# NJ EMS is Awful, and Here's Why



## ReebTop

As I mention regularly, I'm a paid EMT working in East Orange, NJ.  East Orange is a hard town with a high call volume but no money, so the proverbial belts tend to be drawn tight up here.  Old vehicles that are falling to pieces, old equipment, crap pay, and long hours with the stong potential of no relief showing up are more than commonplace, they're almost hallowed traditions at this point.  I was hired shortly after the new directors (or Chief and Assistant Chief, if you prefer) came on from NYC EMS and OEM.  They've tried to fix things but it isn't easy, thanks again to the utter lack of funding.

I have two gripes about Jersey EMS; one is more of an amusing anecdote and the other will likely infuriate some people, but both relate back to the same issue.  

New Jersey has a terrible tendency to believe that volunteer organizations can handle all fire and EMS, except in major urban areas where the call volume is simply to high to expect the FFs/EMTs to maintain "day jobs".  This is rapidly proving to be an outmoded concept.  Volunteerism, at least in EMS, was beginning to become obsolete in the late '90s, in my view.  Fire departments in suburban and rural areas, while call volumes are increasing, are still usually receiving no more than 2 calls a day.  EMS is wildly different, with call volume only growing as immigrant populations increase and the "indigenous" population ages.  Many volunteer agencies have taken to hiring paid EMTs (usually) during the weekday, leaving nights and weekends to the volunteer corps.  Some municipalities have opted to go fully paid, while others hire private companies, most notably MONOC, to cover their EMS 911.  The state has no direct regulation over the agencies which remain volunteer, as they are under the jurisdiction of their municipality and that is usually only in a cursory role.  Volunteer agencies, particularly in sparsely populated regions with few riding members, are well-known to allow non-certified individuals to ride and function in a BLS capacity.  As these individuals aren't paid, there are no real repercusions for whatever action they may take, as it isn't a case of getting one's cert. revoked and losing their job.  If they have a cert, losing it doesn't always guarantee that they will cease riding.

BLS scope of practice in NJ is laughable, which only compounds the problems raised by increasing volume and decreasing volunteerism.  I've heard medics complain about those of us BLS folks as being totally dependent upon them, which is not by our choice.  We function as either just a taxi service to the hospital or just as muscle for the medics.  There is truly no middle ground.  We are incapable of operating on our own in the simplest of emergencies; while other states allow BLS to provide baby aspirin, albuterol, nitroglycerin, activated charcoal, etc. etc., the state of NJ allows us to administer only one medication: oxygen.  There is nothing between EMT-B and EMT-P in this state.  It's all or nothing.

All of these problems, while not necessarily caused by, are certainly exacerbated by the First Aid Council, which is essentially a union/lobbying group for the volunteer corps.  Whenever a new treatment has been brought up as a possibility for BLS to exercise, the FAC has blocked it, because it would have forced them to allow the state oversight on their agencies.  Due to their ubiquitous nature, many municipalities consider paid EMS a pointless expenditure, having the concept of "why pay for something you can get for free?"  This attitude is quickly showing itself to be foolish, totally without merit, as response times suffer and the quality of care plummets.  However, the volunteer agencies and the local politicians are unwilling to give up their ground or admit defeat.  The end result of all this is that those 911 agencies which do pay their EMTs are generally only in the most difficult areas to work (i.e. high-crime areas or areas with great distances between patients and the hospital) and get away with underpaying them for the trouble.

As for the aforementioned anecdote, my partner was nosing around in our dispatch room the other night and discovered a folder full of old run reports.  From 1987.  Just for a goof, we started leafing through these 20-year-old reports; I found myself getting depressed, and said so to my partner.
"These are making me kinda sad, bro."
"Why's that?"
"Nick, these are 20 years old, right?"
"Yeah?"
"We could be using the exact same paperwork right now, man.  There's absolutely nothing on the brand-new sheets that isn't on these ancient ones.  EMTs have had nothing new to do in Jersey for at least 20 effing years."
"Yep, Jersey sucks, man."
20 years with not a single advancement or improvement to the system.  20 years of training EMTs, not with caution or quality, but with speed, simply to put warm bodies on trucks.  Thanks a lot, FAC.


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## Nycxice13

Wow...

That is one horrible system in NJ! So EMT-B in NJ is pretty much the equivalent of a MFR in NYC?

That system needs to be burned down and rebuilt from the ash.


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## ReebTop

Nycxice13 said:


> Wow...
> 
> That is one horrible system in NJ! So EMT-B in NJ is pretty much the equivalent of a MFR in NYC?
> 
> That system needs to be burned down and rebuilt from the ash.



I have no idea what an MFR is, but yeah, we're pretty useless in the grand scheme of things.  I wouldn't say the system needs Biblical vengeance enacted upon it, but we definitely need to stop screwing around to facilitate the FAC and update across the board.


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## firecoins

MFR is half the EMT class.  Cops and firefighters usually take it.


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## Recycled Words

EMT-Bs are nothing more than glorified First Responders in NJ in that they give us a big truck with flashy lights and let us deal with BS calls on our own. We can't do anything on real calls without calling for medics.

Supposedly they had something in the works to let us do more stuff, but that's never going to happen....


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## Stevo

most ems state agencies _only_ answer to legislature ReebTop. and most states insist on reinventing the wheel without looking past their borders

so, inasmuch as our brothers and sisters here could easily comiserate via your letter, it may serve you better to clean it up a tad, lend clarity to the case you'd like presented for the layman, and e-mail it to your state rep

~S~


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## markdk86@hotmail.com

I work over in Hudson County in NJ. EMS in NJ is for the most part, bull:censored::censored::censored::censored:. I've been saying since I started that we need t at least be able to give asprin. Luckly I'm in a 1 mile radius to at least one hospital so even if it is a serious call we can hi-tail it over there. We need a larger scope of practice. NJ EMS is basically (insert yor problem here) + (oxygen) and VROOM VROOM AND AWAY !


