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MONOC's Advanced Life Support (ALS) services started in 1985 to provide a more advanced level of emergency medical services to the community in partnership with the many local municipal volunteer first aid squads throughout Monmouth and northern Ocean counties. Over the next few years, MONOC's MICU service grew to a system of seven MICUs that were strategically located throughtout the area to provide the best response to life threatening emergencies. In the beginning, these units were dispatched by their respective count dispatch centers. In 1999, MONOC received NJ Department of Health approval as a regional ALS dispatch center and we began to dispatch our MICUs into the community. This change allowed for more efficient utilization of limited assets.
In 2003, through an agreement with the Saint Barnabas Health Care System, the Community Medical Center MICU program was acquired by MONOC. This acquistion added five more MICUs and it emcompassed the remainder of Ocean county for MICU to be covered by MONOC. In 2004, through another agreement with the Saint Barnabas Health Care System, MONOC acquired five MICUs in the northern Saint Barnabas Health Care System's catchment region. In 2005, Passaic Beth Israel Medical Center became a member of MONOC which brought with it one MICU serving the Passaic and Clifton area.
Today, MONOC's MICU program has 15 full-time and four part-time MICUs on the road during peak times of the day. MONOC's MICU footprint spans over 1,800 square miles, providing ALS services for over 2.8 million people throughout Monmouth, Ocean, Bergen, Essex, Hudson, Passaic, and Union counties. MONOC receives just under 100K requests for paramedic services throughout the region annually.
All of MONOC's 40 ALS ambulances are licensed by the NJ Department of Health's Office of Emergency Medical Services. MICUs carry cardiac monitoring equipment, first line emergency medications, advanced airway equipment, IV access supplies, and are staffed with two Mobile Intensive Care Paramedics who receive advanced training through both classroom and in hospital and in field internship program. Their skills include advanced invassive medical procedures such as intubation, intravenous medication administration, chest decompression, intraosseous infusion, cardiac monitoring, cardiac pacing, and cardiac defibrillation. All of these skills and procedures take place through a designated medical practice on behalf of the MONOC System Medical Director who is Board Certified in Emergency Medicine with a Fellowship in Emergency Medicine. Paramedics speak with physicians trained by the System Medical Director during each patient interaction and the most appropriate care is provided through this collaborative process. The MONOC MICU through its over 200 Paramedics, brings the the capabilities of an emergency department directly to the patient.
In 1995, MONOC began the first Specialty Care Transport Program of its kind. Through discussions with our member hospital's leadership, MONOC was asked to help with a growing RN shortage in the hospitals. In the past, nurses from the floor or the emergency department left the hospital with their patient and did the transport in a commercial basic ambulance. This not only reduced staff in the hospital but it was not the best way to clinically transport a patient. MONOC created Mobile Critical Care Services or MCCS which changed to SCT when the Department of Health began to regulate SCT in NJ as others used our model to start their own SCT service line.
SCT is provided by a registered nurse and a paramedic or an EMT. SCT transports are for patients who have a condition that is being treated beyond the scope of practice for a basic ambulance with two EMTs. Typically, these patients are critically ill or injured and need to be transported to another hospital for further care or surgical intervention. MONOC provides SCT service primarily for CentraState Medical Center, Deborah Heart & Lung, Community Medical Center, Monmouth Medical Center, Clara Maass Medical Center, Newark Beth Israel Medical Center, and Saint Barnabas Medical Center, while also backing up other SCT programs around the State as needed and as long as units are available to do so.
Our nurses are trained to clinically manage all types of adult and pediatric critical care transports through rotations within sub-specialties in our member hospitals. This builds a cohesive relationship between MONOC's SCT program and our members and users of the service. Additionally, each of our nurses go through an annual competency exam and hands on simulation lab proficiency process. Our 12 SCT ambulances are are licensed by the Department of Health and deployed from a northern and southern location and posted as necessary based on anticipated volume or pre-scheduled workload. In 2017, MONOC's SCT program completed over 4,500 SCT transports.
Scope of Service
The MONOC Control Center is responsible for answering 9-1-1 calls for contracted municipalities, answering requests for Basic Life Support (BLS) and Advanced Life Support (ALS) emergencies from seven counties; requests for both on-scene and inter-facility cases with our Air Medical Helicopter; as well as arranging non-emergent BLS, wheelchair and Specialty Care High Risk Inter-Facility Transports (SCT). MONOC's Control Center has been in operation since 1996 and is a State approved regional communication center. The Control Center shares the same mission statement as the MONOC Corporation which is to improve healthcare and reduce costs. We obtained our status as a 9-1-1 Public Safety Dispatch Point (PSDP) in August of 2005 and began our services with the City of Orange.
Currently MONOC provides emergency medical call screening services for the following municipalities in Essex County: Fairfield, Irvington, Livingston, and Roseland. In Union County: Berkeley Heights. This service requires MONOC to answer over 35,000 9-1-1 Emergency Medical Dispatch (EMD) calls a year. As an EMD agency, MONOC provides the 9-1-1 caller with pre-arrival medical instructions until an Emergency Medical Services unit arrives on scene.
