My complaints and grievances about EMS in NJ

[Disgruntled]

EMS in NJ sucks. We're 30 years behind the rest of the country when it come to EMS

Here is a list of 8 things that need to be changed immediately:

1. ALS

Why is it that ALS in NJ has to be hospital-based in NJ? This is ludicrous, no other state has this regulation. This leads to blatant patient steering (persuading patients to go back to the hospital which the "MICU" is based out of even if other facilities are closer), which happens to be illegal. Transport is often delayed while waiting for medics to come from hospitals which are sometimes over 10 miles away. Municipalities should be allowed to provide their own ALS.

2. The national standard EMT-B curriculum

Bring back the old EMT-D. This new "assesment-based" curriculum is bull****, it's simply a watered-down version of the EMT-D (diagnostic-based treatment) that NJ used to have.

3. First Aid Squad

I'm not dissing the volunteers themselves, but what is with the name "First Aid Squad," it sounds like a bunch of first responders. The name "First Aid Squad" doesn't exactly instill confidence in your abilities. EMTs, whether paid or volunteers are highly trained professionals. The dictionary defines First Aid as

Main Entry: first aid
Function: noun
Date: 1882
: emergency care or treatment given to an ill or injured person before regular medical aid can be obtained

You're supposed to be the "regular medical aid"

How about simply calling your organizations EMS. Not First Aid Squad, Volunteer EMS, VAC (Volunteer Ambulance Corps), Emergency Unit, Vol. Rescue Squad. These names are leftover from the 1920s to the 1950s what was the norm back then sounds highly unprofessional now. And remove the word "volunteer" from your names, the public doesn't care whether you're paid or volunteer.

4. EMT-I

I'd like to get my hands on the imbecile who eliminated the EMT-I cert. from NJ. Due to the fact that in NJ medics can only come from hospitals this cert. is a necessity here. An EMT-I can tube a pt, start a line and give some drugs, due to the typically horrendous response times from MICUs in most of the state, these skills can make the difference between life and death for many patients.
Having EMT-Is can also free up MICUs for the serious calls.

Or better yet, why not add the EMT-CC (Emergenc Medical Technician-Critical Care) cert. that NY has. This cert. requires nearly half the training that Paramedics have (728 hours minimum for Medic vs. 300 to 400 hrs minimum for EMT-CC). However
EMT-CCs can do almost everything paramedics can do except EMT-CCs are under much stricter medical control instead of standing orders.

Here's a link to the EMT-CC portion of the NYS DOH website, where you can find out about EMT-CCs and their curriculum:

http://www.health.state.ny.us/nysdoh/ems/emtcco.htm

However I am a realist and I do realize that with the stronghold hospitals have on NJ, EMT-I or EMT-CC
will never become a reality in NJ because it will take money away from the hospitals.

5. MICU/MICP

"Mobile Intensive Care Unit"/"Mobile Intensive Care Paramedic," no other state has used these terms for 20 years...how about calling them "ALS Units" and "EMT-P's" like the rest of the country.

6. NorthSCAB (NorthSTAR)

The JemSTAR system for Northern, NJ sucks, If NorthSTAR is unavailable they will send SouthSTAR (South Jersey) or PennSTAR (Pennsylvania) before they will call for mutual aid. NYPD air units, Statflight(Westchester), NCPD (Nassau County NY Police Dept.), and SCPD (Suffolk County NY Police Dept) all run medically equipped helicopters which are capable of reaching a large portion of Northern NJ well before SouthSTAR or PennSTAR can if NorthSTAR is unavailable.

7. 16 Year-Old EMTs

The minimum age to become an EMT in NJ is currently 16. A 16 year old is too young to be an EMT, they lack the life experience required to be provide to make split-second life or death decisions. If the state doesn't feel that a 16 year old is capable of operating an automobile (you get your license at 18 in NJ now), what makes you think that a 16 year old is capable of providing emergency medical care to others. Allowing 16 year olds to be EMTs is like allowing 9 year olds to be issued drivers licenses, sure some 9 year olds are capable of operating a motor vehicle safely, however the vast majority are not. We need to raise the minimum age to 18.

8. Background Checks

There have been numerous instances where private ambulance companies (proprietary services) in NJ have hired people who claimed to be EMTs but really weren't. Laws need to be passed requiring all prospective EMTs to undergo a complete and thorough background check, especially since terrorists have already tried to obtain emergency vehicles in NJ.
These background checks need to apply to everybody, not just employees of private services, but paid municipal EMTs, and volunteers also.

Here's a link to the legal actions section of the NJS OEMS Website where you can read about all of the people who weren't EMTs however
were hired as EMTs and were performing the duties of NJ State certified EMTs:

http://www.state.nj.us/health/ems/legal.htm

IT'S TIME THE PEOPLE IN NJ STATE OEMS (Office Of Emergency Medical Services) TO TAKE OFF THEIR TIN FOIL HATS AND REALIZE THAT IT'S 2002 NOT 1972 AND CHANGE THE LAWS GOVERNING EMS IN NJ

Well thanks for taking the time to read this

Stay Safe



:mad:

[panther]

WOW! Remind me to never complain about my states regulations again!