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## Medic's Wife

I was thinking the exact same thing as Stevo on this one. Additionally, you may want to try to get it in the op/ed section of some newspapers across the state to spark a little citizen outrage (that is if the population hasn't become so complacent that they've forgotten what outrage is).


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## Guardian

Interesting post, I enjoyed reading it.  It's up to you to change things.  Around here, we have medical directors for individual ems systems (ex. usually 1 or 2 medical directors per county or city).  This is the way to go.  Usually the med directors set up their own protocols independent of everyone else and can allow you to do whatever they want.  In a communistic place like NJ, you might not be allowed to do this but it's food for thought.

A lot of times, people will try and blame everyone but themselves.  Take a good hard look at yourselves, because your unprofessionalism might be to blame.  I don't know enough about NJ ems to know if this is the case but, again, just food for thought.  The lone emt's are just as much to blame as the ems directors if you'll allow untrained/uncertified people to ride on your ambulances.  Again, it goes back to looking at your own level of professionalism first.

I do like that there is no level between emt and paramedic.  That’s a good thing.  The last thing you’ll need is a bunch of half-*** paramedic wannabes running around.

I don’t think this is a volunteer vs. paid issue.  I think it’s a professionalism issue.  There are plenty of volunteer departments that equal or surpass paid departments.  For example, in my volunteer fire department, our members have more training and experience than most of the paid guys in the surrounding areas.  We put a lot of emphasis on training, retraining, and physical fitness.  If there is one word you use to describe us, we would like it to be professionalism.

Anyway, I might be way off on all this as I know very little about NJ ems but I hoped this helped.


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## Stevo

well I agree, introspect should be a prerequisite virture (or vice depending on one's view) of any ems professional *Guardian*

however, in a broader overview of the ems system in it's entirety, _who runs ems?_ who constitutes the prevalant voice(s) that make the changes?

is it Jim O'Page and his JEMS crew, and all the gala ems conventions prostituted by manufacturer's ?

or is it us, the wee folk at the bottom of the food chain?

~S~


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## Ridryder911

Stevo said:


> well I agree, introspect should be a prerequisite virture (or vice depending on one's view) of any ems professional *Guardian*
> 
> however, in a broader overview of the ems system in it's entirety, _who runs ems?_ who constitutes the prevalant voice(s) that make the changes?
> 
> is it *Jim O'Page *and his JEMS crew, and all the gala ems conventions prostituted by manufacturer's ?
> 
> or is it us, the wee folk at the bottom of the food chain?
> 
> ~S~



I hope it's not James Page, he has been dead for 3 years. ! JEMS corporation (aka Brady, aka Mosby, aka Lipincott, Williams & Williams publishing) Have nothing to do with EMS structure development and curriculum development. Now, many of their authors and editorial board are members of organizations (such as Fire Chiefs Assoc, NAEMT rep.'s etc) that are on the committees.

Apparently most EMT's are not well educated and diverse on how EMS functions at a national level. 

First, unfortunately most EMT's are not educated enough to develop national standards and curriculum development as well as professional standards. This is saying since the average reading level of an EMT is just above sixth grade and the paramedic is just over tenth grade. Want more proof read some of the posts located on EMS forums sites. I do wish the majority was able to constitute an understanding of adult education, protocol development, financial savvy, to perform functions, but after spending several years assisting and being on committees, I can assure it is not true. Again, we cannot expect anything more, since we do not require a formal education for entry level to through the highest level of care. 

The national organization is managed by bureaucrats of the National Highway Traffic Safety Administration (NHTSA..formerly D.O.T.) because of the origination of EMS under that structure. Billions of dollars are funneled and managed through this agency related to highway safety and this does involve EMS. Believe it or not EMS consists far more than ambulance and EMT's, which is just a part of EMS, not the whole main point of EMS.

From this organization selected persons based upon education levels, positions, titles are asked to perform on selected committees, and then selected ad-hoc committees, etc..These members have far more education in EMS than a 13 month trade school program. Again, most EMT's may know some patient care, but are very ignorant in EMS systems. Representatives are from each state (State EMS Directors, the NREMT, Fire Chiefs Assoc, ENA, ACEP, NEMSP, NAEMT, etc..) Each procedure is then discussed and argued in detail, in which is why it takes so long for changes to occur. As well, if there is a curriculum change to occur it is placed in a trial area(s) being metropolitan, urban, and rural over years and then carefully evaluated to see if it is successful or not. Each program goes through scrutiny to be evaluated. 

Over all ,most medics just do well enough to understand the little required knowledge of performing basic life support and the limited ALS procedures. Don't believe me? Read the statistics of the pass rate of most states EMT cert test. It is major accomplishment for some that they were able to pass a nighttime trade school class twice a week class for 16 weeks, not realizing the person that cuts their hair went to school four times longer than they did. 

I am not a fan of most of the decisions at the national level, but as well I thank God that it is not ran by the majority of street medics. Should we trust those that have a hard time of understanding even basic drug calculations to perform a system analysis and statistical review? We want those same people developing curriculum's when they do not see the problem of allowing Basics to perform advanced procedures ? 

Again, many assume it is just "street medicine" and making sure ambulances are working on the street. This is just proof that those within the system is ignorant of their own profession. I agree our profession should be managed by those in the profession and involved in patient care, but definitely not as it is with the current education and experience level of the majority of EMT's now. If we could require more education and advanced studies.. definitely yes !

R/r 911

Link to National EMS Curriculum Development :
http://www.nemses.org/

National Committee and subcommittees for National EMS development
http://www.advocatesforems.org/


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## Nycxice13

I have to agree, most of the students in my EMT-B course were high school dropouts. It truly is scary that these people who could probably not pass a HS English test are working to save lives. Now this is not to say that might not be good EMT's, it is just to say that, uhhm, how do I put this nicely, aren't the brightest bulbs in the box..


