# Difference between PA medic and NJ medic



## susiegirl07 (Oct 27, 2011)

What is the difference between a NJ medic and a PA medic. I know NJ works with two medics and PA only one medic with an EMT. Are standing orders the same? Personally if you have a cardiac arrest and you have to do it all isn't that putting the patient at risk cause your only one person? Any information on this would be helpful. Thanks


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## medicsb (Oct 27, 2011)

By law, all MICUs must be staffed with 2 paramedics in NJ.  This is not the case in PA, whereby only one medic is required to be present in order to be considered "ALS" ("MICU" isn't used much at all in PA).  Whether care is better or worse with 1 vs. 2 medics, no one really knows.

In NJ, almost all MICUs are hospital-based.  This does not mean that they are stationed at a hospital, just that they are run by a hospital or health system.  MONOC differs in that it is a consortium of hospitals that run the MICU.  MONOC has some weird agreement with Hatzolah so that they can staff a MICU as volunteers (I believe the medics for HAtzolah must work PRN for MONOC).  

Most MICUs in NJ are SUVs, but ambulance MICUs are much more common in Northern NJ.

Standing orders are pretty limited in NJ and medical command contact is required for every patient contact, but you usually get the orders you need, but at times it can be a pain in the ***.  You usually have to call for 2nd or 3rd line drugs, but the primary treatments are all under standing order, so there isn't much in the way of delaying care, but it does happen.  This will likely change once/if the proposed EMS legislation gets passed.  Right now, ALS standing orders are tied up in administrative code.  Other than waivers, it literally takes an act of congress to change them.

Generally you will see 2-4 times more sick patients in NJ based on my experience having worked in both states.  This is just a result of the low number of MICUs in NJ.  Camden county has 4 FT and 2 18 hour trucks for a population of 500,000.  Burlington County has 5 FT and 1 12 hour truck for a pop. of 450,000.  You're busier and you tend to only get kept for patient that need ALS (more in theory than reality).  In Southeast PA (Bucks, Mont., Delaware counties, etc.), most all ambulances are ALS.  Outside of Philadelphia, it is rare to find an ambulance that runs more than 4000 jobs in a year.  In NJ, the slow trucks run about 2000-2500 per year (this is about average in SE PA).  Average is probably between 3500 & 4000.  Busy trucks will run 8000+ in a year.

A lot of long timers in NJ.  Still a few who have been working since the mid to late 70s or early 80s.  Medics tend to be a little older in NJ - its not uncommon to have a partner in their late 50 or early 60s.  There was a medic who recently retired who was in his 70s.  Most of the "old" or "long-time" medics in PA were in their 40s.  But this probably has to do with the fact that a lot of places didn't go ALS til the 80s.

As far as what's between the ears of medics in PA vs. NJ.  I don't think there is much of a difference.  But, I do think that the average medic in NJ is more proficient than the average PA medic by virtue of experience (a higher lowest common denominator, so to speak).  

Personally, despite the BS that NJ offers, I loved working there.  A lot of hard working medics, you're usually busy, you see sick patients pretty frequently, and the pay is better.

Note: I worked in SE PA and South NJ.  So what is most relevant to those areas.  Some big differences between SE PA and central and western PA, same between South NJ and North NJ.


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## 18G (Oct 29, 2011)

Pennsylvania staffing requirements allow for only a single Paramedic onboard an ambulance with an EMT partner. Some regions of PA operate ALS out of the hospitals as a chase unit with the ambulance staffed as BLS mainly out of combonation paid/volly FD's. Usually, these chase units are staffed with a Paramedic and an EMT who is often classified by job description as an "ALS Assistant". The EMT drives to the call, assists the Medic with whatever onscene, and then drives the Medic unit back to the hospital. 

I'm not familiar with the scope of practice or protocols in NJ, but I would put any state up against PA and I'm just not saying that because my alllegiance is to PA (currently work in WV/VA). PA has pretty aggressive protocols and they allow their Paramedics to treat patients as clinicians and utilize clinical judgement. 

For example, if you have a seizure patient and need to give a benzo, your not arbitrarily told a single drug and specific dose. You have a box that say's "pick one" and it lists three different benzos... Versed, Valium, and Ativan. And the doses are ranged (ex. Versed 1-5mg). Another example is pain management... you get a box that say's "pick one" and you choose morphine, fentanyl, or nitrous oxide (most don't use nitrous but still an option if your service does). Again, doses are ranged.  

And PA protocols are more and more evidence based and is obvious in many of the protcols.


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## susiegirl07 (Nov 1, 2011)

Thank you both for such informative posts.  I start my orientation shift tomorrow on a PA unit.


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## 325Medic (Nov 1, 2011)

susiegirl07 said:


> Thank you both for such informative posts.  I start my orientation shift tomorrow on a PA unit.



