EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewRecommendation 25: Add the administration of oxygen-nebulized or metered-doseinhaled beta agonist agents to the EMT-B scope of practice.5. Expand the scope of practice/service for EMT-Bs – As recommended in the firstcomponent, EMT-Bs are trained to perform many basic skills that would be of benefitin other healthcare situations. This will be explained further in the chapter onworkforce issues.Information Systems – Regardless of what component that the focus groupsdiscussed, one could hear a theme of all New Jersey EMS system roads lead back to informationsystems. Much of our ability to assess the New Jersey EMS system was the lack of data. Thisincluded response intervals, staffing, patient care, or any measurable item. This frustration wasalso felt by many of the focus groups.The focus groups discussed 17 ideas and chose the following five items as top priorities.1. Statewide EMS database – Each focus group agreed that a statewide database shouldexist. There was less agreement as to whether this should be aggregate data or eachpatient contact. The NJSFAC has developed a database and collects aggregate datafrom squads who wish to voluntarily participate. It is estimated that 25 percent ofsquads participate.2. Statewide Patient Care Report (PCR) – There is no uniform statewide patient carereport. All ALS units and licensed BLS agencies are required to complete a patientcare report and forward aggregate data to the NJOEMS. Several ALS and licensedprograms are testing a computerized PCR known as EMSCharts. The NJOEMS iscurrently analyzing the use and efficacy of this report. Some NJSFAC squads are alsopiloting a computerized charting system.3. Funding for technology – New Jersey EMS needs to commit to technology regardinginformation management. Until a complete, accurate and reliable statewide EMSinformation system is implemented, we will never know the true state of EMS in NewJersey.4. Require PCR for all patient encounters – One of the shocking revelations about theEMS system is that a PCR is not required for each patient care encounter. EMS is thepractice of medicine outside the hospital setting. No other practice of medicine occurswhere patient care reports are not completed. In most EMS systems, patient carereports become part of the patient’s medical record.TriData, a Division of 66September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review5. Web-based communications system for access by all – Two-way informationsystems should be accessible by all. Some information will be restricted due to legalissues.Based on the above information and our investigation, TriData offers the followingrecommendations involving the NJEMS information system.Recommendation 26: NJOEMS should create a statewide EMS database using theNEMSIS minimum data set.Recommendation 27: NJOEMS should create a statewide PCR that can be used by allALS and BLS units. Use of this report should be required for all EMS units. Reporting ofaggregate data should not be accepted as a substitute for the statewide PCR.Recommendation 28: All EMS patient care encounters must be documented on anofficial patient care report. A copy of all patient care reports must be left at the receivinghospital. Emergency departments must place a copy of the PCR or download the PCR data intothe patient’s chart. Under no circumstances should EMS PCRs be discarded.Recommendation 29: EMS services must adopt an approved statewide PCR to receiveany state funding.Recommendation 30: Primary access points and primary dispatch points centers mustemploy appropriate hardware and software necessary to provide accurate data and populatedata fields on the PCR.These recommendations are some of the strongest that we make. Until the EMSinformation system becomes accurate and usable, New Jersey will be unable to provide effectiveoversight of its EMS system.Evaluation – Knowing the strengths and weaknesses of the EMS system is a key to asuccessful future. The focus groups identified 21 ideas choosing the following six as the toppriorities:1. Internal QI process – The NJOEMS should begin a formal internal QI process.2. Timeline for evaluation – There should be specific timelines set for EMS systemevaluation. There can be different levels of evaluation with different timelines(i.e. certain items evaluated annually, others triennially and a comprehensiveevaluation every five years).3. Publish evaluation results and recommendations to the EMS community – Thisinformation should be published through the NJ EMS Council.4. Independent evaluation of OEMS – A comprehensive evaluation of NJOEMSshould be performed by an outside organization every five years.TriData, a Division of 67September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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