How to fix the mess that is NJ's EMS system

[stcommodore]

Give me one good reason why Hospitals in NJ should have a monopoly on ALS units when patients are dying on the streets because of the shortage of medics.

Better control of the quality of care and providers.

Take for example the county I work in. X County has aprox 25 separate ALS services that are independent squads separate from the hospital, fire dept, township, etc.

There are 25 chief's, 25 medical directors, and a numerous amount of Paramedics that work in the county. While the county is also a Region that has overall control and reports to the state its still basically every kingdom for its own. You have Paramedics that work for 2,3,4, etc services and easily work up to 72 hours or more strait going from one department to another. Some do it for the love of the job, most though to make enough to get by. None of which is at all healthy!

Now if this was a County Based service, be it hospital based, county controlled or whatever you would solve a lot of problems.

-Central Purchasing for Supplies and Units

-Units Staged/Staffing Levels based on demand and not a static system based on 20yrs of "this is how we have always done it"

-Increased pay for EMT's/Medics because a central service could have better funding and many other reasons

-Better control over work loads of the staff: A medic couldn't get away working 72 hours when it was one service, overtime may not decrease but you could control things better.

NJ may not be perfect but don't blame the hospitals.

[EMS Solutions]

Whne I first read the NJ report and discovered that the squads didnt even need to have an EMT on board, I was actually shocked to learn this. And I worked in NJ as a Medic.

When I told some of my family about this they were shocked as well.

I dont think the issue is at the ALS level however, besides there not being enough units. But that comes down to money and how the medic projects are going to pay for them.

With the vollies often picking the calls they respond to -

3-4 call outs for an abdominal pain VS. 1 for a vehicle roll over on a Saturady night.

Tends to be an issue.

So, is the answer having paid BLS? To a point yes. But then you're back in a circle to who gets paid. If the BLS transports and the medic is in the back providing care. The BLS gets paid and the ALS gets nothing. How can a medic provider survive like that?

What the answer is I just dont know. In the interest of patient care, BLS units should be paid and medic projects whether hospital based or not should be increased. Dispatching should be done via one radio per region or county etc. Insurance should pay for the highest level of care given and not the ambulance the patient was transportated in.

Maybe that is breaking it down a little too simple. Maybe that is what is needed to break away from the current system.

I actually did an audio interview with one of the presidents of an ALS provider in NJ regarding the NJ Report and the EMS system in NJ. If anyone is interested in what he had to say visit

http://ems-safety.com/audio.htm

I dont agree with everything he said but he makes some good points.

[FormerEMSLT297]

Guys and Gals, Do Not get me wrong, I do not blame the Hosptials, I blame the corrupt NJ legislature that allows ONLY HOSPITAL based EMS systems to provide ALS,,,, that is who is to blame.

And as for "proving this" ,,,, yes, pick up any NJ paper and read about the lack of ALS providers, the decisions that Medics have to make, about which call do i take vs. which I do not, etc.

I know it ias hard to truely MEASURE an EMS system (response times are crap) but Isn't the best EMS system meand having ALS to all or as high a percentage of patients that need it as possible.

I'm not advocating a CA, FL, or any other nightmare situation, just that by simply ALLOWING providers other than Hospitals to have ALS units would increase the amount of ALS units.

Now, if you ant to do a state wide protocol, or coubnty wide or something, that may be something to look at ...

Ohh and you can not tell me that Hospital based systems are fool proof. I worked in several that had some SEVERE issues. Patient shopping, slow responses becuase the Medics doubled as ER techs, Taking insured patients to their ER while taking uninsured or just plan undesireable patients to Municpal ER's.

Please spare me the BS that because the are Hospital based, there is somehow better QA/QI, the truth is some Medical Directors (be it FD, Hosp, Pvt, or 3rd service, or PD) are ENGAGED, and others are not... nothing to do with the type of service that you work for.

[scratrat]

Hey, AJ, grow some nads! Just leave already!!

I'm never going back!! Except for maybe a Junuzi's sub on Atlantic Ave. God I miss those. And WaWa's too....

Anyway, having come from that system to Florida's I can argue some.

That it is hospital based, does not necessarily make it better in terms of QA. Our medical director here is very much involved. (County based and employed, well PRN anyway. Now I'm a federal slob..haha). He stays abreast of new technologies and is all for us using it, if he feels it's necessary.

The system in NJ needs to scraped and started brand new from day one. They need to just start over. Regionalization is the only way to help. Working up there, lets see, every municipality has it's own 911 system. They answer the call. Those dispatchers would call if they felt a medic unit was necessary, which most of the time it was not but whatever. Then we were dispatched. Then we had to figure out what channel they operate on. Was it on the 800 mHz system, which they only allowed the medics to access a few years AFTER the squads were on it. Or was it the VHF repeater. Or was it, guess and hope someone on the ambulance would answer you. Every time I responded to a cluster MVC with multiple agencies and vollies bagocking on the radio, I always played the same song over the radio system. Maybe you'll recognize it. "Voices. Voices. A thousand thousand voices." So let's start with that. Regionalized dispacth for each and every county. For the smaller counties, maybe they'll combine and work as one.