Where at may I ask?

325.


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## medicsb (Nov 2, 2011)

18G said:


> I'm not familiar with the scope of practice or protocols in NJ, but I would put any state up against PA and I'm just not saying that because my alllegiance is to PA (currently work in WV/VA). PA has pretty aggressive protocols and they allow their Paramedics to treat patients as clinicians and utilize clinical judgement.
> 
> 
> And PA protocols are more and more evidence based and is obvious in many of the protcols.



I agree that PA generally has pretty good protocols.  I hear some people complain, but its usually people who came from some place that allowed them to do stuff that they probably shouldn't have been allowed to do anyway (e.g. chest tubes or pericardialcentesis) and they're mad cause now they can't do it on one patient every 5 years or something like that.


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## Trashtruck (Nov 2, 2011)

*NJ v. PA*

Hi,
I've never worked in NJ, but have heard from people who've worked there that it's a 'mother, may I?' state.
Here in PA, at least the region where I work, our protocols are exactly the same as the state protocols. Albeit, we do not carry all the drugs on the state approved drug list(thus, we can't  give drugs that we don't carry, obviously), but the ones we do, we are allowed to give as per protocol without medical command contact, which is virtually never. A few come to mind in our 'Contact Medical Command' box...dopamine, 1:1,000 epi for asthmatics, third round of adenosine, etc.  I find it to be liberal compared to what I've heard about Jersey. Like I stated before, I've never worked in NJ, but I would also find it a pain in the *** to have to call command for many of the things we do not have to call command for. 
And yes, we do work EMT/Medic frequently.


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## medicsb (Nov 2, 2011)

Trashtruck said:


> Hi,
> I've never worked in NJ, but have heard from people who've worked there that it's a 'mother, may I?' state.
> Here in PA, at least the region where I work, our protocols are exactly the same as the state protocols. Albeit, we do not carry all the drugs on the state approved drug list(thus, we can't  give drugs that we don't carry, obviously), but the ones we do, we are allowed to give as per protocol without medical command contact, which is virtually never. A few come to mind in our 'Contact Medical Command' box...dopamine, 1:1,000 epi for asthmatics, third round of adenosine, etc.  I find it to be liberal compared to what I've heard about Jersey. Like I stated before, I've never worked in NJ, but I would also find it a pain in the *** to have to call command for many of the things we do not have to call command for.
> And yes, we do work EMT/Medic frequently.



Eh, it is more 'mother may I' than many places.  But like I said previously, most standing orders cover 1st and 2nd line treatments.   And while it can be a pain, you also learn to give a good concise reports and tell the doc or nurse what you'd like to do instead of asking and 95% of the time you get what you want.  

I just checked and the protocols have been updated and narcs are now finally allowed under standing order (midazolam, morphine, ativan, and fentanyl).  Not the best, but, again, if the proposed legislation (S818) gets passed, regional protocols will be allowed and will likely improve greatly.

http://nj.gov/health/ems/documents/als_adult_standing_orders.pdf


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## medicsb (Nov 2, 2011)

Trashtruck said:


> Hi,
> I've never worked in NJ, but have heard from people who've worked there that it's a 'mother, may I?' state.
> Here in PA, at least the region where I work, our protocols are exactly the same as the state protocols. Albeit, we do not carry all the drugs on the state approved drug list(thus, we can't  give drugs that we don't carry, obviously), but the ones we do, we are allowed to give as per protocol without medical command contact, which is virtually never. A few come to mind in our 'Contact Medical Command' box...dopamine, 1:1,000 epi for asthmatics, third round of adenosine, etc.  I find it to be liberal compared to what I've heard about Jersey. Like I stated before, I've never worked in NJ, but I would also find it a pain in the *** to have to call command for many of the things we do not have to call command for.
> And yes, we do work EMT/Medic frequently.



Eh, it is more 'mother may I' than many places.  But like I said previously, most standing orders cover 1st and 2nd line treatments.   And while it can be a pain, you also learn to give a good concise reports and tell the doc or nurse what you'd like to do instead of asking and 95% of the time you get what you want.  

I just checked and the protocols have been updated and narcs are now finally allowed under standing order (midazolam, morphine, ativan, and fentanyl).  Not the best, but, again, if the proposed legislation (S818) gets passed, regional protocols will be allowed and will likely improve greatly.

http://nj.gov/health/ems/documents/als_adult_standing_orders.pdf


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## susiegirl07 (Nov 5, 2011)

Thank you guys for all the information.  As I have had a couple of shifts I can see that NJ is the "mother may I" state and Pa is very different.  I am working in the Northeastern part of PA and I enjoy riding a lot.  

I have learned that when in doubt call med command, otherwise follow your state protocol up to second, third line treatment.


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