Seriously though. If this is how it truly is, I feel for you guys and can understand your frustration. NJ is about 20 years behind.

The one thing I find to be most disturbing is the time from call to pt contact. It seems the system has forgotten its supposed to be about the pt. Not the turf.

Best of luck to you. And don't look for me to be moving to your neck of the woods any time soon.

[Ohiovolffemtp]

I read through a number of the actions on NJ's EMS agency's web site. Some of the actions are shocking:

- disciplining medics who under direct orders from their medical director, gave a patient their own insulin. NJ medics can give insulin, it just wasn't on their drug license.

- suspending EMTs & medics because a combative patient died shortly after they delivered him to a hospital. They'd called for and received extra assistance, including from the police. There's no allegation that the care they gave was improper.

What's clearly needed is a review panel of EMS providers: EMT's & medics chosen by their peers to be the final authority in evaluating providers.

[UpstateEMS]

Disgruntled,
This is the first time I've posted on this board, matter of fact the first time I've ever posted on a board. Your thread really captured my interest as I ride in both NY and NJ. I think you've really got some great points there, and I can't comment on some of them because I think I'm in a completely different situation from you. I'm in a somewhat urban section of NJ. I've never had to use a helicopter for trauma or medical in NJ as I've got two hospitals within ten minutes, and another five or seven in fifteen minutes, including UMDNJ. (I have used the bird a couple of times up in NY.) But, as far as the ALS issue goes, I can both agree and disagree with you. I will first admit that I have two medic units assigned to my district 24 hours a day, and then there is another one on from 0700-19 or 2000. Occasionally we'll have a difficulty breathing or chest pain with no medics available, but not that often. Most of the time the medics will be arriving as we are finishing up our assessment or packaging the patient for transport, so response time really isn't a problem either.

Hospital based ALS has it's good points. I feel that professionals coming out of a hospital have much better training and a greater number of skills that they can perform outright and/or on standing orders alone. My only experience with service provided ALS has been in Upstate NY with a volunteer corps certified at the Paramedic level. The EMT-CC program run by New York has definitely been a positive for the region, many people have been saved and received ALS care then before. We're in a very rural area, so hospital based ALS wouldn't fly.

But, 90% of our ALS providers who ride with my squad in NY are volunteers, and I truly applaud them for putting in the CE hours to maintain their cards with the state, our REMAC, and squad SOGs. However, the fact of the matter remains that during the day they are teachers in the high school, professors and students at the college, etc. What I am trying to get at is that hospital based ALS, or maybe I should say paid ALS, has the opportunity to focus on their profession and hone their skills to become an expert in their field. To some degree, I believe that NY and my REMAC have realized this. I don't know if you were aware but NY is in the process of changing their curriculum to make the CC more consistent with the new release of NREMT-I. It is my understanding that the classroom and field time has been increased, and the practical skills are becoming more comprehensive.

Would an I or CC program work in NJ? I don't know. I take it you are from rural NJ with long response times on ALS. I think it definitely would be a good thing for you. Another possibility is "enhancing" the B curriculum. Allow ET tubes for basics with long transport times, that type of thing. In NY I can give albuterol via nebulizer to asthmatics, I carry two Epi-Pens and Epi-Pen Jrs. which I can give for anaphylaxis even if the individual does not have one prescribed. These were all "enhancements" to my NY EMT-D; both were a 1-2 hour inservice with a short quiz and practical at the end. In the end though you wind up with the debate about this system. Picking up an "enrichment" skill every so often makes you start to encroach on an intermediate or paramedic card. Why not just go for the higher card? Of course, in NJ this really isn't an issue as there is no "I" and going "P" means becoming an ALS professional simply due to the law.

Having professional ALS providers also allows the ability to have more progressive and or radical ALS treatment protocol. The protocols my service follows in NY does not include any sort of RSI, 12-lead monitoring, very limited narcotic based protocol, or surgical airway. Granted NJ does not allow surgical airways to my knowledge, RSI and 12-leads are the norm as is morphine for chest pain. Another interesting fact about NJ ALS is that the physicians at each hospital with a MICU truck set the protocol for their service using a state issued formulary for the drugs.

Again, some of the issues you speak of I truly cannot comment on, I haven't had to work with OEMS yet or use the helicopter services. I agree with you that sixteen is fairly young to be an EMT, the thing I don't understand is how you can be an EMT at sixteen but not be able to defib until you're eighteen. Doesn't make any sense. Things I would like to see in NJ EMS? 1. A state mandated PCR or runsheet, what ever you would like to call it. 2. Better medical direction/control from the receiving hospital for BLS providers, ok having them answer their HEAR would be a start.