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## BossyCow

I'm not generally a conspiracy theorist..... but..... is there any correlation between our working 24 hour shifts and being notoriously sleep deprived and our inability to work actively to improve our working conditions?  Let's see... I could spend a few hours blogging and campaigning for better EMS regulations, attend those meetings on protocols, be active in my local Regional EMS Council... or I could get some sleep!


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## Nycxice13

UNIONIZE! :excl:


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## TKO

This is interesting stuff.  Is this how it is throughout most of the USA?  What is the general educational requirements for the different levels and how are they managed?

I can say that here in Canada that 1st Aiders and First Responders are courses that anyone can take, but Primary Care Paramedics have to go to colleges/univerities to be certified, and so require a Grade 12 with a minimum academic average (set by the college based on number of admissions, seats, etc).  The Advanced Care Paramedic level is a 4 year degree in Alberta and Ontario.

Our academic career is dependent on passing every test with a standard passing average.  Failure of a test below 80% (in most colleges) gets you re-write, failure below 70% gets you the boot.  And the course failure rate is approximately 60%.  Then there's the practicum where a lot of preceptors will kill students just to keep the system to their standard.


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## Ridryder911

Unfortunately, our neighbors up North are way ahead of EMS education than those of U.S. 

Yes, in U.S. one only has to have a GED and take a Basic class (just barely above first-aid level) to get a job on an EMS unit. Even our Paramedic classes and training are a joke and disgraceful and not much better than EMT course. 

Maybe, someday we can meet the same standard Canada has set.. but I doubt it. We have way too many activities that claim that it would take away volunteers, and cost too much to become educated and develop professional standards. Again, American apathy and ignorance at its finest!

R/r 911


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## Nycxice13

If they increase standards, they must then increase pay. Therefor, not gonna happen..


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## fm_emt

"We are incapable of operating on our own in the simplest of emergencies; while other states allow BLS to provide baby aspirin, albuterol, nitroglycerin, activated charcoal, etc. etc., the state of NJ allows us to administer only one medication: oxygen. There is nothing between EMT-B and EMT-P in this state. It's all or nothing."

Hate to tell you, but supposedly progressive (HAH) California is pretty much the same way. A few counties recognize the EMT-I (called EMT-II here, cuz we just HAVE to be different!) but they're rural.


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## Mercy4Angels

i'll disagree. my town is 100% volunteer and we handle our calls fine. once in a while it goes mutual aid but thats rare. and about us being useless ? well yea we kinda are. we can administer nitro, epi, albuterol but only if its prescribed to the patient. 02 any moron can administer. activated charcol we cant use ever.


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## Stevo

nice response Ryder, but you somewhat missed the jist of what i was aming at .

allow me another professions example

they are trained, and told that a democratic order decides the future of it via the input from the trenches.   after all, they see what works, and what doesn't, just as we do. 

unfortunatly, the 'officals' (also with many letters after their names) are coerced by external influences who realize that their lobbying will position them for windfall profits

they unionized also, but nothing really changed for the betterment of the end user.... 

so by the same token, _collusion_ undeniably exists in the American medical system 
(i won't speak for the rotw)  , or in simpler terms _s**t rolls downhill, and ems is at the bottom of it_

now everything else you stated about our ignorance is absolutely true. In fact i can recall when our state didn't even require literacy for ems, and up until 00' two eca's (about a 60 hr course) were allowed to transport

but the bottom line is going to be the same, isn't it? 

how does ems manage to adequately proliferate the public _and_ grow to professional status with people who are allowed to partake in it with only 60-130 hr courses?

rock/hard spot eh?

~S~


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## TKO

Up here in Canada we had an EMT-B level for a really long time and wages weren't anything to build a life on.  However, that changed with the decision to standardize training across all the provinces.  This was accomplished by abolishing the EMT standard and redefining the EMS provider to be a paramedic regardless of level.  So now it goes PCP (primary care paramedic), ACP (Advanced Care Paramedic) and the flight medics are CCPs.

The standard PCP training is the same, but each province has their own definitions in the field so extra training above that standard varies.

Where I originate from, there is an ICP (Intermediate Care Paramedic) level between PCP and ACP but it is because Saskatchewan really restricts what PCPs can do in the field, despite everyone receiving the same training as defined by the Federal Gov't, and it more closely resembles what my PCP is like here in British Columbia with a few differences (I can give Narcan and ICPs can manually defibrillate and combitube).

But back to the thread, Canada started a new standard, but the pay didn't follow for a few more years.  Alberta still doesn't pay it's employees enough to live on ($11/hr).  The rest of Canada starts around $21/hr (PCP).

Those of you Americans could push for the same thing.  Redefine the EMS providers and standardize the training across the country with different states providing their own additional curriculum.  From what I have witnessed here, most of you are more than capable of making this change with a minimum of effort.  Your understanding of Biology, Anatomy and Physiology, Pathology and Pharmacology is exceptional for "a better than first aid" education.

I think it would be great to one day work in the US without having to jump through too many hoops, even if just for a little while.  I had enough difficulty with transferring my medical license from SK to BC.


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## TKO

As for the volunteers....well, start paying them or let them go.  We don't have "volunteers" anymore but we still have Occupational First Aiders and EMRs/First Responders.  

They mainly just drive or manage the scene before we get there.  They work in a lot of rural areas and get paid "pager wage" on top of their other jobs, while they wait for a call and then they get paid 4 hrs full pay.

It's not a life in EMS, but if that is what they want then they should get the education for the career.  Otherwise, it's a nice addition to their regular jobs.


