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. This shortage has become more serious as the years have passed. 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 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 handle 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. Today, virtually all the paramedic services of New Jersey report a shortage. We have looked to our legislators to help resolve this problem, providing several options that require their action. Adequate funding remains the most important way to solve the problem. Without sufficient funding, we are unable to attract new recruits for training. For more information on this problem and available solutions, contact us at: Vincent D. Robbins, FACPE, FACHE President & CEO; MONOC 4806 Megill Road, Neptune, NJ 07753