One thing I have found about running with a volunteer ALS service is that the BLS providers’ skills often suffer. Always having your medic partner do the assessment and then decided ALS isn't warranted makes the BLS provider's assessment skills suffer. Granted, ALS providers should have a better background on A&P, diseases, treatment, and just overall EMS knowledge. Nevertheless, BLS shouldn't stand for Vitals Checker Only. There will be that time when no ALS is available, and your patient is going down the tubes. BLS providers need to be just as fluent and not rely on the ALS partner to do everything.

EMS isn't perfect in NJ, nor is it perfect in NY or any other state that I can think of. EMS truly is the baby of the "Allied Health Sciences" or whatever you would like to call it. Some physicians and lawmakers simply do not understand what we do on a regular basis. I had the opportunity to take the Level III or CC class and test in NY this fall. I declined to take it, being a full time college student I knew I couldn't commit the time to the class or continuing ed this year. Maybe I'll take it this fall, who knows, but I feel better about being a comfortable BLS provider than an ALS provider who struggles to keep up with CME's. Hopefully the MICUs that cover your district will fix up their act; you could try talking to the physicians or your dispatch about moving their posts to more adequately cover the larger district. Maybe even see if they will consider doing a study on adding another truck during the day. Keep a log of your ALS calls, see how many go BLS due to availability problems and get a general sense for how long it takes the ALS to get there. Having some documentation when you go speak to the medical director may help you get somewhere. But, in the end it all comes down to training. For volunteers and professionals alike, the amount of time and effort you put into training will directly effect the outcome of each and every patient you make contact with.

[ALSfirefighter]

Disgruntled, first let me applaud you, this is one of few posts that reflects negative aspects that isn't filled with whining, rambling, and emotion filled facts, instead your articulate & used straight up facts. Now I'd like to share mine:

1: I agree that municipalities should have the ability to choose their own ALS & make changes when needed. There is also a flip side, there are many municipalities that will also low ball the system and even reduce the coverage to below what should be the proper level.

2: I disagree with you on this one. NY I believe had a similiar EMT-D curriculum before they adopted the national EMT-B standard. Like you said it is slightly watered down, but it is the national standard, which many people have been screaming to have for years. It also assists those who move and wish to continue serving in EMS by having them at an accepted level (in most states). I can't comment more on it because you didn't give strong supporting evidence in your argument as to why it is bull$h!t and why NJ should go back.

3: I also never liked the "first aid squad" name either, just sounds kiddy and inferior. I used to bust the balls of a couple NJ guys I used to work with when I was a federal ff about that. As far as having VAC or volunteer on the ambulance, you said it yourself it, people don't care if your paid or volunteer, so it doesn't matter what you put on it. If it makes them take a little more pride in themselves then great. Go to one of the fire forums and tell them to remove volunteer from their department name and trucks and watch it hit the fan.

4: I agree with you that some level of basic ALS care would be valuable for many agencies. However, I have to say in my experiences and opinion I do not like the CC concept here in NY. While I understand that it does work in some rural areas of NY, I think it is a bad concept. I can tell you my region doesn't recognize the CC curriculum. NY has been saying for years that it wants to move to the national standard of "I" now for years, which I'm also hesitantly happy with, but again, when looking at how things work in the tri-state area it gives the opportunity of low-balling. Why pay 4 medics when I can have 1 and 3 CC's? Like you said, half the training = half the training.

5: To me MICU/MICP/ALS, mute point, who really cares, the general public again can't tell you the difference most times, or give you a defintion of ALS. Call it what ya want, just make sure everyone involved knows what it means.

6: Another form of negligence, and another form of patient steering. And unfortunately another issue that takes place in many other places.

7: I agree with you that this is a problem. It falls on the agencies involved for not checking credentials and the state for not checking out those who submit the PCR's or other patient info forms. Even if they do it randomly of every agency they are bound to catch a few and that will make the agencies assess how they look at their personnel.

Thanks for bringing out some of these deficiencies, at least if I or a family member gets hurt in NJ I know to look into the details and be able to sue the $h!t out of someone!!

[Engine58]

