This article is a companion piece to the Sept. 2008 EMS Magazine article Docs on Demand: New Jersey incorporates a physician go-team into its response arsenal.

In the early part of the decade, authorities in New Jersey identified emergency medical services as an aspect of the state's public safety capabilities that needed to be enhanced, particularly the areas of incident management and specialization. As a result, officials in 2003 proposed the New Jersey EMS Task Force (EMSTF), a state resource designed to fill gaps in response using a well-coordinated all-hazards approach and working through the state's emergency management system. The EMSTF would be composed of assets from agencies throughout the state and activated for large-scale emergencies and high-profile events, providing needed resources and incident management support to impacted areas when their own resources were overwhelmed.

A steering committee was created to help bring the idea to reality; it included representatives from the state Department of Health and Senior Services (DHSS), the University of Medicine and Dentistry of New Jersey's University Hospital EMS, the New Jersey Association of Paramedic Programs, the Medical Transportation Association of New Jersey, and volunteer EMS. The plan would divide the state into three regions: North, Central and South, each with seven counties. Three hospitals--University Hospital in Newark (North), Robert Wood Johnson University Hospital in New Brunswick (Central) and Atlantic City Medical Center (South)--would serve as regional "anchors." Activation would occur through the North Regional Dispatch Center.

The EMSTF was formally announced in a June 2004 letter to state EMS providers from the Senior Assistant Commissioner of Health. This letter provided information about contacting the state EMS office to establish membership. Members would receive additional education and training in a variety of specialties. Once their training was complete, the EMSTF would provide the resources and tools for these individuals to do their specialized jobs.

The EMSTF was initially planned to have a response capability of 42 BLS ambulances, 14 ALS units, four special-operations vehicles, and lighting and communications vehicles that would be deployable to an incident. However, as it came together, the focus changed to a modular structure of specialized resources that could supplement and plug holes in EMS response capabilities. These modules include:

• Incident Management Team--This team is deployed with EMS specialists to assist local responders in operations, planning, logistics and finance.
• Mass-care specialists--These personnel are trained to set up, supervise and operate all the components of a mass-casualty incident, including the triage, treatment and transport areas. They receive additional training in burn, chemical and radiation injuries and pediatric and special-needs populations, and regularly practice MCI management skills.
• EMS hazmat specialists--Currently, New Jersey providers are limited to providing medical care in the cold zone. The EMSTF includes EMS personnel trained to the hazardous-materials technician level. Their job is to assist local hazmat response teams with medical monitoring of technicians and provide prehospital triage and decontamination assistance with limited medical treatment in warm zones (using appropriate personal protective equipment).
• Urban Search and Rescue Medical Support Team--This team is deployed in support of the state's USAR team, New Jersey Task Force 1. Members provide medical support and assist in caring for victims of collapsed structures, and are trained to function in hazardous collapse-type environments.
• Tactical Medical Group--This group supports law enforcement operations with paramedics who have received CONTOMS (the Counter Narcotics and Terrorism Operational Medical Support program) or equivalent training. It is available to provide support for tactical operators who lack medical components on their teams.
• Communications and technology specialists--These are available to provide communications interoperability solutions for EMS at large events, and technology solutions to enable patient, equipment and responder tracking, weather monitoring, plume modeling and other special capabilities.
• Equipment and structure specialists--This group is responsible for maintaining and managing all the EMSTF's specialized equipment, including Western Shelter tent systems, generators, John Deere Gator utility vehicles, moving equipment, mass-care response vehicles, special-operations vehicles and trailers, etc. It also provides logistical support for the setup of field hospitals and casualty collection areas.
• Staging and Accountability Team--Members are trained to manage mobilization or staging areas. They bring fully equipped trailers and technology to enhance coordination of assets during large events and improve security by requiring responders and vehicles to be checked in for scene access. In addition, they track personnel using technological resources.
• Planning Team--Members provide EMS planning for long-term and high-impact events. This includes development of emergency operating plans, incident action plans, situation reports and after-action reviews. This team was responsible for developing a regional EMS response plan for the 2004 Republican National Convention.
• Training and Exercise Group--Practical experience in large-scale catastrophic events is hard to come by, so proficiency must be achieved through regular training and exercising. The EMSTF has assigned a lead training instructor and developed an aggressive training schedule.
• Finance Team--These individuals assist with cost tracking and maintain all deployment procedures, travel manifests, time cards and expense records.
• Safety Officer--The health and safety of membership is of paramount importance. A Safety Officer ensures that respiratory protection and bloodborne pathogens programs are in place, and that the safety function is always fulfilled in any training or deployment.
• Physician Response Team--Physicians trained in an urban prehospital environment can deploy to a scene of a disaster and interact with other emergency care providers. The Physician Response Team assists with triage and treatment, and provides medical consultation to paramedics at disaster sites.

