EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewWhile the concept of EMT-Intermediate merits implementation is some areas, is not rightat the present time for New Jersey.Recommendation 49: New Jersey should not pursue adding EMT-Intermediate as anEMS provider level.Potential Provider OrganizationsThere are several organizations that could take a larger role in providing or augmentingALS services in New Jersey. This section identifies the challenges associated with these potentialnew providers.The Fire Service – In many parts of the country, the fire service provides all or part ofALS service for its community. Initially, New Jersey had a few fire departments with pilot ALSprojects, but these services quickly yielded to the present system. With some notable exceptions,New Jersey’s fire service has not shown significant interest in providing ALS services. Manydepartments still do not provide first responder BLS. The reasons for this are many, but ahistorical marker can be identified. When the current 2K legislation was enacted, volunteer BLSsquads were much stronger and provided more services. The fire service was excused from EMSobligations, which was welcomed by traditional fire departments.Today, the playing field is different. Some New Jersey fire departments provide BLS firstresponder or BLS transport services. The desire to perform ALS is not overwhelming, but someservices have expressed an interest such as the Cherry Hill, Ocean City, Asbury Park andHackensack Fire Departments.Some may desire to provide full ALS service while others may wish to limit provision tofirst responder ALS leaving transportation to current sources. In these situations, successdepends on definitive project standards and strong medical oversight.Municipal EMS – There are opportunities for municipal, non-fire service EMS systemsto provide ALS. These opportunities will likely be confined to full service ALS, but “chase car”services to areas where volunteer or commercial BLS provide transport are possible. This alsoincludes police agencies who are performing EMS. Tom’s River has expressed interest inproviding ALS services.Another model of municipal ALS (that could include fire) is a countywide system. Thecounty could become the ALS provider or take over supervisory responsibilities at an operationaland administrative level. The county might, for example, provide ALS supervisory personnelwhose primary duties would include quality management, data analysis and training. They alsowould be available for field supervisory duties and supplement when an additional ALS providerTriData, a Division of 116September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Reviewis needed. Primary ALS responders could respond with one paramedic and a supervisory couldrespond to calls assigned to “Level E.” If, as we recommended in Chapter 3, counties couldbecome the licensed billing agent for all EMS services, then these supervisory personnel couldplay a greater role.Commercial EMS – Commercial services that might provide ALS service but see itbeing a considerable financial and legal risk, and may find it not worth taking. Only thosecommercial services who have the capital, understand the risks and serve in areas that have theneed, should consider this venture. Commercial services should consider providing emergencyBLS services in areas that are underserved by volunteer providers.Hospital/Hospital Consortiums – While some hospitals may choose to opt out ofALS services, others may find opportunities. There are good reasons for hospitals to continueALS provision. The medical care provided is usually superior and medical oversight is usuallystrong. Those services that are willing to invest in their personnel and can remain financiallysolvent may find great benefits from continuing or adopting ALS services.New Jersey’s hospital-based system has a major flaw that prohibits full use of ALSproviders. The current 2K statute prohibits ALS (or any EMS) providers from performing skillsin a hospital setting except during training. Legislative restrictions have lead to vast under use ofskilled personnel. Some believe that eliminating restrictions would improve the skills ofparamedics. 67Another caution to consider is the aging workforce of hospital EMS providers, with manyALS providers being in their 50s and 60s. Adding transportation duties to these providers maylead to earlier retirements due to increased physical demands (lifting and carrying).Volunteers – There are many counties, cities and towns that rely exclusively onvolunteer ALS services. While their numbers are decreasing, some continue to provide excellentservices. This could be true in New Jersey, especially in areas where squads merge into strongorganizations that can guarantee response and quality management. Realistically, we believe thatthere is little interest from New Jersey volunteers to embark on this effort.Organizations other than hospitals can successfully provide ALS services. They canprovide full ALS services or supplemental ALS first response. Counties can take a stronger rolein assuring the best economies of scale while keeping the high level of care. There are severalcautions for organizations who are considering adopting ALS:67 IOM (2006). Emergency Medical Services at the Crossroad. Institute of Medicine. Washington, DC: NationalAcademic Press.TriData, a Division of 117September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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