EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System Reviewpersonnel; lack of nationwide training requirements leading to a wide range of quality of care;possible dangers of prehospital care including risk of violence, infectious and contagiousdiseases, risk of terrorist incidents, and dangers from ambulance crashes; and low pay andbenefits, particularly among providers outside the public safety sector. 2Those choosing EMS as a career, who are not either firefighters or police officers, do not receivecompensation and benefits equal with their fellow public safety providers. To increase salary andbenefits, many providers have become nurses or other mid-level health care providers.Traditionally, a volunteer EMS provider was someone who provided their time and services forno compensation. The current definition of a volunteer is not universal since many receive sometype of compensation for their services. Some volunteers feel excluded, especially in placeswhere career providers have taken over prominent roles. In order to achieve any success,volunteer services will have to “let down their guard” and allow for new ideas and concepts.Volunteer EMS leadership should support EMT-B as the standard for BLS care and advocate fordiverse methods of education that will increase accessibility to training. The next few years arecritical to the future of volunteer EMS in New Jersey. Critical decisions that favor good patientcare and wise uses of resources may help keep the volunteer system strong. Leaning towardsterritorialism and resisting change will likely continue the current spiral toward the demise ofvolunteer services.2 IOM (2006). Emergency Medical Services at the Crossroad. Institute of Medicine. Washington, DC: NationalAcademic PressTriData, a Division of 6September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewI. INTRODUCTIONThe New Jersey EMS system must change to continue effective delivery of prehospitalcare. The system’s financial structure, decline in volunteer membership, lack of comprehensivelegislation, and weakened ALS system is in near crisis. One particular issue encountered by NewJersey EMS leaders involves the public’s acceptance of EMS, which has led to changes inexpectations of quality care, the role that EMS should play in our healthcare system, and howEMS is best provided. These are critical as citizens of and visitors to New Jersey are dependenton the expedient and reliable response of EMS personnel for the provision of prehospital careand transport to an appropriate medical facility.In addition, changes in social, technological, educational, environmental, and politicalaspects of emergency care require governmental entities to rethink how EMS should beregulated. This includes medical oversight of patient care, EMS system design, stewardship ofaccess, economies of scale, and the integration of new technologies that enhance patient care andinformation management. Factors such as an increase in demand for EMS among the seniorcitizen population, the growing number of underinsured and uninsured citizens, and tighteroperating budgets challenge governmental and private providers to provide competent EMSservices at a reasonable cost. Public expectations are not easy to respond to as their impression ofEMS is different from what actually occurs. Until recently, the media portrayed EMS systems asalways prepared, always staffed, and usually within a few minutes of any emergency. Save ratesfrom cardiac arrest were shown as high and emergency departments were always standing bywith a full team of experts ready to save almost everyone who arrives. 3The challenges and opportunities that face New Jersey EMS can be summarized in byfive major items:1. The need to sustain EMS organization’s capabilities and mission in the face ofgrowing resource needs and reimbursement constraints.2. Meeting the multifaceted workforce crisis that exists throughout the country.3. Ensuring patient safety and good clinical outcomes; reducing variability in qualityand cost; and demonstrating positive impact on the health status of individuals,families, and communities.3 Bledsoe, B. (2007). Have We Set the Bar Too High? Journal of Emergency Medical Services [Online Version],32(3), 1-7.TriData, a Division of 7September 2007System Planning Corporation
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