NJ moving close to removing head from posterior

[Asysin2leads]

It looks like the Great State of New Jersey is maybe possibly a little bit moving close to getting their EMS system up to standard. A report in the Asbury Park Press spoke of a review that was commisioned in January 2006 and finally completed. The report states: "The current legislation emphasizes restrictions and political pacification over an effective systems approach for quality EMS care." NO WAY! Say it ain't so! Must have been a real exhaustive study, no?

Anyhoo, here's the recommendations that report has for the Garden State, and my own .$02 thrown in...

1. Requiring local municipalities to provide EMS, or cause it to be provided.

This is a good thing. I've always felt muncipalities need EMS.

2. Ending restrictions on paramedics and EMT's providng care in hospitals and other healthcare settings.

This is also a good idea, as it fosters EMS as a career, rather than a hobby, by allowing people to continue to use their skills even if they don't have the physical capacity to do field work anymore.

3. Requiring all EMS agencies to be licensed by the state, including volunteer ones.

OMG, increased oversight and accountability of patient care providers? What are they thinking???

4. Encouraging mergers of small volunteer squads, through financial incentives.

How about encouragement through threat of dissolving the squad altogether? That'll save some dough.

5. Allowing advanced life support services to be provided by nonhospital agencies.

This is actually something I'm in favor of. I think the best EMS service comes from paid municipal agencies.

6. Transporting some patients to facilities other than emergency rooms for care.

I'm not sure how this is going to help the EMS system. To me it would seem to open the opportunity to further inappropriate use of the 911 system.

7. Changing rules to facilitate EMS research, which now requires multiple approvals for

retrospective studies and is practically impossible for prospective research.

Research? EMS? That thar's that college boy pointy headed stuff. We done need faster vehicles and more lights, dammit.

8. Directing some money from a car registration surcharge now earmarked for State Police helicopters to a revamped EMS office.

One of the few innovative things that NJ does. I've always been fond of the car registration surcharge for funding of EMS.

9. Letting advanced life support ambulances be staffed by one emergency medical technician and one paramedic rather than the two paramedics now required.

I've already made my feelings clear on this, but I'd be willing to let it go if it meant some of the other changes would be implemented.

10. Including paramedics and EMT's in the state's pension system for firefighters and police officers, or in a special public employee pension fund.

This is also beneficial to EMS as a career, but I would advise the state to watch this fund like a hawk, lest EMT's Gambino, Lucchese, and Corleone start dipping into the "special public employee pension fund".

11. Putting a state EMS medical director and three regional directors in charge of overseeing what is now a fragmented system that includes little coordination.

Coordination is good, but I think more than three regional directors should be required, given the extremely diverse nature of the state from area to area each with its own special challenges.

12. Using county government to obtain and distribute Medicare payments to local EMS providers.

Again, from what I know about the corruption factor in NJ's county governments, Medicare should appoint its own special task force in monitoring these payments, lest Medicare wants to start funding certain individuals' waste management services.

The text in bold face comes from an article in "The Asbury Park Press", dated Saturday, September 22nd, 2007, starting on page A1. The full text of the article can be found here:

http://www.app.com/apps/pbcs.dll/article?AID=2007709220460

[CBEMT]

5. Allowing advanced life support services to be provided by nonhospital agencies.

This is actually something I'm in favor of. I think the best EMS service comes from paid municipal agencies.

I think you might be forgetting that although yes, this opens the door to paid municipal ALS services.....

It also opens the door to Fire Department ALS.

I think given the alternative, NJ should stick with it's hospital-based system but give them transport capability. I think keeping the ALS providers small in number and high in QA oversight (typical of hospital systems) is a good combination that has worked.

[MeekoBB]

I myself posted an article in regards to the state report...You may find it under General News and within it another Jersian posted the direct link to the report itself.

[Asysin2leads]

I think you might be forgetting that although yes, this opens the door to paid municipal ALS services.....

It also opens the door to Fire Department ALS.

I think given the alternative, NJ should stick with it's hospital-based system but give them transport capability. I think keeping the ALS providers small in number and high in QA oversight (typical of hospital systems) is a good combination that has worked.

Except that there actually relatively few paid fire departments in New Jersey, and most current municipal BLS is run through PD, which tends to do a pretty good job at it.

[pacman]

http://www.emtcity.com/phpBB2/viewtopic.php?p=128934

and the link to the report is:

http://www.state.nj.us/health/ems/document...tudy_report.pdf

Change is needed STAT.

[Dustdevil]

1. Requiring local municipalities to provide EMS' date= or cause it to be provided.

This is a good thing. I've always felt muncipalities need EMS.

Glad they would have the option to "cause" it, because I seriously disagree with Asys' belief that municipalities provide a better service.

2. Ending restrictions on paramedics and EMT's providng care in hospitals and other healthcare settings.

This is also a good idea, as it fosters EMS as a career, rather than a hobby, by allowing people to continue to use their skills even if they don't have the physical capacity to do field work anymore.

It doesn't foster EMS as a career. It gives EMS'ers a way out of EMS as a career. Luckily, NJ Nurses Council will thoroughly trounce that idea before it ever gets anywhere. Thank God.

3. Requiring all EMS agencies to be licensed by the state, including volunteer ones.

OMG, increased oversight and accountability of patient care providers? What are they thinking???