Ok..I agree and Disagree with some of your comments. First off, I've never had a problem with ETA's of ALS units based out of local hospitals.. Most of the time the medics I work with dont care who's hospital they have to go too. Can I say theres ones that do care and persuade there patients sure..I know there is...but like I said..I've never had the situation where a medic unit would persuade a patient to go to there hospital even if theres another one closer. EMT-D..I dont know what to say on that because I've been one of those "EMT-B/D" students. "SUNSTAR" oops i mean northstar..SUCKS!! Many many times they've "cancelled" themselves or "we cant fly" theres a little cloud in the sky.. I agree they should have another type of medical helicopter that is not only closer but that will fly when the weather isnt so great. THe name first aid squad...Well theres really nothing we can do about that..just have to live with it.. EMT-I..would sure love to have that...Godforbid you need to tube someone asap and the medic unit isnt as close as you would like it to be You could have tha PT tubed and ready to go just enough time to go to the local hospital... Hospitals in my area are a good 10 minutes apart..not even..so if the patient is that critical and require ALS but they are tied up or to far of an ETA we would either #1 Request a line of site with another medic unit closer to the hospital we are going to or #2 load & go & pray...16 yr old EMT's.. Im gonna have to disagree with you on that one..I was a 16 yr old EMT im turnin 18 in a couple months but IF first aid squads use the 16yr old EMT title as they are supposed to then it works like is has with me...The LAW that 16-17yr old EMTs are "PROVISIONAL" which means they CANNOT provide patient care in teh back of an ambulance by thereself A EMT who is 18 or older MUST be present over seeing The "provisional" emt's actions correcting if wrong and guiding them on how to better there skills.Have I seen imcompentent 16 yr olds with EMT titles..YUP!! Do I think they should be an EMT..HELL NO! I cant really argue to much because I've been in ems for only 3 1/2 yrs. so dont get me wrong here im not trying to shoot my mouth off and acting like I know everything..cause I dont... the name MICU or MIC-P whiever I really dont care as long as I get htem when I need them... Background checks I would like to see get done more often especially after the events of sept 11... Like I said in the beginning I agree with some comments and I disagree..in the long run I cant say to much more because like I said I've only been doing this 3 1/2 yrs...

[T.E.M.S.]

I can agree with most things you said.

I've never had to use the bird yet. For me, I see no real use having a variety of hospitals only minuets away (including Robert Wood run by UMDNJ).

First Aid Squad does sound dorky but I think the squads still call them selves that out of tradition. They are PROUD to be volunteers as am I, some patients and people do care.

I work with some 16yo and 17yo EMTS that can dazzle even the most experienced medic. It's all how you train them, don't generalize the age.

[Disgruntled]

I received this email and thought it was worth posting since it's from a South Jersey perspective:



I can understand and have the same problems with the State of New Jersey and how they treat the ems. This state is such a "mother my I" state. The paramedics have their hands tied with the current standing orders.

I agree New Jersey is atleast 20 years behind the rest of the country. Yes we should bring back the EMT-I. We should also allow the EMT-B to utilize a combitube. Even as EMT-B we can control & manage the airway, cause bagging a patient with a bvm without a controlled airway sucks.

The their is the ground star system (north star & south star) we can not have a mutual air craft come in when they won't fly, that is bull ****. I prefer Penn Star to south star, penn star will land just about any where. I have had south star circle above me and I could see them and they told me they could not see me and made me ground transport a patient 45 minutes to a trauma center after waiting for them for 20 minutes.

We need to find a way and have our voices heard about our concerns with the EMS system in New Jersey.

[LA7Mary3]

Dear Disgruntled,
You really gave me a good laugh in reading your
post, because I agree with everything you have said.
I just can't believe you managed to fit all of your
complaints on one post. It is ovbvious that NJ is
20 years behind the rest of the country in most
things, not only EMS. However, please allow my
2 cents on some of these issues.

Hospital-based ALS- I agree 100% that it is patently
absurd. Why not follow the ever-progressive West
Coast and allow FD-based ALS? Why not do like
some states do and have an EMT-B and EMT-P ride
together on the same unit? Does one EMT-P really
have to hold his/her partner's hand like they
do here in NJ? Does the ER doctor really have
to hold the medics' hands? Don't we have standing
orders that the medics can follow, like in most
other states?

I found it funny when the whole MEDICARE billing
question arose about duplication of services.
Hospitals were (and still are) scrambling to get
ambulances so they could transport ALS patients.
They sould have been doing that from the beginning,
but now that regional ALS unit doing that transport
will not be available to cover their area.

As far as the term "First Aid Squad," I agree
completely, but as one reader pointed out,
tradition is the reason.

As far as the 16-year-old EMT, I do agree with
you, but look at the reason. These small towns
with First Aid Squads rely heavily on volunteers.
The townspeople have no interest in paying a crew
to respond from the station, even if it means a
10-minute delay while the members respond from
home. Therefore, the towns must rely on this form
of child labor (no disrespect intended) to carry
the squads. Let's be careful not to criticize
these young people who taken advantage of the
lower age, but let's go after the state to correct
its EMS problems.

Thanks for your time, and stay safe.

[Bones42]

LA7Mary3 - Not all EMT's want to be Paramedics. I do not have the time nor the interest in becoming an EMTP. My Squad runs between 1300-1600 calls per year, ALS is needed on about 200 of those. Does it really make sense to tie up the paramedics in the area for 1100 calls that they are not needed on? Driver and 1 EMT-B handle the rest with no difficulties, actually we average 3-4 members riding on each call. I can not remember a call when medics were needed and not available and we tend to cancel them before their arrival fairly often. We have had ALS transport in our area when needed (last week). We do not bill any patients for services, we rely on donations. First Aid Squad, yup, tradition from 73 years ago - kind of like at stadiums and public places, you see a "First Aid station", not an "EMS station". We are a small town and rely soley on volunteers for our First Aid and Fire Department, both separate organizations. We have a strong junior membership (under 18) of which most of them have been getting their EMT training. Do we rely on them? Yes, for parades, concert standbys, fund raising, etc. Are they the reason we get rigs out? Nope. Only allowed 1 junior member on a rig at a time. Funny thing, most squads around my area all function this same way and have no complaints about it.