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## Stevo

very interesting TKO

can you tell us what that transition was like? did it strain the system , or did the proctors of it allow grandfathering abundantly?

to further my prior anological scenario, there was a liberal amount of grandfathering in said profession 

the vestiges of which survive to this day

while i suppose ems could , maybe just _maybe_ pull it off down here, i worry that we would leave much of the populance waiting for someone to show up in the interum

~S~


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## TKO

Actually, I think it went quite smoothly.  They developed the curriculum and it was adopted by the colleges easily, the instructors were all EMT-P's so it was easy enough for them to teach the material.

After a couple of years, the services only hired PCPs or higher.  A bridging program was developed for the EMTs to upgrade their skills to a PCP standard and most services paid for that (con-ed is a requirement to maintaining our licenses yearly anyway).  So all the old EMTs that didn't want to upgrade still have their jobs but they work with partners that are higher skill than they are so they don't attend as often, but that was their choice.  I think most people upgraded tho; it increased their pay-scale.

It took awhile for the PCP license to gain merit too.  Hence why Saskatchewan created the ICP level.  They really tie the hands of the PCPs as for what we could do.  We were trained to be PCPs but only licensed to act as EMTs.  But that's changing (slowly).  I am glad that I moved to BC now as I can work at the level of my training: I can give about a dozen different drugs, give IVs, make provisional diagnoses and work from them, and attend to most calls without the need for ALS (tho they show up on their own anyway).  I am waiting for BC to give me a cardiac monitor so that I can interpret ECGs since I have that skill too, but that isn't currently part of my license.  ETT intubation is an endorsement that is coming my way eventually.


You could start your own school, hire PCP instructors to teach and as long as you teach the required skills, even exceeding the standards, you could work as EMTs (little more to it than this, of course, but doable).  I wouldn't necessarily go this route, but just to illustrate how it could be done.


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## TKO

Stevo said:


> while i suppose ems could , maybe just _maybe_ pull it off down here, i worry that we would leave much of the populance waiting for someone to show up in the interum



It wouldn't be any different than changing of the CPR standard: EMS and bystanders will update and some won't.  In the meantime, pts will get CPR whether it is old or new; it won't just stop until everyone is on the same page.


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## Stevo

while i still have my druthers, i'd have to say most taxpayers wish to get the max for the minimum investment, which is only natural.  

i'm also not quite sure about the levels of paramedic are able to do, that you speak of TKO (guess we need a reference chart or something eh?)

here, for instance, an emt-i can do sticks, monitoring, and a 1/2 dz drugs, and that's all on no more than 200 or so hours of total training from walking in the door

there is, inarguably, the good/bad/ugly of minimalizing education to serve the maximum potential.   but my fear is imposing any tighter standards in a capatalistic enviroment _(vs your socialist system i wish we'd pay 1/2 a mind to)_ would create more 'have nots' than we already subject our citizeny to

then again, maybe the real problem is dinosaurs like myself have always considered ems a community service vs. a profession too..

old dogs/new tricks eh?

~S(woof!)tevo~


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## Glorified

Reading this thread makes me feel unintelligent.  In Maine, we can't even take a blood glucose level.  But then again, all we would have had to do was ask for that ability from our EMS headquarters in Augusta (or so my teacher says).  Maine EMS consists of a lot of "mother may I?" type runs, where you call up medical control and ask to do this, that and the other thing.


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## Stevo

you seem Ox4 to me Glorified....

actually, didn't Maine's state medical director institute an moi based rule-out for backboarding a while back? methinks Maine was a leader (so goes the nation?) bringing the issue of over-immobilization for the sake of keeping radiologists or soft tissue litigants employed to light

iirc, our common state New Hampshire allows each and every of it's district medical directors to pick and choose from it's state menu

i.e.- a MD can say that Stevo can do everything but abuterol until he recieves further education.  i find this much closer to where the rubber meets the road ....

perhaps a _cowhampshireite_ can comment?

~S~


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## Medic's Wife

TKO, your posts are interesting and thought provoking. It seems there are a lot of benefits to be had from moving to a system like that, but one thing would concern me.  I would imagine that instituting federally mandated standards across the board would take control away from the medical directors and regional managers who have valuable insight into their own particular areas of the country and who know specifically how to best meet the needs of the population in their area.  Would a system like this allow any leeway for decision making on local levels, or would everyone just hope that the generals would listen to the lieutenants in the field?

Also, I like that different locals are able to train above and beyond the minimum standard, but does that do any good if the license doesn't permit practice of those skills?


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## TKO

> I would imagine that instituting federally mandated standards across the board would take control away from the medical directors and regional managers who have valuable insight into their own particular areas of the country and who know specifically how to best meet the needs of the population in their area.



Not at all.  Think of it as everyone trains to a common standard that is recognized as the new EMS level, call it, EMT-B2.  But each state/county still says, "Well, we accept this and this of the EMT-B2, but we don't accept this.  EMT-B2s won't be allowed to do this."

It isn't very different than the way things are done now, as there is an EMT-B standard and everyone everywhere takes similar training, is that not right?  And each state mandates the skills you can and cannot use in the field?

That is the same as Canada's EMS.  This was a response to the discussion on educational requirements, and my point was that if you increase the educational requirements to a higher recognized standard that you will be given more skills down the road.  And that you could do it as easily as we did.  Also that Rid would have less room to criticize


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## EMTBandit

I am in NJ. I Volunteer in a town and have family on a paid FD EMS who also volunteer with me. So I do not believe it is a Volunteer Vs. Paid basis here. Medics here do not see us as a pain as they might as you described. ALS is not needed on all calls to begin with and as was said in a previous post, im glad there is no EMT-I because the last thing we need is Paramedic wannabes running around. I have a Paramedic student on our Ambulance Corps. now and she thinks shes hot stuff because she learned something new. Half the time of course there are BS calls, but you are going to get that whether you are ALS or BLS and not much you are going to do about that. In our area BLS and ALS arrive usually around the same time on scene. And I believe myself and the ones around me very competent in what we do. Whether it is just giving oxygen and transporting to the hospital or helping to extricate someone out of a car/splinting, whatever have you. Just because you have problems with your rigs and equipment where you work, doesn't mean it is the same all over and the same goes for the pay. It might depend on the area and not the whole state, and im sure there are many places that are the same. But I do agree with the training, there should be more to it than there already is. Im sorry, I do not mean to start a fight here, I am just sharing my view on my area.


