There is little doubt we have a problem in New Jersey with our EMS System. Or more correctly, our “non-system”. Virtually every segment of the industry in the state agrees there are problems, we just don’t always agree on what they are. A few years ago (2007), the state’s legislature commissioned a study to comprehensively look at EMS in New Jersey and analyze what’s wrong. A company named TriData completed the task and issued a thorough report, itemizing many issues that impair the state from providing a modern-day efficient, effective EMS System.

 

To our credit, the entire industry, regardless of parochial interests, banded together and responded to the study. Members from the 35 stakeholder groups in EMS, from BLS and MICU providers, to hospital emergency department physicians and nurses, to the volunteers, municipalities, legislators, and regulators, met over a four-month period and produced model legislation that would have transformed our “non-system” into a true EMS System. Unfortunately, it was never enacted.

 

Since then, little effort has been made by any group to address the fundamental problems we face with EMS in New Jersey. An overarching problem we have is our lack of data and performance standards. It is difficult to fix a problem when one lacks the specific information needed to describe it or to assess how we are meeting established needs.

 

The serious and critical problems identified by TriData have not gone away, and many have simply festered, growing worse.

 

The study verified what many of us knew (and continue to experience):

1)      Funding for the ALS tier of EMS in NJ is inadequate and unsustainable. Paramedic services in the state are financed purely through fee-for-service (billing insurances, patients and Medicare/Caid). Reimbursements from these entities is insufficient and do not meet the cost of providing care. Tax subsidies are required to maintain statewide ALS that is available for all patients needing care.

2)      Over dispatch of ALS units plagues the MICU programs in the state. This overuse depletes scarce resources and causes paramedic units to be unavailable for about 5 – 10% of requests. Additional MICUs are unaffordable.

3)      Requiring two paramedics as the minimum crew complement for MICUs is archaic, unnecessary and inflates the cost of service beyond sustainable levels. No other state requires two paramedics on every call and medical research argues that single paramedic crews perform faster, with better proficiency and less errors, than two medic crews.

4)      It impairs high quality EMS care to allow a large segment of the industry to remain unregulated, unlicensed and accountable only to themselves.

 

Some of the more important recommendations, directly from the study;

 

Recommendation 4: Legislation should be passed that requires local municipalities to

provide EMS (or cause to be provided).

Recommendation 5: All EMS provider agencies should be licensed by NJOEMS.

Recommendation 6: There should be a comprehensive overhaul of the current state

EMS legislation and regulations; System Finance – This has been identified as one of the weakest components of the New Jersey EMS system. Identify dedicated sources of funding

Recommendation 18: Aggressively move toward compliance with the consolidated

countywide 911 centers.

Recommendation 20: The NJOEMS in conjunction with the NJ EMS Council should

determine response time standards for EMS that apply to all agencies.

Recommendation 24: All BLS ambulances, regardless of delivery platform, must be

staffed with at least two NJ certified/licensed EMT-Bs.

Recommendation 43: Quality management of medical priority dispatch must be

established for ALS services to be efficient.

Recommendation 44: Eliminate the use of ALS projects as de facto cover for BLS

services.

Recommendation 47: Modify legislation and regulation to allow ALS transport units to

be staffed by one paramedic and one EMT and non-transport units to be staffed with one

paramedic.

 

It’s time to get back on track and address our deteriorating EMS Non-System.