Yes, some more advanced skills would be nice. Intubation being one that I would put at the top of that list.

Stay Safe.

[ALSfirefighter]

Bones, you stated a very poignant point about the first aid squad name. But I still have to agree that it just in anequated. Yes they do have first aid stations at stadiums and theme parks, and that is for people that walk there, those who are injured get an EMS ambulance. Also, you see them called "aid" stations more today, and that's because they are usually staffed by a nurse who can only basically aid and not treat, being that they do not have standing orders, or the means to get them the way we do.

[NJMedic]

Being involved in NJ EMS for the past 24 years, the last 15 as a paramedic I think I have the background to answer your questions.

1. "Why is it that ALS in NJ has to be hospital-based in NJ? This is ludicrous, no other state has this regulation."

Back in 1978 when the State began setting up the paramedic program, little to no interest was expressed by volunteer BLS agencies or career/volunteer fire departments to began providing ALS level service. There were almost no commerical ambulance services that had an experience providing any emergency services. Since the hospitals were going to be partners in the training, it only seemed natural to have them provide the response also. Even today many squads want nothing to do with ALS and many firefighters I have spoken to want nothing to do with EMS, much less ALS. While I do know of some progressive FD in NJ that would embrace the idea of providing EMS, I don't see too many of them even doing first responder work.

2. "This leads to blatant patient steering (persuading patients to go back to the hospital which the "MICU" is based out of even if other facilities are closer)"

Personally I could care less where the patient's go, I don't get paid per patient. Most of the hospitals are on divert anyway and don't even want the patients. Now of course if the patient is a trauma they are going to get steered to a trauma center. The same thing with critical pediatric patients. Now if I'm treating a patient that is having a big time MI and wants to go to the 100 bed hospital that has no cardaic expertise, and the larger hospital that does tPa and cardaic caths and open heart is within distance, I going to provide the option to the patient and let him decide.

3. "Municipalities should be allowed to provide their own ALS."

Most towns don't want to provide EMS much less ALS. Show me a town that wants to spend tax money on EMS. They are few and far between. It's much easier for the town fathers to hand it over to some one else and let them worry about it. There are hundreds of towns in this state that do not have the call volume to justify the expensive of full time caree EMS providers. And don't think regionalization is going to be embraced, the is the capital of Home Rule. Each town has to have its own 911 center, PD, FD, EMS, school, system, DPW, Library, etc. And people still whine about the high proerty taxes.

4. " Bring back the old EMT-D. This new "assesment-based" curriculum is bull****, it's simply a watered-down version of the EMT-D (diagnostic-based treatment) that NJ used to have"

Can't give your a clear answer on this since I'm not involved on the education side. it is interesting that the pass rate dropped from 80% to below 50% when the State adopted the NREMT test for EMTs. Something must be lacking. I don't know too many peole that are impressived while the quality of the students coming out into the field.

5. "I'm not dissing the volunteers themselves, but what is with the name "First Aid Squad," it sounds like a bunch of first responders. The name "First Aid Squad" doesn't exactly instill confidence in your abilities."

70 years of tradition unimpeded by progress.

6. "I'd like to get my hands on the imbecile who eliminated the EMT-I cert. from NJ. Due to the fact that in NJ medics can only come from hospitals this cert. is a necessity here."

They tried EMT-I several years ago in Hunterdon County and down south, I believe it was Salem County. The rentention level of personnel dropped off after people began to realze that there the volume was not there to justify to time and energy to take the classes. Also the skill level among those who took the classes began to significantly drop off because not one performed the skills and a regular basis. I know plenty of people who say they want to be EMT-Is but have a hard time with their EMT-B skills and knowledge.

7. ""Mobile Intensive Care Unit"/"Mobile Intensive Care Paramedic," no other state has used these terms for 20 years..."

The State adopted the title "EMT-Paramedic last year. There are other states (Texas comes to mind) that use the tile MICU. otherwise it's not a big deal.

8. "The JemSTAR system for Northern, NJ sucks."

I know Statflight comes into NJ. I don't know what order they are called. NYPD does very little medevac work in NYC. Scene flights are rare. I think Nassau and Suffolk are a bit too far to be pulling resources from.

9. "16 Year-Old EMTs"

I didn't know the State lowered the age to 16. If it's true I can only imagine it was because a particular organization lobbyed the state in order to increase the pool of people that could ride on an ambulance. Back in the day I join the local ambulance at 15 with a five point card. We called them youth squads back then. But we could not roll an ambulance with anything less then two adult members who were EMTs.