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## Glorified

Stevo said:


> you seem Ox4 to me Glorified....
> 
> actually, didn't Maine's state medical director institute an moi based rule-out for backboarding a while back? methinks Maine was a leader (so goes the nation?) bringing the issue of over-immobilization for the sake of keeping radiologists or soft tissue litigants employed to light
> 
> iirc, our common state New Hampshire allows each and every of it's district medical directors to pick and choose from it's state menu
> 
> i.e.- a MD can say that Stevo can do everything but abuterol until he recieves further education.  i find this much closer to where the rubber meets the road ....
> 
> perhaps a _cowhampshireite_ can comment?
> 
> Not sure about the backboard thing. You know more than I do on that one.  I think New Hampshire and Maine are similar in that regard.  Southern Maine has it's own Medical director, and his protocols are probably much different than the standing orders of the director of Northern Maine, where it is very VERY rural.
> ~S~


Not sure about the backboard thing. You know more than I do on that one.  I think New Hampshire and Maine are similar in that regard.  Southern Maine has it's own Medical director, and his protocols are probably much different than the standing orders of the director of Northern Maine, where it is very VERY rural.


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## Jon

NJ EMS is screwy... one of the big issues is that the First aid council encourages a double standard - one set of reuirements for Vollie squads, enforced by the FAC, and a seperate set of requirements enforced by the state for the paid squads.


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## ReebTop

Glorified said:


> Reading this thread makes me feel unintelligent.  In Maine, we can't even take a blood glucose level.  But then again, all we would have had to do was ask for that ability from our EMS headquarters in Augusta (or so my teacher says).  Maine EMS consists of a lot of "mother may I?" type runs, where you call up medical control and ask to do this, that and the other thing.



Jersey has no online med. control, just standing orders.  It sucks because it hamstrings us, but I can definitely see a system like that getting terribly bogged down around here.

*EMTBandit*
There is a decent number of EMTs at my job who ride volly elsewhere, but that is by no means the closing argument in the "paid vs. volunteer" debate.  They either do so because they genuinely care about their community, they're insane and just seem to hate having time off, or they are wackers through and through.  My problem is not usually with volunteer EMTs, it's with the entire volunteer EMS system, in this state, as a whole.  It does bother me that some people feel I'm greedy or something for wanting to be paid decently to do this job (which they maintain as a hobby), but I do.  I think that, since we have greater oversight from the state and since it is our job, we tend to take the entire thing more seriously.

Granted, there are volly squads that have their heads on straight.  Franklin/Somerset FAS in central Jersey is one of them.  From what I can tell, Maplewood's squad is good, too.  But FSFAS operates in a town which is succumbing to some urban sprawl and, as such, the call volume is going up while the calls are tending to become more serious.  Even still, Robert Wood Johnson Hospital in neighboring New Brunswick covers FSFAS's area during the day because they simply couldn't get crews out.  Maplewood borders Irvington, which in turn borders Newark, so it's essentially at the south end of a crime pipeline.  It just seems to me that a lot of other, middle-class, quiet towns have substandard EMS care, due to a lack of membership and a seeming emphasis more on cool new toys and less on effective training.

I suppose my main problems are that, even with paid agencies being brought in to cover for volly squads all over the state, our pay rates aren't improving, and that the continued focus on the FAC by the state essentially means that there will be no development or advancement in Jersey's BLS care for the foreseeable future.


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## EMTBandit

Yea, I can see straight where your coming from. And I have seen a lot of what you just described. Sorry, when I first read what you were saying I must have seen it in a different way. My brother, who is also my Lt. at my ambulance corps was at a FAC meeting last night for our district. And he was saying he's becoming real annoyed at the FAC and some of the things thats going on or with the just the way things are. In Rochelle Park we tend to get a rig out all the time and don't really have a problem with missing calls. But then you have some of the towns around us or a few towns over that constantly miss calls and need paid services to cover them during the day. Which puts us and the other towns around us who get rigs out in a bad light. Because as the saying goes, one bad apple ruins the bunch. All one person needs to see is that if this town cant get an ambulance out, every town must be like that. And as of now, our town and the towns around us are fighting the local Hospital as they are now getting Ambulances and are trying to forcefully take over our 911 calls. And they have on more than one occasion in areas around us, listened to their radios and heard an accident and heard a request for a bus and they "just happened to drive by" and take that call. And we (and other towns) have had numerous confrontations with these EMT's from HUMC who think they are hot stuff because they have HUMC EMS on the back of their shirt. And yet, the Medics who run out of HUMC can't stand those EMT's either. I had one medic tell us and I quote, "It is a disgrace to see these guys have almost the same patch as us, and walk around like they do. They're starting to give us a bad name." I've talked to nurses in the ER who can't stand them either. So we do our best to get rigs out and we are pretty solid on that and have good relationships with our Mutual Aid towns. So if one town calls for an ambulance for mutual aid, we have no problem going to help out. By no means am I saying that paid EMT's such as yourself have this attitude problem, im just saying this Hospital does. So I can see where your coming from and things could/should be drastically different.


