EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System Reviewthen will the NJOEMS issue a certificate of need and authorize the ALS project. The certificateof need requirement has allowed New Jersey to assure 100 percent ALS coverage throughout thestate, an accomplishment that few states can boast. To keep their certificate of need, ALSprojects must provide services described in their application and no change their response planwithout NJOEMS approval. NJOEMS carefully reviews requests for changes to preventjeopardizing the 100 percent ALS coverage goal. ALS projects must also agree to provideservices to areas that are not served by ALS projects. Often, these services are “pro bono,” asthere is not guarantee of reimbursement.. When profitability was greater, this requirement hadlittle impact. A decrease in profits has services crying foul at the requirement to provide this highfinancial risk care. Recently, an ALS provider chose to reduce ALS coverage, potentially leavingan area without ALS service. The NJOEMS was forced to intervene to assure ALS coverage.In 2005, New Jersey ALS projects responded to over 400,000 calls for service. Thenumber of requests continues to slowly rise even though New Jersey’s population is decreasing.By 2015 the number of requests should exceed 425,000. This is happening because the seniorcitizen and minority communities are increasing, generating greater requests for services (Figure25).Figure 25: MICU Call Forecast Model Through 2015Responses50000040000030000020000010000000 2 4 6 8 10 12 14 162000 - 2016Raw DataTriDataForecastFor 400,442 ALS dispatches, only 173,535 (43.34 percent) required transport. Excludinga relatively small number of physician-directed termination of CPR cases and DOA’s, mostcancellations were due to ALS not being needed (Figure 26).TriData, a Division of 108September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewFigure 26: ALS Calls Requiring Transport-Forecast Until 2015ALS Transports2000001500001000005000000 2 4 6 8 10 12 14 162000 - 2015Raw DataTriDataForecastMedical Priority Dispatch and ALS Response – Although 2005 showed a slightincrease in the percentage of calls requiring transport, 2006 and 2007 data will be needed todetermine if the long-term trend is changing. Chapter 3 identified possible reasons for the highnumber of ALS cancellations. Three items are expanded upon to emphasize how poor dispatchprocedures have negatively affected the ALS system.1. Primary dispatch points are not following MPD protocols, resulting in too many callsbeing dispatched as needing ALS response. With little quality management,dispatchers may inflate the dispatch level of a call to provide a margin of safety.While this seems logical, operating out of fear instead of following the protocolcauses unneeded dispatches, poor economies of scale and compromised provider andcitizen safety. The effectiveness of medical priority dispatch protocols has beenquestioned for certain situations, but has been validated as a method to identify lowprioritycalls that do not need advanced level care. 59 Another study done in Salt LakeCity, UT reached similar conclusions. 60Concerns about the effect of MPD have often been overlooked due to lack of supervision,low volume systems with less experienced operators, or high volume systems that are notproperly staffed. In our experience, dispatch centers that attempt to provide MPD but do not59 Hinchey, P., Myers, B. and Zalkin, J. Low Acuity EMS Dispatch Criteria Can Reliably Identify Patients WithoutHigh Acuity Illness or Injury. Prehospital Emergency Care, 11(1), 42-48.60 Shah, M.N., Bishop, P., Lerner, E.B., Czapranski, T., and Davis, E.A. (2003). Derivation of emergency medicalservices dispatch codes with low-acuity patients. Prehospital Emergency Care, 7(4), 434-9.TriData, a Division of 109September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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