10. "Laws need to be passed requiring all prospective EMTs to undergo a complete and thorough background check, especially since terrorists have already tried to obtain emergency vehicles in NJ"

Good idea but who's going to pay for it? Point of order here.....where have terrorists tired to obtain ambulances? The story as I heard it was that two men of middle easter descent wanted to buy a replica ambulance from a movie studio vehicle company with cash. The owner thought this was strange and contacted law enforcement. When law enforcement found out who these men were the reported that they wanted to use the vehicles to carry tools. Now if you beleive that store thats another matter.

11. "Here's a link to the legal actions section of the NJS OEMS Website where you can read about all of the people who weren't EMTs however were hired as EMTs and were performing the duties of NJ State certified EMTs:"

Just a reminder that all the agenices and personnel lsited on this web site (with the rare exception) are career and paid. NJ law expemts volunteer EMS agenices from any regulations and oversight. Volunteer BLS covers about 90 percent of NJ.


12. "IT'S TIME THE PEOPLE IN NJ STATE OEMS (Office Of Emergency Medical Services) TO TAKE OFF THEIR TIN FOIL HATS AND REALIZE THAT IT'S 2002 NOT 1972 AND CHANGE THE LAWS GOVERNING EMS IN NJ"

Don't assume it's OEMS they doesn't want change. There are alot of organizations out there that are happy with the status quo.


I get down off the soap box for now......

Brian

[Kiernan]

Disgruntled,
First of all, I agree with many of the points you made, but not the one regarding "16-year old EMTs."
I come from PA and here a teen can also become an EMT at 16, but must be 16 to enroll in the course. Who's to say a 26,36,46,56 year old and beyond are capable to become an EMT? You can't go around saying 16 is too young unless you know damn well EVERY 16 year old is not ready for it.
Here you have to be 16.5 years old to get your lisence, 16 to ride in an ambulance(junior EMT or not), 14 to volunteer in the ER at my local hopsital, 18 to buy tobacco, 21 to drink...Who's to say every person who meets the age requirement is mature enough to do those things? You just can't know until you sit down, speak with them and watch how they act and present themselves. They might blow you away-THEN!!...you'd retract that "16 year old EMT" statement.
But I do agree many 16-year olds are not ready, yet many are. As someone else said, you can't generalize that to all teens that age.

[Disgruntled]

How much misinformation can somebody fit in one post?

I'll deconstruct this post statement by statement

[/B][/QUOTE]Being involved in NJ EMS for the past 24 years, the last 15 as a paramedic I think I have the background to answer your questions.

After reading your answers, obviously you don't

1. "Why is it that ALS in NJ has to be hospital-based in NJ? This is ludicrous, no other state has this regulation."

[/B][/QUOTE]back in 1978 when the State began setting up the paramedic program, little to no interest was expressed by volunteer BLS agencies or career/volunteer fire departments to began providing ALS level service.

Actually the first ALS program in the state was developed by Overlook Hospital in Summit in 1975

And there was interest expressed by the "First Aid Squads" which was why the Llifemobile program was formed in 1977. "First Aid Squads" in the Lifemobile were allowed to train their members as Paramedics and they were were able to run ALS. The program was a success and towns that participated in the program were able to offer much better response times then we see today for ALS. However, when this program really began to grow in the mid-80's the hospitals got their panties in a wad and the Lifemobile program was eliminated in 1985.

[/B][/QUOTE]There were almost no commerical ambulance services that had an experience providing any emergency services. Since the hospitals were going to be partners in the training, it only seemed natural to have them provide the response also.

Using what logic?

[/B][/QUOTE]Even today many squads want nothing to do with ALS and many firefighters I have spoken to want nothing to do with EMS, much less ALS. While I do know of some progressive FD in NJ that would embrace the idea of providing EMS, I don't see too many of them even doing first responder work.

There are quite a few FDs up in Northern NJ who have expressed an interest in taking over EMS if they were allowed to run ALS and bill for it. With the hospital-based "MICUs" billing patients over $1000.00 to for a pt who is actually transported in another agencies ambulance, the FDs see the oportunity to turn a profit with running EMS.

More and more FDs are running EMS first responder just look at Bayonne, Jersey City, and Union. However I don't see why a FD who doesn't transport would want to run first responder, they need the revenue from EMS billing to support running FR engines.


2. "This leads to blatant patient steering (persuading patients to go back to the hospital which the "MICU" is based out of even if other facilities are closer)"

[/B][/QUOTE]Personally I could care less where the patient's go, I don't get paid per patient. Most of the hospitals are on divert anyway and don't even want the patients. Now of course if the patient is a trauma they are going to get steered to a trauma center. The same thing with critical pediatric patients. Now if I'm treating a patient that is having a big time MI and wants to go to the 100 bed hospital that has no cardaic expertise, and the larger hospital that does tPa and cardaic caths and open heart is within distance, I going to provide the option to the patient and let him decide. +

There numerous instances of patient steering and patient dumping by hospital-based paramedics in NJ. The state however allows these practices to continue blatantly

3. "Municipalities should be allowed to provide their own ALS."