They're not already? :shock:

4. Encouraging mergers of small volunteer squads, through financial incentives.

How about encouragement through threat of dissolving the squad altogether? That'll save some dough.

That's a no-brainer. Although, if you structure #1 and #3 properly, volunteer squads will no longer exist, which would be the preferred method here.

5. Allowing advanced life support services to be provided by nonhospital agencies.

This is actually something I'm in favor of. I think the best EMS service comes from paid municipal agencies.

Not me. In fact, I think this is the only thing NJ is currently doing half-way right.

6. Transporting some patients to facilities other than emergency rooms for care.

I'm not sure how this is going to help the EMS system. To me it would seem to open the opportunity to further inappropriate use of the 911 system.

I agree, although I can't really imagine wtf they are even talking about.

7. Changing rules to facilitate EMS research, which now requires multiple approvals for

retrospective studies and is practically impossible for prospective research.

Research? EMS? That thar's that college boy pointy headed stuff. We done need faster vehicles and more lights, dammit.

The last thing NJ needs is a policy encouraging them to continue to make up their own policies and solve their own problems. They need rules that requires them to finally pay attention to the research and results from the rest of the country.

8. Directing some money from a car registration surcharge now earmarked for State Police helicopters to a revamped EMS office.

One of the few innovative things that NJ does. I've always been fond of the car registration surcharge for funding of EMS.

Not a single cent of new money is needed. If the NJ governor cannot find a billion dollars of total waste in the state budget that would be better allocated to EMS, then he's not only an idiot, he's a crook.

9. Letting advanced life support ambulances be staffed by one emergency medical technician and one paramedic rather than the two paramedics now required.

I've already made my feelings clear on this, but I'd be willing to let it go if it meant some of the other changes would be implemented.

Better yet, require dual paramedics on any and all EMS ambulances, period, and relegating EMTs to first responder status only. You want something to encourage EMS as a career? There ya go.

10. Including paramedics and EMT's in the state's pension system for firefighters and police officers, or in a special public employee pension fund.

This is also beneficial to EMS as a career, but I would advise the state to watch this fund like a hawk, lest EMT's Gambino, Lucchese, and Corleone start dipping into the "special public employee pension fund".

Agreed. But what if EMS aren't public employees? Does that still apply?

11. Putting a state EMS medical director and three regional directors in charge of overseeing what is now a fragmented system that includes little coordination.

Coordination is good, but I think more than three regional directors should be required, given the extremely diverse nature of the state from area to area each with its own special challenges.

The best systems are in areas where control is left at the local level and the state does little more than facilitation. The worst systems are in states where they get all anal about "state protocols" and other such nonsense. Coincidence? I think not. Too much "coordination" is worse than too little.

12. Using county government to obtain and distribute Medicare payments to local EMS providers.

Again, from what I know about the corruption factor in NJ's county governments, Medicare should appoint its own special task force in monitoring these payments, lest Medicare wants to start funding certain individuals' waste management services.

I know exactly how this is going to work. The county will demand a 40 percent administrative fee for this service. Of course, Medicare only paid 30 percent of the bill in the first place. So when the occasional ambulance bill actually gets paid, the provider only ever sees 60 percent of 30 percent on the 40 percent of the bills that Medicare paid. EMS still loses money. Meanwhile, the county buys new SUVs for all their employees.

Sorry if I sound cynical, but really... does anybody have any serious hope for the future of NJ EMS?

[brentoli]

Sorry if I sound cynical, but really... does anybody have any serious hope for the future of NJ EMS?

[Asysin2leads]

Lemme clarify a few things here. This is my view of what EMS needs if it going to be a serious career, that is, something somebody can go to school for, apply for, be trained in, and work at for 20-25 years or so and retire. To do this, EMS needs to overcome many obstacles. The first is making it attractive as a serious career, and once you remove the 'whacker factor' and/or 'skill needed to become a fireman', this is a very, very unnattractive job. By in large, unlike other similar professions, the injury rate is fairly high. This needs to be addressed by having adequate compensation for Line of Duty Injuries, and the places that have the best coverage for these type of injuries are municipalities, which unlike hospitals or private companies, are able to give extended benefits and unlimited sick time, things you will need if you plan on basing any sort of life on working in EMS. This is what I mean when I believe municipalities provide for the best EMS environment. At least for the employees, its true.

The same goes for my view that part of an EMS career should be options in place for a career beyond EMS. I've only been at this 10 years, I haven't even hit 30, and already my body is showing signs of wear and tear. This is why I wish when the time came, without having to start another career as an RN or associated field, I could keep my salary and still use my skills. Of course, this needs to be developed, but the option to work in an offline setting, to me, is a good start.

I also understand Dust's view about the general waste and bureaucracy that is associated with government work, and his view that moving medics into the ER to 'assist' RN's is in the same vein as moving an EMT-B in to 'assist' a medic on a call. However, I think that offline positions for seasoned medics can be created without stepping on other medical professions toes, and should be investigated.

[Scaramedic]

ICE IS HERE WITH A BRAND NEW EDITION!!!

Sorry,

Good luck NJ you have a lot of work ahead of you. Does this mean that the sales of EMT belt buckles is going to drop? Damn better dump my stock in Whacker Inc.

Peace,

Marty

[brentoli]