EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewRecommendation 35: Implement a regional EMS system within the NJDEMS, withone region for northern, central, and southern New Jersey.County-Based EMS – New Jersey’s reliance on home-rule has resulted in littleinvolvement by counties in daily EMS operations. The recent implementation of the New JerseyState EMS Task Force and appointment of county EMS coordinators signals a change. This isnot a command position, but one that provides liaison with the EMS task force, interface withdispatch centers and other duties as assigned by the counties. Although not the intention of thisposition, it has developed into some interesting possibilities.New Jersey should look at the possibility of greater county involvement in EMS. Asdescribed in Chapter 3, county level programs could be of assistance with EMS financing. Thereis also a role for oversight and supplementation of existing services. If the state requiresmunicipalities to become responsible for EMS they may be obligated to provide financialassistance. Effective January of 1996, a state constitutional amendment was passed that limitedthe state’s ability to enact unfunded mandates. The amendment is not absolute as there areexceptions such as compliance with federal mandates. 51Should states have to financially supplement a mandate requiring municipalities toprovide EMS, economies of scale would favor supporting county-level services. This would notonly make financial sense, but would be consistent with Governor Corzine’s plan concerning themandate for countywide 911 centers.Recommendation 36: Encourage the development of county-level EMS oversight.Information SystemsA critical shortfall of the New Jersey EMS system is the lack of information to measurewhat is done and how well it is done. The state lack of information stems from several reasons:1. There is no statewide EMS patient care report.2. Volunteer rescue squads are not required to complete ambulance reports.3. Hospitals have not encouraged EMS services to submit reports. There are anecdotalreports that some emergency departments place these reports in the trash.4. ALS and licensed BLS service that are required to complete PCRs only submitaggregate data to the NJOEMS. The lack of data for each patient care encountercompromises the accuracy of data.51 State of New Jersey (1996). Constitutional Amendment, Article VIII, Section 2, Paragraph 5.TriData, a Division of 90September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review5. The NJSFAC has enacted a voluntary PCR program that involves entering aggregatedata via an internet program. The compliance rate is rumored to be 25%. They willnot share any data with state officials and did not share data with the TriData team.6. The NJOEMS is slow to enforce the minimal data collection requirements that exist.As of this writing, some ALS services have not submitted their 2006 response data.What Needs to Occur – There are several actions that should occur to remedy thiscritical situation:1. Development of a statewide dataset based on the NHTSA NEMSIS guidelines.2. Development of a statewide PCR. Completion of this report is mandatory for everypatient care encounter.3. Continue the development of an electronic patient care report. Upon development, theelectronic PCR should become the required report.4. Dispatch centers should adopt the hardware and software needed to populate anelectronic patient care report.5. No exceptions should be made for volunteer squads. Regulation of all ambulanceswill assist with enacting with this requirement.6. Emergency departments should attach paper or runsheet data to the patient’s medicalrecord.These recommendations seem stringent and constraining. Unless New Jersey wants tocontinue the cycle that the lack of information causes, then they must adapt. To not have patientcare data, system performance data or clinical practice data is shortchanging the citizens of NewJersey. There can be no tolerance for any group to withhold or refuse to participate in thisprocess. Continuing to do so is a violation of ethical and moral standards.Recommendation 37: Accept the above six principles as a plan for upgrading the stateEMS information system.Response Time AnalysisThe sample incident dataset was obtained from a County computer-aided dispatch (CAD)system. The data included 64,392 unit response records for 24,457 unique ALS, BLS, criticalcare, and air medical incidents from calendar year 2005. The dataset contained records from bothcareer and volunteer providers, although responding units were primarily career (out of a total of52,977 unit records with valid on scene arrival data, less than 10 percent involved volunteercompanies).TriData, a Division of 91September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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