EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review• JEMSTAR remains the primary EMS air medical provider.• MedCom will continue to be the centralized point of dispatch and communications.• If the primary JEMSTAR unit is unavailable, the next fastest commercial unit will besent.• If a commercial unit base of operations is within three nautical miles of an incident,that unit may be immediately dispatched.• If a commercial unit is in flight and available, they may be immediately dispatched tothe incident.The same considerations will be given to emergency inter-hospital transfers. 54The draft protocol is a genuine attempt to take reasonable actions. Unfortunately, it maylead to further confusion as it fails to offer clear direction. It also does not provide for sanctionsif a unit is determined to be “self-dispatching.”Recommendation 39: If the NJOEMS wishes to enact a protocol for commercialhelicopter dispatch, it should be precise and easy to follow. Documentation should be kept tomeasure key time intervals and patient outcomes.The ability to regulate air medical EMS is a national EMS issue. The Institute ofMedicine report recommends that “states assume regulatory oversight of the medical aspects ofair medical services, including communications, dispatch and transport protocols.” 55Discipline and safety are of primary concern for organizations with stewardshipresponsibilities for air medical EMS. New Jersey has been fortunate to achieve the safety recordit has. This safety record is not universal.Between 1983 and 2005, there have been many instances of EMS helicopter crashes inthe United States. Of the 182 EMS helicopter crashes analyzed in the study, 39 percent werefatal. A total of 184 occupants died—32 percent of the 513 crew members and 45 percent of the44 patients.Overall:• 77 percent of the crashes occurred while flying in weather conditions necessitatingthe use of instrument flight rules as opposed to visual flight rules;54 JEMSTAR (2007). Dispatching New Jersey Licensed Commercial Air Medical Units (AMU) for in-state medevacrequests. (Draft). April 17, 2007.55 IOM. (2007). Emergency Medical Services at the Crossroads [Uncorrected Proofs]. Washington, DC: TheNational Academies.TriData, a Division of 102September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review• 56 percent of the crashes occurred during nighttime flights;• 39 percent of the total fatalities happened in crashes with post-crash fires and of allcrashes with post-crash fires, 76 percent were fatal. 5657The safety of citizens and EMS providers cannot be compromised. All servicesparticipating in NJ Air medical EMS must be held to a strict set of rules. Violations cannot betolerated and must be addressed in an appropriate manner.Recommendation 40: EMS helicopter units which are determined to have “selfdispatched”to emergencies should be subject to suspension. Repeated violations should begrounds for license revocation.Financial IssuesJEMSTAR – Historically, allocated funds have been insufficient to cover the operatingexpenses of this program, both during the early years of the program and since the establishmentof the dedicated helicopter fund. Due to restrictions on the NJ State Police Aviation Unit, onlypublic funds may be used to support the aviation activities of the program. In order to close thebudget shortfall, the mobile intensive care unit (MICU) hospitals providing the medicalcomponent were directed to bill the patient for medical services provided when patients aretransported by the program. This fixed charge represents only a portion of the cost of the medicalservices provided during the flight, and is billed in a manner similar to the billing of patientstreated by ground-based MICUs. Effective September 14, 1999 , the charge was increased from$535 to $1337 to cover a larger share of medical expenses and reduce the burden on thehelicopter fund. The billing charge has not changed since. All MICUs are required to bill thepatient for the medical services they receive; in this regard, the air medical program differs fromground-based MICUs only in the mode of transportation. This also differs from air medicalhelicopter services operated by commercial agencies or by out-of-state hospitals, which charge inexcess of $10,000 per flight.The NJSP is able to fund their part of the aviation program with the $3.00 per vehicleregistration that is earmarked for the program. A conservative estimate is that $9 million is56 Hendry, J.M. (2006). Night Flights, Weather and Fire Associated with Helicopter Crash Fatalities. Merginet.Available [Online]. http://www.merginet.com/index.cfm?pg=airmed8fn=helocrash.57 Baker, SP; Grabowski, JG; Dodd, RS; Shanahan, DF; Lamb, MW; Li, GH. “ EMS Helicopter Crashes: WhatInfluences Fatal Outcome?” Annals of Emergency Medicine. Published online January 20, 2006 .doi:10.1016/j.annemergmed.2005.11.018.TriData, a Division of 103September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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