EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewJersey’s EMS system is compared to those of five other states (i.e., Ohio, Virginia, Maryland,Delaware, and Connecticut) assessing the strengths and weaknesses of the state EMS system.Comparisons were based on states that had population densities similar to New Jersey. Ananalysis of the samples states found that New Jersey differed from most, since their localmunicipalities are not legally responsible for the provision of EMS. In addition, New Jersey hasno state EMS medical director nor does it have a regional EMS system.EMS System AssessmentNew Jersey’s EMS system was evaluated through feedback provided from 13 focusgroups representing EMS organizations and EMS providers. The assessment consisted of twoparts which were evaluating the current state EMS system based on the National HighwayTraffic Safety Association’s (NHTSA’s) 14 components and determining future priorities for thestate based on each component. Overall, the focus groups determined that the state system was“marginal” with EMS Research and System Finance being unsatisfactory. The focus groupsidentified up to seven priorities for each component.Recommendations for Changing EMS Regulation and LegislationTriData was requested to review the current EMS legislation, executive orders, andregulations that govern New Jersey EMS and to provide appropriate recommendations. NewJersey must develop and enact comprehensive legislation that overhauls the entire EMS system.The current legislation emphasizes restrictions and political pacification over an effectivesystems approach for quality EMS care.Major changes recommended include adopting enabling legislation, removing therestrictions on paramedics and EMTs using their skills in hospitals or other healthcare settings,removing patient care protocols from regulations, deleting the regulation that requires onlinemedical direction for all patients treated by ALS providers, and requiring that all EMS servicesbe licensed by NJOEMS.The New Jersey State EMS SystemThe New Jersey EMS system should be redesigned to manage a modern statewide EMSsystem. NJOEMS should be renamed the New Jersey Division of EMS (NJDEMS) and beheaded by an Assistant Commissioner. State-level staff positions should be filled and notallowed to remain vacant. A northern, central, and southern EMS region should be created, eachhaving a regional director and staff. These changes should be phased in over 2 years. NJDEMSshould hire a full-time, state EMS medical director who has full medical oversight of the system.Changes to EMS protocols and procedures should not require approval of the Commissioner ofHealth and Senior Services.TriData, a Division of 4September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewAir Medical EMS (JEMSTAR)Air medical EMS is provided mainly by a state air medical transport (JEMSTAR)program that is augmented by private agencies. Specifically, air medical EMS response isprovided by a joint venture between the New State Jersey Police (NJSP) and contracted EMSproviders. The NJSP provides the aircraft and two pilots per helicopter and the DHSS providesfunding for two flight nurses or one flight nurse and one flight paramedic. Air medical responseis performed via the use of the two helicopters available. One aircraft called the NorthStarprovides coverage for northern New Jersey while the other, called SouthStar provides coveragefor the southern region. There are three private air medical units that serve as a backup sourcewhen the NorthStar and SouthStar are unavailable.Discipline and safety are of primary concern for organizations with stewardshipresponsibilities for air medical EMS. New Jersey has been fortunate to have maintained a highsafety record during flight transport. JEMSTAR provides approximately 1,700 transports peryear. The number of transports by private air medical agencies is unknown. JEMSTAR isfunded by a $3.00 charge on vehicle registrations and a charge of $1,337 for each transport.Private agencies are not limited as to how much they charge, but receive no state funding.Recommendations were made to adjust the distribution of vehicle registration money andcharges for transport.Advanced Life Support DeliveryNew Jersey’s ALS system provides excellent clinical care by well-trained paramedicsand an active cadre of physicians who provide medical oversight. However, financial issuesthreaten the infrastructure of hospital-based ALS as they are faced with the challenge ofmaintaining adequate staffing and keeping ALS programs profitable. A paradox exists betweenALS care and ALS project viability. Once profitable for hospitals, ALS projects are strugglingto maintain financial stability as non-transportation providers are unable to earn sufficientMedicare/Medicaid funds to assure profitability. Currently, ALS projects must be hospitals orhospital consortium services. ALS provision should be permitted by non-hospital agencies with astrict set of standards in place prior to the commencement of these services. One paramedic andone EMT should be the minimum crew for ALS transport units and one paramedic should be theminimum for non-transport ALS units. Organizations such as the fire service, municipal EMS,commercial EMS, hospital/hospital consortiums, and volunteers could take a larger role inproviding or augmenting ALS services in New Jersey.EMS WorkforceThe workforce is the most critical factor in the provision of effective EMS. It is also the biggestchallenge faced by EMS. The Institute of Medicine report identifies several workforcechallenges that are common to EMS nationwide including recruitment and retention ofTriData, a Division of 5September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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