[/B][/QUOTE]Most towns don't want to provide EMS much less ALS. Show me a town that wants to spend tax money on EMS. They are few and far between. It's much easier for the town fathers to hand it over to some one else and let them worry about it. There are hundreds of towns in this state that do not have the call volume to justify the expensive of full time caree EMS providers. And don't think regionalization is going to be embraced, the is the capital of Home Rule. Each town has to have its own 911 center, PD, FD, EMS, school, system, DPW, Library, etc. And people still whine about the high proerty taxes.

So you're saying that a municipality who wishes to provide ALS to their residents shouldn't be allowed to?

If you're so worried about then being out of practice why not make them do an ER rotation once a month?

4. " Bring back the old EMT-D. This new "assesment-based" curriculum is bull****, it's simply a watered-down version of the EMT-D (diagnostic-based treatment) that NJ used to have"

[/B][/QUOTE]Can't give your a clear answer on this since I'm not involved on the education side. it is interesting that the pass rate dropped from 80% to below 50% when the State adopted the NREMT test for EMTs. Something must be lacking. I don't know too many peole that are impressived while the quality of the students coming out into the field.

The passing rate is higher because the test is harder, however the curriculum is is much less in-depth then the old New Jersey stste curriculum

5. "I'm not dissing the volunteers themselves, but what is with the name "First Aid Squad," it sounds like a bunch of first responders. The name "First Aid Squad" doesn't exactly instill confidence in your abilities."

[/B][/QUOTE]70 years of tradition unimpeded by progress.

6. "I'd like to get my hands on the imbecile who eliminated the EMT-I cert. from NJ. Due to the fact that in NJ medics can only come from hospitals this cert. is a necessity here."

[/B][/QUOTE]They tried EMT-I several years ago in Hunterdon County and down south, I believe it was Salem County. The rentention level of personnel dropped off after people began to realze that there the volume was not there to justify to time and energy to take the classes. Also the skill level among those who took the classes began to significantly drop off because not one performed the skills and a regular basis. I know plenty of people who say they want to be EMT-Is but have a hard time with their EMT-B skills and knowledge.

EMT-I is 100 hours more training then EMT-B. Some states like Georgia have eliminated EMT-B entirely and require all providers to be EMT-Is which has shown positive results. If you're worried about them being out of practice, why not require them to do a monthly ER rotation. And give them back-ups in the field like Combi-Tubes or PTLs if they can't get an ET tube in,and Sternal I/Os (like the navy seals use) to use if they're having trouble starting a line.

7. ""Mobile Intensive Care Unit"/"Mobile Intensive Care Paramedic," no other state has used these terms for 20 years..."

[/B][/QUOTE]The State adopted the title "EMT-Paramedic last year. There are other states (Texas comes to mind) that use the tile MICU. otherwise it's not a big deal.

You better let the state know about these changes. The reason I object to the terms "Mobile Intensive Care Unit" and "Mobile Intensive Care paramedic" is that they're not truly providing mobile intensive care. In other states they have ALS administering pre-hospital thrombolytics, inserting chest tubes, and other advanced procedures which are notdone in NJ. Medics in NJ can't even perform a crich or any other level of surgical-level airway. In the late 70's when this term was coined they were performing Mobile Intensive Care in the field, however as medicine has evolved these units are no longer performing treatments comparable to a hospital ER or ICU.



8. "The JemSTAR system for Northern, NJ sucks."

[/B][/QUOTE]I know Statflight comes into NJ. I don't know what order they are called. NYPD does very little medevac work in NYC. Scene flights are rare. I think Nassau and Suffolk are a bit too far to be pulling resources from.

Actually Nassau and Suffolk County are closer to a large portion of Northern NJ then SouthSCAB or PennSCAB. Looking at a map can confirm this.


9. "16 Year-Old EMTs"

[/B][/QUOTE]I didn't know the State lowered the age to 16. If it's true I can only imagine it was because a particular organization lobbyed the state in order to increase the pool of people that could ride on an ambulance. Back in the day I join the local ambulance at 15 with a five point card. We called them youth squads back then. But we could not roll an ambulance with anything less then two adult members who were EMTs.

16 y/o EMTs are not a new thing in NJ they've been around as long as the EMT cert has been in NJ. 16 y/o EMTs are supposed to be provisional EMTs however many "First Aid Squads" allow them to do everything adult members are allowed to do.


10. "Laws need to be passed requiring all prospective EMTs to undergo a complete and thorough background check, especially since terrorists have already tried to obtain emergency vehicles in NJ"

[/B][/QUOTE]Good idea but who's going to pay for it? Point of order here.....where have terrorists tired to obtain ambulances? The story as I heard it was that two men of middle easter descent wanted to buy a replica ambulance from a movie studio vehicle company with cash. The owner thought this was strange and contacted law enforcement. When law enforcement found out who these men were the reported that they wanted to use the vehicles to carry tools. Now if you beleive that store thats another matter.

