For years the number of paramedics certified in New Jersey has been insufficient to meet the full staffing needs of the state’s mobile intensive care unit (MICU) programs. Advanced life support (ALS) providers have been unable to always staff all the MICUs they planned to operate to meet the demand for services. However, in recent years, the staffing issue for paramedic units has become more serious.


New Jersey is covered by 20 regional paramedic programs designated by the Department of Health, who operate as the advanced life support tier of the state’s emergency medical services system (EMS) using MICUs staffed with two paramedics each. The first tier of the EMS system is provided by local basic life support (BLS) ambulance agencies using emergency medical technicians (EMTs) as their staff.


Since the 1980’s when New Jersey established paramedic services as a certificate of need (CN) health service, only hospitals in the state have been authorized to provide this high level of EMS for life threatening emergencies. Routine, non-life threatening emergencies, such as fractures, lacerations, minor injuries and illnesses that need a physician’s attention, are handled by the BLS ambulances local to each town. But, when a critical emergency occurs; a heart attack, stroke or severe trauma, MICUs are dispatched along with the BLS ambulance, so paramedics may attend to the patients using their advanced medical skills, equipment and medications, which EMTs are not trained to provide.


This two tiered EMS system in New Jersey has saved countless lives over the years. BLS ambulance and MICU paramedic teams have worked together for decades to provide cutting edge, advanced pre-hospital medical care to those in desperate need and whose lives hung in the balance. Unfortunately, the system has begun to erode and unravel. Fewer paramedics being trained each year has reduced the number of trained personnel available to adequately staff all the paramedic units needed in the state.


MONOC is the largest paramedic provider in the state, covering more than 20% of New Jersey. It is also the hardest hit by the paramedic shortage. To make matters worse, reducing reimbursement rates from both the state of New Jersey and the federal government (primarily through Medicare), have sucked millions of dollars annually out of the system, leaving paramedic programs nowhere to recoup the loss. Salaries for paramedics have become unattractive to those seeking rewarding careers.


Therefore, not surprisingly, a trend recognized over the last two years in particular, has identified a shrinking number of candidates applying for paramedic training classes in the state. All five training sites have reported smaller numbers of incoming students. The pipeline that has continually replaced paramedics leaving the field or retiring, is drying up. This will result in a devastating shortage of paramedics within 18 months to two years.


This growing shortage of paramedics has hit virtually every provider in the state. The New Jersey Association of Paramedic Programs (NJAPP) met with, and alerted, the Department of Health regarding this serious situation earlier this year. NJAPP represents all the paramedic provider agencies in the state. However, the Department has made no effort to ease the situation.


New Jersey could quickly cure this problem, at least for the short term. New Jersey is the only state in the country that requires MICUs to be staffed with two paramedics. Every other state allows the crew to be composed of one paramedic with an EMT partner. This has proven to be safe, efficient and has not impaired patient care. In fact, changing crew configuration of MICUs to one paramedic and an EMT, would increase the exposure rate for the paramedic to critical cases, providing him/her more experience and improve their skills. Converting to this new crew configuration would solve the paramedic shortage problem overnight, and allow the system time to recruit more students. The state needs to act quickly.