Currently, the EMSTF consists of more than 200 members from 40 agencies. They represent the full spectrum of EMS throughout the state, including career and volunteer departments, as well as municipal, hospital and private services. An administrative section includes an EMSTF coordinator who works in the state Office of EMS and a planner in each region. The administrative section is responsible for developing and implementing policies and procedures and serving as a liaison between the membership and OEMS. The operations section consists of six task force leaders, managers of the different sections and supervisors for each of the modules. There is also an EMSTF advisory board that meets monthly and sets goals, objectives and overall direction. It includes representatives of various EMS associations, county emergency management offices, anchor agencies, EMS coordinators and volunteers.

Elements of the EMSTF have already been involved in responses to a variety of high-profile events, such as New Jersey's response to Hurricane Katrina, the 2004 Republican National Convention, events at the United Nations General Assembly, and large community events such as fireworks celebrations, concerts and festivals. The EMSTF has also participated in numerous federal, state and municipal exercises. During TOPOFF 3, the EMSTF planning group successfully planned and executed Operation Exodus, an exercise to test the movement of patients from New Jersey hospitals to Newark Liberty International Airport for NDMS evacuation to other states. As well, the planning team has become the planning branch of the New Jersey Department of Health and Senior Services' Office of Emergency Medical Services, and has produced numerous emergency operating plans for EMS, such as the Statewide Staging Area Management Plan. It is currently engaged in incident-specific planning with the United States Coast Guard, the Port Authority Office of Emergency Management, the New Jersey State Police and various county OEMs.

Substantial funding for the task force has come through federal grants. To date, the EMSTF has received over $6 million of monies for specialized equipment, personal protective equipment, training and exercises. Sources have included UASI (Urban Area Security Initiative) grants, Homeland Security Grant Program (HSGP) awards and Health Resources and Services Administration (HRSA) grants.

This ongoing project is far from complete, but the anticipation of having a well-organized statewide group of specialized prehospital care providers and EMS physicians is now within reach in New Jersey. We feel our state's model can serve as a guide to other states looking to improve, specialize and unify EMS assets statewide.

Mark A. Merlin, DO, EMT-P, FACEP, is medical director for the New Jersey EMS Task Force's Physician Response Team and EMS medical director at the Robert Wood Johnson University Hospital, New Brunswick, NJ. He chairs the state Department of Health and Senior Services' MICU Advisory Council.

John J. Grembowicz, Sr., EMT-P, is a leader of the New Jersey EMS Task Force and associate director of the University of Medicine and Dentistry of New Jersey's University Hospital EMS.

Henry P. Cortacans, MICP, NREMT-P, is a planner for the New Jersey EMS Task Force.

William Gluckman, DO, EMT-P, FACEP, is medical director for the New Jersey EMS Task Force and EMS medical director at University Hospital in Newark. He is vice chair of the state Department of Health and Senior Services' MICU Advisory Council.

Louis A. Sasso, MBA, NREMT-P, is a leader of the New Jersey EMS Task Force and EMS director at Robert Wood Johnson University Hospital.