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## NJSquadTrainer

I need to disagree with several of your comments although I do agree with quite afew. We do alot more than simply administer O2. Our  NJ Squad is in an upscale suburban comunity about 45 minutes outside of NYC. In New Jersey we are permitted to ASSIST with Nitro, and MDIs, and we are  permitted to carry and administer activated charcoal ( although few rigs carry it in practice here)  and carry and  administer EPIpens so long as the additional training mandated by the DOH has been met. In our volunteer squad , we routinely see cases where we need to suction patients, dress wounds, apply a variety of splints,  evaluate stoke patients ( BLS) , deliver babies (BLS)  -apply c-collars and boards- and CPR-  While we do have our share of "O2 and transport"-  our squad is an active BLS squad-

Medics are routinely dispatched for all chest pain and heart related calls- and most of these are "load and go" in terms of our EMT assistance. Our volunteer squad also covers a 5 mile stretch of Route 78, which sees a fair share of MVAs ( MVCs) with major traumas- Most of our members have been with the Squad for 10+ years or more, and still get alot of satisfaction out of it-  We have modern rigs and equipment, due to  active annual fund drives, and  our Squad house is very comfortable and user friendly-  Important in recruiting volunteers and keeping members happy - ( it helps to have a pool table!)  I would recommend that you consider joining a volunteer squad on a part time basis, if you want to keep your hand in EMS,  and give up the paid service for something more lucrative and satisfying as a " career"-


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## Airwaygoddess

Welcome to the Tribe!!


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## ckrump

*First Responders in EMS*

I live in a VERY rural area.  We rely on our volunteer First Responders due to ambulance response time >20 minutes.  I am the Training Officer for 2 of the 3 squads that I am on and we train every month.  However, our First Responders are allowed to assist patients with their own nitro, assist the patient in taking their own BS, and may even ride along in the back of the ambulance to assist the paramedic.  We consider our volunteer FRs as a vital part of our EMS system.  Payment for EMT-Bs depends on the service.  Some services pay a set amount per run or "per loaded mile", others pay EMT-Bs on an hourly basis or salaried.  Ambulance services and rescue squads in MN and ND can obtain variances from the state for their EMT-Bs to administer some meds.  We also have EMT-I level who can start IVs.  As you can see, each EMS level in both ND and MN are vital to prompt response and vital care for our patients.


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## Ridryder911

Okay, there are communities that have to have volunteers and those that want to have volunteers, a big difference ! 

If a community is able to afford nice rigs, a station house etc.. Then why don't it place a paid professional ALS unit for responses ? 

All those things mentioned .. i.e. Epi pens, Activated Charcoal  (in which I do not see why a BLS should ever be able to administer either one Side note only in rare circumstances should an Epi-pen be used, and activated charcoal is no longer recommended in most poisonings, and if unless you have sorbital it is useless) as well as NTG without a XII lead !  Ever seen right sided AMI's ?

Again, it goes back to the old adage the volunteers are more into it for their sakes than the patent's ! If the volunteers really was concerned about their patients welfare, the BLS would go out the window and they would have educated ALS personnel on those trucks! Remember, it is for the patient sake ? 

Yes, there are communities that are too rural and poorly populated to ever have an EMS full time, and especially ALS, but those are rare and rendezvous can usually be acquired enroute. I live in a state that is declared frontier (which is less than rural) so please I am aware of what one has to do and what one can do. We are loosing about 3-4 EMS services a year, due to expense and medics leaving (we don't have very many volunteer EMS) so now, what to do? Maybe not all towns and cities get their own EMS... regional EMS districts have to established with tax mill or water tax to supplement those that are unable to produce revenue. The same not all towns get to keep or place a hospital in that community. 

I can't believe it is the year 2007, and we in the U.S. would still be endorsing First Aid units, and BLS care for stabilization and transport of those with life threatening injuries and illnesses! Even Johnny & Roy had provided better care in the early 70's, and now 35 years later we still have not progressed? How shameful! 

Sorry, please don't give me the old "we are too small, and too poor" crap. You have a sanitation department, paid LEO's, city  kept parks, then you can afford a ALS EMS unit. It is where your priority lies and those towns that choose to have a BLS volunteer agency in lieu of paid ALS, definitely demonstrates what they rather choose for their citizens.  Sorry, I have managed Paramedic systems in towns < 500 so YES it can be done.

Too bad, parts of the country want to bury their head in the sand and meanwhile pat themselves on the back. Patients deserve a secured airway, they deserve rapid defibrillation and continuous ECG monitoring as well as medications for pain control and re-current v-fib. Our patients deserve much better than that..when it can be given. 

It seems everyone in EMS always has an excuse.. the law, we are too small, etc.. etc.. If you really do care about patient treatment and what is best for them, then you would change your laws, change the way you do things, and work on a system...

R/r 911


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## Stevo

great rant Ryder, bravo

i like it...

in fact, i might write you in for the '08 election if you don't mind.  Have you ever considered a carear in politics? Personally i'd hook up with Obama if i were you _(i know, i know....too close to Osama)_ then two minorities could get a shot at the brass ring at once

Personally i'd stay away from Hillary, that'd be like a 'vote Nader' bumper sticker on a Corvair you know....tacky...

i might even volunteer as your campaign manager , seeing as the platform of health care might be rekindled here, and compassion for our fellow man actually makes a comparable dent bigger than a zit on the federal budget...

....right after i have an explosive rectal episode of flying monkey's....



~S~


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## Ridryder911

By far I am not for "socialized medicine" and a staunch Republican; but, as the old saying you get for what pay for. 

People deserve at least adequate medical care.... sorry aspiration, no IV access, no electrical therapy and no medications within the first 15 minutes is non-sense. 