Next, EMS needs to regionalized. Every county (same thing - small ones maybe two) needs to have regionalized units. I've grown kind of fond of the system here. It's an EMT and a medic, sometimes two medics depending on staffing, but never just two EMTs. Maybe throw in a chase vehicle or two for added support during traumas or something. Down here, the fire departments are sometimes ALS so we can grab a fire medic if need be. The thing I don't like about this system, is that your skills diminish. Otherwise, every single truck is ALS with at least one medic. EVERY patient gets a medic. So that unknown medical call that is now a code, doesn't have to wait an additional 15 minutes for an ALS unit. (Yeah, cause I've never been dispatched to that... ) Every thing would be regionalized. EVERY city/town pays for the service equally (oh well to those smaller communities - deal with it). Or I guess I play fair, maybe it should per cap. Whatever.

Next, going back to skills diminishing. EVERY single employee is retested every 6 months (maybe yearly depending on call volume.) This includes EMT's. Give scenarios suited to their licensure. EMT's do BLS, medics obviously do BOTH. If you can't pass, bye bye. This needs to be overseen by DOH so medical directors can't circumvent anything. Make the test come from DOH if needed or something like that. Every medic needs to successful tube XYZ amount of people in 6 months. If need, you have to go do 8 hours in the OR and tube some people (preferably a trauma center or something so it's realistic to the street.)

The two tiered system needs to go and regionalization is it. It's the only fix. It's not fair to the EMS and it's definately not fair to patients. I could tell stories for days about people waiting for an ALS unit with someone acutely ill, and they suffered. That's another discussion, but still. It needs to stop. And the only way it will stop, is regionalization. The region is responsible for EVERYTHING. Transports, 911 transports, interfacilty, back to nursing homes (my favorite passtime), air transport, EVERYTHING.

Even better! Three regions, three employers and that's it! South, central and north. Each one covers the entire area from BLS transports to ALS to air. That way, the little bumscrew towns are covered with the same staff working in the cities. Make it state operated so it is in the state retirement system. There goes that complaint of no retirement.

In the words of the immortal Ozzy, "I'm a dreamer....."

[triemal04]

How many ALS 911 services are there in New Jersey? I get it that there are a huge number of volunteer BLS services (more than there needs to be I see), but how many are ALS?

Crap, the entire state is only 8700 square miles...you don't need 50 different services covering the whole place. Hell, you don't even need 10, even with a high population density.

Hey, if corruption and crime are so bad, maybe everybody who wants a change should invest in a well priced...ahem...personnel removal specialist who can...remove...the members of the first aid council (can anyone explain why that even exists) and anyone else not pulling their weight.

On a serious note, there has to be a way to sell it to state legislators that consolidating the system and removing redundant services would save them money, as well as lead to a happy populace. Well...somewhat happy...they do still live in Jersy I suppose.

[Flasurfbum]

Hey, AJ, grow some nads! Just leave already!!

I'm never going back!! Except for maybe a Junuzi's sub on Atlantic Ave. God I miss those. And WaWa's too....

Anyway, having come from that system to Florida's I can argue some.

I'm out Brother, I escaped! I got less then 3 more months till I'm done Medic school.

But, it just keeps calling to me. And with jobs here rare...... :roll:

[scratrat]

I'm out Brother, I escaped! I got less then 3 more months till I'm done Medic school.

But, it just keeps calling to me. And with jobs here rare...... :roll:

Nice. That's why I went Federal. Not the glory job, but pays SSSOOOOOOO much better. Then I just work the ambulance once a week or something whenever I feel like it.

[dahlio]

How many ALS 911 services are there in New Jersey? I get it that there are a huge number of volunteer BLS services (more than there needs to be I see), but how many are ALS?

There are 36 MICU projects in NJ. Many counties, such as my own have 3 in it.

[FormerEMSLT297]

Maybe if I get really motivated, I'll do my MA/MS Thesis on fixing the NJ EMS system, and specifically on how many ALS level patientd DO NOT receive an ALS unit pre-hospitally.

Maybe,,, If i ever get off my A$$, and step up.

At the very least I'll have plenty of material to work with LOL.

[Medic2588]

While i concur something needs to be done in NJ to fix the problem, I am staunchly against removing ALS from the hospitals and placing it in the hands of fire departments or local first aid squads. The first departments and first aid squads have a hard enough time staffing 2 EMTs, how can they expect to staff 2 paramedics (and yes, I'm very much in favor of keeping 2 paramedics).

Do we need more ALS units? Absolutely. But we should remove the Certificate of Need policy and allow any hospital within a county to staff an ALS unit if they so choose. But those ALS units should fall under a single dispatch center for better coordination. Its also very ridiculous that I have to ask for orders for everything. So we should expand the standing orders protocols to include a whole lot more and leave contacting medical control for extreme cases.

Should the First Aid Council be disbanded? They are pretty harmless in the grand scheme of things now. With the expection of a few old timers, most of the state's agencies have recognized the futility of the organization. The state needs to step up though and regulate every ambulance providing 911 service though. I'm not against volunteers in the slightest. If the agency has no problem staffing ambulances with volunteers, then by all means continue. But something has to be done about agencies that flounder when it comes to staffing.

Just my thoughts.