my opinion OVER regulated), does not require an ambulance to be licensed by the Department of Health nor meet any minimum standards, nor mandate minimum response times. áBetter yet, EMS in New Jersey isn’t even considered an essential service like police, fire, and municipal services are. áIt’s simply, sickening.

Like I told you, there is a bill that we are trying to pass which will overhaul the EMS system in NJ, and change A LOT of things. áThis is in response from a outside consulting company that spent quite some time in the state, auditing the way our EMS system is running, and what we can do to improve it. áI have included a copy of the report as well as a copy of the bill, which is a response to the system report in this e-mail. áIn a nutshell, the report stated that the NJ EMS system in a “state of near collapse.”

The main opponent to this overhaul bill is the New Jersey State First Aid Council, which we so affectionately call “The First Grade Council.” áI am thoroughly convinced that they are the sole reason EMS in NJ is so backwards and antiquated. áIf they are allowed to maintain any type political or lobbying power, there is no way we can progress into the 20th century here, let alone the 21st century. áThey oppose a two EMT minimum standard, increasing the amount of time an EMT class takes to complete (we’re trying to comply with the new National Scope of Practice with this bill), allowing the Dept. of Health full authority over the operation of an ambulance, as well as many other things. áToo many to list actually. However, if this passes, the Council will basically be rendered powerless, and we can finally move on, without them.

Here is a link to the TriData report that was done on the EMS system a few years back. Verrrry interesting.

http://www.state.nj.us/health/ems/documents/ems_study_report.pdf

Here is a link to the bill they want to pass. áThey’re hoping to put it in front of the governor by the end of the month. But don’t hold your breath.

http://www.njleg.state.nj.us/2010/Bills/A2500/2095_I1.PDF

Here is a link to the website that all the stakeholders in the new bill setup in support of the bill.

On the “The Issue” page, there is a short commentated video that explains what the bill is going to accomplish.

http://www.supportnjems.com/

I hope this gives you some interesting reading. áTalk to you soon!

->Signature and Name withheld.

11 Comments

  • Undoubtedly, one of the best article l have come across on this precious topic. I quite agree with your conclusions and will eagerly look forward to your coming updates.

  • Sam Pagliantino, MD FACP (+ Vol. Firefighter & EMT-D says:

    NJ has a longstanding tradition of just horrible pre-hospital emergency care. The NJ First Aid Council has great conventions, but has consistently stood in the way of improvement in education, standards & equipment. They were the sole “overseeing” entity that represented most of the volunteer first-aid & rescue squads in the state of NJ for nearly half a century.

    They developed the infamous “Five-Point” system of training/certification that was the sole requirement of most of the squads for most of that period of time. The “Five-Pointers” were trained with 5 individual (primitive and only a few hours each) courses of study —> CPR/First-Aid/Emergency Childbirth/Vehicle Extrication/Emergency Driving.

    An additional 2 modules were later added: Advanced Fund Raising / Political Lobbying & Strategies. ROFL.

    As an example of this fine, in-depth training, the “extrication course” consisted of a single day playing around with some primitive hand tools at a staged MVA, followed by removal of the patient via a long spine backboard. When *I* took this course, we actually used cloth cravats to secure the patient to the board. (secure=patient sliding around while actual sandbags slid about the cervical spine area. There was no use, or even introduction to — modern tools & techniques.) As a “first aider”, I guess that hands on Hurst “Jaws of Life” tool use was not really required, but interaction with the entity actually handling the physical extrication (typically the local vol. FD) would have been a great way to teach this course.