The MONOC Control Center currently has a staff of 40 employees, including one Director, one Coordinator, four Supervisors, and dispatchers and call-takers, operating 10 dispatch and call taking positions. There is an on-duty manager in the MONOC Control Center 24/7 who is medically trained to ensure proper call handling regarding ALS/BLS being appropriately dispatched and operationalized.
For EMS services, MONOC has emergent call-takers who receive requests for ALS and BLS services from other emergency agencies requiring our services. The Emergent Call-takers have all received 80 hours of 9-1-1 training and are CPR certified. The MONOC Control Center employees have successfully completed this training and received their certificates in Emergency Communication Officer and Emergency Medical Dispatch. 9-1-1 operators have to control the caller and guide them through the medical crisis through the use of the IAED Guide Cards offering pre-arrival instructions to assist the person in need until help arrives. MONOC operates within a large geography in the State of New Jersey. There are three Dispatchers coordinating communication operations within our north and south region. It is their job to ensure the closest available and most appropriate unit is dispatched.
When an Air Medical Transport request comes in to the MONOC Control Center, a communication specialist is required to flight follow "MONOC 1" (MONOC's Air Medical Transport Helicopter) as well as Atlantic Health System's two air medical units and Cooper Health System's two air medical units and ensure their safety during the flight. There are over 20 employees currently trained in flight following. MONOC has been providing dispatch and flight following services for twelve years; since April, 2006. The natural progression of advancement within the MONOC Control Center is from newest call-takers, who receive approximately four weeks of training; initially operate within the non-emergent division and, as they gain experience and receive necessary emergent call taking training, they move to the emergent division. The Dispatchers and Communication Specialist are our most experienced personnel who have received training in each of these disciplines.
On any given day the MONOC Control Center manages over 50 EMS and transport units within the system, answering approximately 500 requests for service daily, and fielding several hundred calls requiring some form of an administrative response from the MONOC Control Center. The MONOC Control Center processed over 180,000 requests in 2017. MONOC is proud to be the largest, busiest and most technologically advanced EMS, medical transportation and emergency medical dispatch agency in the state of New Jersey.
Equipment
MONOC owns all of its dispatch and communication equipment and all equipment has the latest operating systems available. The MONOC Control Center operates 12 9-1-1 trunk lines, 9 emergency phone lines used for ALS, BLS and FLIGHT emergency requests, and 4 non-emergent phone lines used for setting up transports for our SCT units. The MONOC Control Center utilizes Zetron touch screen technology which incorporates an on-screen display of 9-1-1 ANI and ALI information, TTD/TTY capability, an instant playback feature which stores the previous 10 calls from that console position, and all of our resources are stored for speed dialing capability. All phone lines and radio lines are recorded through a Telex recorder, which the on-duty Communications Supervisor can access immediately. The MONOC Control Center also utilizes RescueNet Dispatch (Right CAD) from ZOLL DATA. The MONOC Control Center is capable of tracking MONOC units and others through GPS in our CAD system. It is further capable of air medical helicopter flight following through our CAD using the Outerlink program. All MONOC's call takers and dispatchers wear headsets allowing for better audio and hands-free operation, while minimizing the overall ambient noise in the MONOC Control Center..
Record Keeping
All recordings and documentation are kept in a secured vault in a fire proof room that is under video surveillance. This room also contains the computer servers for our dispatch system. A redundant server system for storage is located off site.
Quality Assurance
The MONOC Control Center management conducts quarterly performance evaluations on all employees, evaluating the overall job performance for their current position to ensure they are following MONOC Control Center Standard Operating Procedures, MONOC Policy and Procedures, State and Federal regulations, and are fulfilling their current job description. If any employee is not at a satisfactory level, they are immediately remediated and assigned an action plan to correct their performance. The MONOC Control Center also performs random daily QA checks on call in-take for 911, emergency and non-emergency cases to ensure policies are being followed and calls are being handled appropriately. This review includes customer service practices to ensure we are meeting a satisfactory level. Dispatching activity is also subject to daily QA by the on-duty Supervisor to make sure each dispatcher remains attentive at all times, ensuring prompt and correct dispatching of units. MONOC utilizes a variety of reports and data to measure call in take times and dispatch processing times to ensure they are within the required parameters. All Q/A results are discussed monthly with our Performance Improvement Committee that includes senior managers, and day to day communications managers who are EMD trained as well as paramedics, nurses and EMTs. MONOC abides by the NAED scoring standards in our QA program.
Accreditation
MONOC received full ACE accreditation from the National Academies of Emergency Dispatch (NAED) in 2011. http://www.emergencydispatch.org/AccredCurrentAces
Facility, Security & Back-Up Power
The communication and dispatch center is a secured large room with an ante room for training and education of our EMD and other communication employees. The center is accessed by an ID swipe card system assigned to each employee. All doors have an emergency key access. The communication center is ADA compliant; is monitored by a fire alarm system with a Halon fire suppression system in both the communication center and the server/records room. The entire facility is under closed circuit video monitoring. All computer consoles are backed up by a universal power supply (UPS) device and all emergency equipment is further backed up by two Kohler 50-Kilowatt Natural Gas Generator with hookups for additional generators (which are under contract).