But, I guess it is okay to build that public softball field, and buy that Peterbuilt ambulance than call haul 6 of those volunteers doing nothing.... 
Sorry, I've seen it and witnessed.. Services can charge EMS bills .. 80% of $600 -800 + can provide salaries 

When ever you the most one can do is have "protocols" on medications that should never be given.. (tell me how many really true anaphylactic reactions one sees-Not adverse reactions (hive, urticaria, swelling, etc) and what specific poison do you administer Activated Charcoal on ? Unique thing is you give it, it still remains in the gut to be absorbed.. unless you have the sorbital or able to place a NG to aspirate fragments, it's useless) 

C'mon folks this 2007 not 1965! First aid is for common citizen to treat until professional help arrives. Anyone and everyone above the 6'th grade level can be first aid trained, it really is not that special, being teaching scouts it for decades.. 

Emergency Medical Services should be able to stabilize the victim for transport and continuous monitoring enroute. 

Again, I realize there areas that have to volunteer. and that is to be expected and I commend them, but let's quit joking ourselves that majority of the communities have to be volunteer. It is they want to and then only provide BLS (for tradition sake) which is short changing the patient.. simply put .. it is not in the best interest of the patient, rather many feel it is the best interest for them.. which is shameful. 

R/r 911


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## ckrump

*EMS as a whole*

All segments of EMS are important if utilized appropriately.  I started as a First Responder in 1992 and am currently on 3 rural rescue squads who are very skilled at what they do and have been doing so for over 20 years with continual training.  I know First Responders who have more people skills and common sense than some medics.  I became an EMT-B and CPR Instructor in 1997.  I am currently taking my paramedic course and will soon be done.  I will continue to work with the 3 rescue squads that I serve with now.  I do not feel that I am more superior than they are, I just have the additional knowledge and priviledge to be able to go the extra step for the people I serve.  I may be looking through rose colored glasses, but I still believe in the common good of people and that we all have our place in EMS that is important to the complete function of the system.  Our goal, whether a First Responder, EMT-B, EMT-I, or EMT-P, is to provide the best possible care for the people we serve.  And I do believe we serve them.


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## Ridryder911

Did'nt say they don't serve them.. truly believe in first response units! Without, them no ALS will matter, however if it is not followed by ALS it is futile. Out of hospital codes only have about a <16% chance of survival and that is everything is done ..Good BLS followed by ALS etc.. 

There should not be an option of BLS or ALS.. without each other, it won't matter. 

And yes, you are looking through rose colored glasses.... 

R/r 911


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## Stevo

> By far I am not for "socialized medicine" and a staunch Republican; but, as the old saying you get for what pay for.



well Ryder, then you should realize _'starve the beast'_ which is purely a republican platform is now 27 years old.  So i guess we won't be looking toward the fed's for anything more than another unfunded federal mandate to make what you wish happen

maybe we could have more bake sales?



> People deserve at least adequate medical care



and are they getting it in America? seems 45-6 million are not, and er's _(that can't refuse them re=jacho, etc)_ are closing down and reopening as urgent care centers to aviod them

i'll forgo the usual 3rd world motality and morbilidy stats....

still, i'll agree with your overall assessment that ems could be done better , anyone who's served in the rural contingent for very long knows how it's been a tooth and nail fight to advance a service. In fact there's no greater advocate of gold standards than those whom realize the public they serve are going without

so what you have is a social dilema, which are typically messy problems akin to threading a needle with an oyster

the rx isn't going to come from isolated little triumps banding together in some grassroots bonaza, nor is it going to come from a governance that is too busy pissing away any viable resources in a military industrial complex raft with cronyism

so what's your rx to it Ryder? we've rode this code 3 equestrian hard and put it away wet repeatedly in this forum, but i have yet to hear a solution that works for everyone eveywhere all the time

~S~


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## Guardian

I don't think there is a solution that works for everyone, every time.  Having said that, show me a county without a criminal justice system and a school system.  If they can afford these, they can afford an ALS system.  That's the bottom line.


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## Stevo

well just for perspective, here's a bottom line calculator 
*Guardian*

anyone here can dial in their own community too

read it and weep folks

~S~


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## Medic's Wife

> By far I am not for "socialized medicine" and a staunch Republican



I _knew_ there was a reason I liked you!  

Stevo, you've got to be kidding with that calculator.  Lets keep this in terms of the medical system, since that _is_ what we're discussing here.  Do I _really_ need to whip out all the stats on how much illegals are costing the healthcare system?


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## oldschoolmedic

So before 9/11 and the war, what was the reason EMS was stuck in the eighties? Apathy. Our system wasn't broken until some terrorists pointed it out to us. People are content to accept half-assed care as long as someone shows up to do it. Only now they want all of the bells and whistles, but still don't want to pay for it. Apathy.

I used to live in NY near the Canadian border and was always amazed at how many of Canadians drove over the border just to get a choice in their medical care or simply to receive care in a timely manner. We are looking north through jaundiced eyes to believe their system is a magic bullet. I am currently working with a Canadian ex-pat whose mother went to the local emergency department and it was determined she needed a CABG, they put her on a waiting list and a bunch of medicines to keep her going until her surgery date. She came down here on "vacation" to see her daughter and went to the ED where her need for a CABG was "discovered", she had the CABG the next day. I went into the ED in rural (five minutes from the nearest cow) SC with chest pain and was on a cath table in two hours. Tell me which choice seems better.

We can whine, grumble, and moan all we want, but how many of us are actually involved politically with trying to change our system? I'm not. I do not have the time, nor am I willing to shortchange my time with my family. I have two jobs, a wife, and four kids, when the heck am I going to find "spare" time to become a lobbyist? I guarantee I am not the only one whose time off is precious to them. Complaining here is merely preaching to the choir.