    I first joined the “Youth Squad” of my local volunteer first aid squad when I was 16 and was told to take the NJFAC 5-Point classes to fulfill my training requirements. (Even though it was 1981, it was still a JOKE!) I did this, and during the process met a great gal. She was a MICU Paramedic from St. Barnabas Medical Center’s “Medic-IV” and really on the ball. She convinced me that my time was being wasted on the training that I was undergoing at the time , and she recommended the newly instituted EMT-A training program. (At the time, it was about 80-100 hrs. or so… compared to the 5-point program’s 10-20hrs) I subsequently signed up in Newark at UMDNJ (College Hospital for you old folks ) for their newly developed course. (after convincing my folks that it was a worthwhile endeavor — and promising my mom I’d continue to pay attention to my school studies and would continue on to med. school )…

    I was one of only a few EMT’s on the squad that in my hometown and it was painfully obvious that, I — at age 16, had significantly more emergency care knowledge than 95% of the other members! Plus.. I had met a few hotties that were riding on a volunteer squad in the [poorer city section] and began to hang out with one of them at their HQ on the weekends, and then joined up to get “hands-on” trauma experience. I managed to rack up more calls (ranging from gunshots to mva’s to “Dun-Fell-Out” calls) in a night than I would get during a month’s worth of Thursday nights in my hometown. (both squads were “live-in” — with sleeping quarters and full-time staffing. – NO Plectrons or Pagers for me ROFL. + cell phones didn’t even exist back then)

    Even with the level of training compared to today’s standards, EMT’s and MICP’s were generally considered to be trained quite well compared to the 5-Pointer’s, who were quite often referred to as “5 POINT *UCKS”

    Bottom line. After doing this for over 25+ years now, I have come to the conclusion that I will have my wife or kids take me to the ER if I ever need emergency medical care. The local squad where I live now is staffed by EMT’s (ONLY because the laws changed and it’s now required — and believe me, they ALL fought the enhanced training requirements). They take 30-40 minutes (and tons of “pages”) to get a rig to my neighborhood during the daytime hours and 1/2 of the time, there is an untrained (usually a DPW worker or garbage man) driving the ambulance with a semi-skilled EMT in the back handling patient care.

    BUT.. the paid services here in Jersey are even worse. The private ambulance staff that I see coming in to our ER look like they just got out of prison… and our nursing staff usually struggles to understand ……… them. Arghhh! Tough call.

    I don’t know where we are heading, but it doesn’t look all that promising… and just wait until [Healthcare reform] takes effect [deletion] We ALL know that it will effectively destroy modern healthcare as we know it!

    Well.. I know that I will surely be busy in our ER for many years to come and will probably end up on food stamps just as soon as my wife pays off her med. school loans (she’s a doc too — and works alongside me to keep my eyes off the nurses — ;) )

    Great site Doc. Keep up the good work.

  • Sam Pagliantino, MD FACP (+ Vol. Firefighter & EMT-D says:

    Does this posting system work? I left a post, but it never appeared…

  • I know little about NJ EMS, other than what I learn from people who live and work down there. I have a vested interest since my son and his family live there and want them to get only the best of care if the need arises.

    With that background a few thoughts, some of which are no doubt obvious.

    1) NJ is not necessarily the most backwards EMS system in the country, but it’s a contender.

    2) Volunteers don’t have to be negative influences on progress, but it appears that NJFAC is.

    3) EM physicians should take a more active role in promoting better care. That not only includes being politically active, but in demanding better reports and better performance from BLS and ALS providers.

    4) The providers themselves, at least those that care about professionalism, should self police.

    I hope the new bill passes and Gov. Christie signs it. It’s long past the time when NJ should move forward in EMS.

  • I agree with all these points.

    I should point out, however, there are political influences which restrict ED physicians from attempting corrective teaching. In many facilities from many ED physicians I have spoken to about this, they are fearful of administrative reprisals for being critical of EMS. The concern is that you don’t want to drive away inbound customers to competing systems.

    I agree that volunteers are essential and there are many systems that function exceptionally well with them. I started out in one! Quality assurance is a necessity for a competent system. As such, your points about the need for ongoing training and hospital feedback and self policing are right on target!