I really don't care who pays for it. Don't place money before human life. Why not take the money out of the volunteer EMT training fund, let first aid squads pay to train their own members. A law needs to be passed requiring an extensive backgroud check before anybody can be volunteer for a FAS, get hired by a hospital or a proprietary service, or attend any EMT training programs.

It's cheaper to perform background checks on all EMTs then to rebuild a city block after somebody loads an ambulance up with explosives, drives into a restricted area, and blows themselves and everything around them up. It's happened before in Israel, what's to keep it from happening here in America?


11. "Here's a link to the legal actions section of the NJS OEMS Website where you can read about all of the people who weren't EMTs however were hired as EMTs and were performing the duties of NJ State certified EMTs:"

[/B][/QUOTE]Just a reminder that all the agenices and personnel lsited on this web site (with the rare exception) are career and paid. NJ law expemts volunteer EMS agenices from any regulations and oversight. Volunteer BLS covers about 90 percent of NJ.

Actually there are a large percentage of individual volunteers who are cited on that page. The reason that there aren't as many volunteer organizations cited is because they're not-for-profit organizations and all of the money they receive goes directly into equipment and training instead of into the salaries and the pockets of a hospital or the owner of a service.

12. "IT'S TIME THE PEOPLE IN NJ STATE OEMS (Office Of Emergency Medical Services) TO TAKE OFF THEIR TIN FOIL HATS AND REALIZE THAT IT'S 2002 NOT 1972 AND CHANGE THE LAWS GOVERNING EMS IN NJ"

[/B][/QUOTE]Don't assume it's OEMS they doesn't want change. There are alot of organizations out there that are happy with the status quo.

That's true, where the hell is the New Jersey State First Aid Council?
They're a large and powerful organization. However it's my understanding that all they do is institute mutual aid plans, and discuss the current state of affairs in EMS in NJ, however they don't do jack $h!t about it.[/B]


[/B][/QUOTE]I get down off the soap box for now.......

Is it a soap box or a crock of $h!t???????



:mad:

[NJMedic]

I guess your are more interested in showing everyone how narrow-minded you are then discussing the issues in an adult manner.

"The program was a success and towns that participated in the program were able to offer much better response times then we see today for ALS. However, when this program really began to grow in the mid-80's the hospitals got their panties in a wad and the Lifemobile program was eliminated in 1985."

The volunteer paramedic program died because they was not enough volunteer medics to provide sufficent coverage. One by one the volunteer squads ALS units began going out of service because of no medics. That's when the Mercer County System started using career personnel to staff units. The program was always under the control of Helena Fuld Medical Center.

" Using what logic? "

Alright then, who do you think should have run the paramedic program


"There are quite a few FDs up in Northern NJ who have expressed an interest in taking over EMS if they were allowed to run ALS and bill for it. With the hospital-based "MICUs" billing patients over $1000.00 to for a pt who is actually transported in another agencies ambulance, the FDs see the oportunity to turn a profit with running EMS. More and more FDs are running EMS first responder just look at Bayonne, Jersey City, and Union. However I don't see why a FD who doesn't transport would want to run first responder, they need the revenue from EMS billing to support running FR engines.

So the FD don't want anything to do with EMS unless they can make money? I guess the idea of provide service to the community arguement
doesn't hold water. What FDs are you talking about?

"There numerous instances of patient steering and patient dumping by hospital-based paramedics in NJ. The state however allows these practices to continue blatantly"

And you have done what about this? Cite any examples? Maybe you are getting your posts on the NYC*EMS board confused with NJ?

"So you're saying that a municipality who wishes to provide ALS to their residents shouldn't be allowed to?"

Name one municipality that wants to provide ALS. Under current state law they can't.

"EMT-I is 100 hours more training then EMT-B. Some states like Georgia have eliminated EMT-B entirely and require all providers to be EMT-Is which has shown positive results. If you're worried about them being out of practice, why not require them to do a monthly ER rotation. And give them back-ups in the field like Combi-Tubes or PTLs if they can't get an ET tube in,and Sternal I/Os (like the navy seals use) to use if they're having trouble starting a line."

First you complain about the lack of education on the EMT_B level then you want to have EMT-Is and increase the amount of skills provided. I don't think there are enough ERs in the state to provide the amount of rotations that you want.

"You better let the state know about these changes. The reason I object to the terms "Mobile Intensive Care Unit" and "Mobile Intensive Care paramedic" is that they're not truly providing mobile intensive care."

Who cares what the ALS units are called.

More later, awaiting another intelligent debate.

Brian

[Bones42]

There numerous instances of patient steering and patient dumping by hospital-based paramedics in NJ. We don't let the EMT-P's (paramedics, micu, whatever you want to call them) decide what hospital we are giving them a ride to. We go to the closet hospital and in case of trauma, go to the trauma center. Medics ain't driving our rig, so they follow where we are going. Really has only been a problem twice and both times, the medics ended up being addressed by their superiors.