EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System Reviewinclude the quality management tools of real-time forced-choice for dispatchers, case review,supervision and medical direction are often disappointed in the results.EMS systems must invest in quality management at the PSAP. Without properintegration of the initial step of EMS care, no other recommendations are likely to come tofruition. If this isn’t fixed, the same over-dispatch will continue.Recommendation 43: Quality management of medical priority dispatch must beestablished for ALS services to be efficient.2. Dispatching of ALS units as a back-up to for BLS units to prevent extended responsetime. Towns use ALS to be first responders just to get someone there. To a politicalentity this seems a logical use of service. If several nearby units fail to respond, atleast someone will respond. Unfortunately, this overuses ALS services especiallythose who cannot provide patient transport. An alternative in communities where thisoccurs is for the fire service to assume more first responder obligations.Recommendation 44: Eliminate the use of ALS projects as de facto cover for BLSservices. Consider using commercial services for back-up BLS transportation or fire services forBLS first response.3. Several focus groups provided anecdotal information that BLS providers havebecome over-dependent on ALS providers. New Jersey’s restrictive protocols alsolimit when ALS providers can assess the patient and allow for BLS transport. Medicaldirectors should determine which patients could safely be turned over to BLS postassessment or care.Recommendation 45: Medical directors should determine which patients ALS unitscan transfer care to after assessment or treatment.Lack of BLS Transport Services – Another threat to New Jersey ALS is theavailability of BLS transportation in some communities. With exception of the services listedabove, ALS units are only permitted to operate as non-transport “chase” units. In 2005, a seminalevent occurred when for the first time the majority of ALS patients were transported by licensedambulances, by a ratio of 48 percent to 44 percent over volunteer squads. An analysis of databetween 2000–2005 revealed that the percentage of ALS patients declined. Projection analysisindicates this trend will continue through 2015.TriData, a Division of 110September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewFigure 27: ALS Patients Transported by Volunteer Squads, 2000–2005# of ALS Transports10000075000500002500000 2 4 6 8 10 12 14 162000-2016Raw DataTriDataForecastThe above data indicates a potential problem with ALS service and EMS response ingeneral. As data were not available concerning overall responses by NJSFAC and non-affiliatedvolunteer services, the above data indicates that volunteer services are declining and are likely tocontinue to do so. Action should be taken before volunteer problems become critical. AllowingALS projects to transport patients or using commercial services may bridge the gap left by thereduction in volunteer BLS transport services.Regression models support the above information. They indicate that as the total numberof completed ALS calls increase, the number of these patients transported by volunteerambulance services decreases. 61Recommendation 46: Allow ALS projects to provide patient transportation.ALS Project Viability – A paradox exists between ALS care and ALS project viability.The two-tiered system appears to facilitate the delivery of good patient care. Paramedics are welltrained and their scope of practice covers the basic services that they provide. In general, ALSprojects have intense medical oversight by qualified physicians who are active in the daily unit61 A Pearson’s Product Moment Coefficient indicated a correlation factor of .76 for the number of ALS alerts inrelation to ALS transports and -.89 for the number of transports and the number of transports handled by volunteersquads.TriData, a Division of 111September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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