  • Mark EMT-B says:

    Please don’t lump all volunteers or First Aid Council affiliated squads into the same group. I have served actively on a north Jersey volunteer squad for 20 years. This Squad is one of them that works right. The majority of our members are EMTs with a few remaining being 1st Responders. We instituted the 1st Responder program a number of years ago to help bolster our ranks and it has been an overwhelming success. 90% of the 1st Responders that join continue on for their EMT. The previous post made a comment about self-policing and that really is the name of the game. We pride ourselves in providing the highest quality pre-hospital care. While we, like any other volunteer squad, occasionally have difficulty covering a call, we answered 93% of our calls last year. The other calls were handled quickly and efficiently due to a well-developed mutual aid plan.
    I will refer to a previous post again… self-policing in mandatory for success in this field. I also had the misfortune of serving several years on another volunteer squad that basically had an “anything goes” and “we’ve done it the same way for 30 years, why change” mentality. I left that squad as I could not effect any change on their broken system and could not be part of substandard EMS care.
    My point is: Please understand that there are Squads out there doing the job well. The original post really gave volunteer squads a bad name.

  • Mark EMT-B says:

    Please note, i left out my last name as I don’t need any c**p from the squad i left…

  • Edna Birch says:

    I live in Carneys Point, and was under the assumption that when we called Carneys Point 911 for am ambulance, we were dealing with a local ambulance. No so, they are members of ALS a national ambulance service who charged me $995  for transporting me seven miles to an ER, when I had pneumonia.  The quesiton I have are Carneys Point taxpapers paying for this ambulance service, and then the ambulance belongs to a for profit transport service. If so this needs to be stopped. On top of that, the ambulance billed Medicare the wrong diagnosis, and Medicare denied the claim, saying it was not medically necessary, when I was admitted to telemtetry unit in guarded condition and was on antibiotics IV for one week, ended up with a partial collapsed lung etc.  This is wrong and I am shocked to learn what is going on. There has to be regulation by the State of NJ into local ambulance services.  Is this true of all small town ambulances in NJ, are the crews volunteers?  If so we are being overcharged by ALS, who are not even locared in NJ they are located in Florida.  Are we being ripped off?

  • claudia hillma,emt_b says:

    EMS has always been backwards in NJ I am an EMT since 1984 was a volunteer first aid squad member and a owner of a private ambulance service.all ems providers whether vol or paid should be licensed.all ambulance should be properly equipped with a minimum of 2 emts. volunteer first aid squads should follow the same regulations as a paid ambulance service

  • Patterson says:

    just failed out of a EMT class,couldn't understand what new language those story telling, so called teachers ,were trying to get across to me. Wasted my money there,but will enroll into another class elsewhere. Trenton

  • dan chambers says:

    Hey, really appreciate the post.  Its good to give real life accounts of what it is like to be an EMT and work for the EMS, good and bad.   I really think that would-be students would really love reading this post and others you have written.  Anyway, I have an info blog myself that help those that are wondering about EMT training  http://www.emttrainingdepot.com, and real life EMT stories.   Always, looking out for EMS/EMT posts like yours.  Keep up the good writing!  Thanks.

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Jordan Barnett

Jordan Barnett, MD, is an Emergency Medicine Physician in the Philadelphia Suburban Region.  He has previously worked as a volunteer firefighter, was a member of New York City EMS, and provides Medical Command for several ALS Ambulance Services. Dr Barnett provides EMS consultation services. Additionally, he is actively involved with EMS education.

JEMS Talk: Google Hangout

Comments
Abby
Hiding In The Nursing Lounge
Agreed. Very well said.
2013-08-19 00:46:31
Abby
Hiding In The Nursing Lounge
I'm several years too late, but I found these posts interesting. One, the students were clearly in the wrong. Their behavior can't be justified. In any profession you're bound to have good days and bad. People are going to say rude things that are going to make you angry. However, you still must do the…
2013-08-19 00:34:56
Olive
Time for Intelligence in Implementing EMS
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2013-04-15 20:21:25
dan chambers
EMS System in NJ
Hey, really appreciate the post.  Its good to give real life accounts of what it is like to be an EMT and work for the EMS, good and bad.   I really think that would-be students would really love reading this post and others you have written.  Anyway, I have an info blog myself that…
2013-02-18 20:54:03
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Time for Intelligence in Implementing EMS
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2013-01-23 23:44:45
January 2011
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