EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System Reviewoverseeing services is a 16 member commission appointed by the Commissioner. They functionas part of the EMS Mobile Intensive Council but also provide the Commissioner with guidanceon Air Medical EMS issues. The New Jersey JEMSTAR program and private programs fallunder these oversight authorities.New Jersey State Police (NJSP) – The NJSP Aviation Division provides the aircraftand pilots for the JEMSTAR program. They also provide all maintenance and fuel for theaircraft. Two helicopters provide primary service with two in ready reserve for immediateservice. Each primary helicopter is staffed by two pilots and two EMS providers. The two pilotissue is controversial, but NJSP believes that their excellent safety record of no aircraft crashesspeaks for itself.$3.00 of each auto registration fee is earmarked for the JEMSTAR program. This fundinggoes directly to the general treasury state police, while the medical providers are reimbursed by acombination of a state grant and patient billing. This provides the NJSP with approximately $9million annually.REMCS is the central aviation communications center located at the UMDNJ in Newark.All emergency EMS air medical missions are dispatched from it. The center can be accessed byall public safety, medical and hospital agencies by calling one telephone number. Anyprehospital response must be dispatched through REMCS. Self-dispatch or “jumping” calls byeither JEMSTAR or private helicopters is a violation of NJOEMS rules. Anecdotal informationindicates that on some occasions, private services have self-dispatched to emergency scenes.There are also times when JEMSTAR has declined a mission due to bad weather, but anotherservice agrees to accept it.Response IssuesThere are several response issues that affect air medical EMS, including when should airmedical services be used and how should the services be provided. New Jersey is a relativelysmall state whose population is concentrated in urban and coastal areas. Most patients needingtrauma center or specialty services are within reasonable ground transport distance. Southern andNorthwestern New Jersey are predominately rural and ground transport times are often long.When Should Air Medical Service Be Used – The NJOEMS has providedguidelines for helicopter use. The patient must meet the criteria for multi-system trauma referral.They include:• Estimated ground travel time to the nearest trauma center (including distance, trafficconditions and terrain).TriData, a Division of 100September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review• ETA of the helicopter including travel and patient transfer time.• Patient entrapment and predicted extrication time.• Number of patients seriously injuredGenerally, if the ground transport travel time is greater than 30 minutes, air medicaltransport is appropriate. If the ground transport time is between 20-30 minutes, the providershould carefully consider the above factors in determining the mode of transport. If the transporttime is less than 20 minutes and there are no mitigating circumstances, then ground transport isusually appropriate. 53The above guidelines are not strict protocols. In the future, these guidelines may becomestandards because of financial reasons. This will be discussed further in the financial section.How Should Service Be Provided – Considerable differences of opinion permeatethe New Jersey EMS system in regard to provision of air medical EMS. Until 2005, JEMSTARwas the exclusive provider throughout the state. Private air medical providers were able toconvince the NJOEMS to license them to provide inter-facility transports and as back-up forJEMSTAR. Since then, private companies have attempted to become primary providers forspecific areas.A prevailing question is that of the interpretation of being “closest to the incident.” Whilethis sounds simple, it is actually very complex. To determine “closest to the incident” the systemmust consider several factors including: nautical miles, interval from alert to being en route,speed capability of the helicopter, and the ability to find a suitable landing zone close to thescene. JEMSTAR helicopters are on wheels and can quickly move from the hanger to the takeoffzone. The other helicopters are towed to a takeoff zone, which adds time to their response.The Sikorsky helicopters used by JEMSTAR units can fly at 175 MPH, faster than those of otherservices.Recommendation 38: Select often used helicopter landing areas and using the abovevariables, pre-determine the closest units. Upgrade REMCS and helicopter units with theappropriate tracking devices that can determine the closest units.In June 2007, JEMSTAR submitted an updated draft protocol for the dispatch ofcommercial air medical units. The protocol was suggested in order to provide effective oversight,limit the state from restraint of trade liability and assure quality patient care. The basic provisosof this draft were:53 NJOEMS. (n.d.). Helicopter Response Program Ambulance vs. Air Transport: Fly or Drive? Available [online.].http://www.state.nj.us/health/ems/flydrive.htm.TriData, a Division of 101September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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