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## Jon

NJSquadTrainer said:


> I need to disagree with several of your comments although I do agree with quite afew. We do alot more than simply administer O2. Our  NJ Squad is in an upscale suburban comunity about 45 minutes outside of NYC. In New Jersey we are permitted to ASSIST with Nitro, and MDIs, and we are  permitted to carry and administer activated charcoal ( although few rigs carry it in practice here)  and carry and  administer EPIpens so long as the additional training mandated by the DOH has been met. In our volunteer squad , we routinely see cases where we need to suction patients, dress wounds, apply a variety of splints,  evaluate stoke patients ( BLS) , deliver babies (BLS)  -apply c-collars and boards- and CPR-  While we do have our share of "O2 and transport"-  our squad is an active BLS squad-
> 
> Medics are routinely dispatched for all chest pain and heart related calls- and most of these are "load and go" in terms of our EMT assistance. Our volunteer squad also covers a 5 mile stretch of Route 78, which sees a fair share of MVAs ( MVCs) with major traumas- Most of our members have been with the Squad for 10+ years or more, and still get alot of satisfaction out of it-  We have modern rigs and equipment, due to  active annual fund drives, and  our Squad house is very comfortable and user friendly-  Important in recruiting volunteers and keeping members happy - ( it helps to have a pool table!)  I would recommend that you consider joining a volunteer squad on a part time basis, if you want to keep your hand in EMS,  and give up the paid service for something more lucrative and satisfying as a " career"-


I think the comment was comparing NJ State BLS care with other states... Do you have protocols for oral glucose?

Some states let BLS providers carry and administer Albutorol nebs... or other things... that was what the comment was about, I think, not that NJ EMS dosen't do ANYTHING but O2.


My biggest concern is that there are 2 seperate standards of care.. one is the paid standard, administered by the state, that requires a STATE PERMIT and 2 EMT's... the other is the Vollie standard, that dosen't require the same stuff.


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## ReebTop

*RidRyder*
To address the local ALS issue:  in NJ, we theoretically have 100% ALS coverage, thanks in large part to having a hospital every 5 or 10 miles it seems, in addition to MONOC being allowed to operate medics.  This by no means gives the ALS system a pass as perfect, given a few factors, but we have coverage nailed down.  The major problems are a total lack of funding, which means that while an area may be covered by hospital X or agency Y, once a MIC unit gets hit out, you're pulling from some other coverage area, and eventually the BLS units are flying solo.  But funding is a problem everywhere, so whatever.  The other annoyance is the general attitude of a lot of medics.  It's not just the usual superiority complex when it comes to EMTs, it's the endemic laziness.  I have a company-mandated 7 to 8 minutes to be on-scene after time of dispatch.  Many times I've made it on-scene in, say, 6 minutes, and the medics are just signing on.  They then proceed to slow-boat it over, turning a 4 minute drive into 8, all in the hopes that we'll cancel them before they arrive.

As for misallocation of municipal funds, Newark, NJ is a prime example.  They used to be the flagship of Jersey FDs and always had a strong PD.  Then Sharp James becomes mayor and torpedos both in favor of a couple of stadiums with his name on them.  Chops the FD in half, their equipment goes to hell, the PD gets swamped with rising crime, the only system that didn't change a bunch (to my knowledge) was EMS, since it's attached to University hospital (University of Medicine and Dentistry of NJ), which is a state institution and thus recieves some serious state funding.  But the influx of illegal immigrants is strangling all of the hospitals in that region, particularly the U.

I think I've kind of wandered from my point here, but yeah.


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## ReebTop

Jon said:


> I think the comment was comparing NJ State BLS care with other states... Do you have protocols for oral glucose?



BLS is allowed to administer oral glucose, but I think it's safe to say that oral glucose is rather limited in its application.  Not useless, just limited.  As for the above poster's squad carrying EPIpens and being allowed to use them with some additional training, I believe they are sadly mistaken.  In NJ, we can assist with oral nitro, assist with albuterol inhalers, and _assist_ in the administration of a patient's prescribed epipen.  However, it must be theirs, the prescription mustbe up-to-date, and technically we aren't allowed to just spike them with it.  So, aside from O2 and oral glucose, we really can't do much of anything with meds.


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## firecoins

NJ EMS sucks because its fragmented. NY EMS has the same exact protocol as NY does for BLS protocols for medications.  I don't really see the problem.  Most places I have been to in Jersey are no more than 5 minutes from a hospital and ALS is available.  

I volley in Rockland COunty, NY. I can actually take people to Pascack Valley Hospital or Englewood Hospital in Bergen County, NJ.


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## Stevo

> We can whine, grumble, and moan all we want, but how many of us are actually involved politically with trying to change our system? I'm not. I do not have the time, nor am I willing to shortchange my time with my family. I have two jobs, a wife, and four kids, when the heck am I going to find "spare" time to become a lobbyist? I guarantee I am not the only one whose time off is precious to them. Complaining here is merely preaching to the choir.



the American revolution was discussed in smokey taverns Oldschool, so don't discount the idea that we're not assuming anything via mutual exchange in this milleniums mode of communicado

change comes when enough people want it



> Stevo, you've got to be kidding with that calculator. Lets keep this in terms of the medical system, since that is what we're discussing here. Do I really need to whip out all the stats on how much illegals are costing the healthcare system?



oh i'm quite aware of the immigration problem Medic's Wife.  In fact i'll bet you a brew the wall that's going to rival China's (and didn't work there either) the powers that be have sold us on will result in a grand job of detering ladder challenged Mexicans

further, our debates here that dwell on the quality of ems are not only influenced by the medical system, they are influenced by the politics inherent in it

we , as we are often called, health cares orphaned child, come last in the federal soup line, which is why i posted the link.  

we are, if you've not paid attention, in a record deficit. and as any family in debt knows, junior isn't getting a shiney new bike on his B-day, is he?

guess what, the Reps are responsible for the last few deficits, including this record one. Of course thier rebutal is trickle down economics, yet i really have a thing about anyone pissing down my back, and telling me it's raining



> My biggest concern is that there are 2 seperate standards of care



ask the 45 million have-nots about that Jon, i gaurantee you'll widen that NJ perspective 

~S~


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## EMTBandit

ReebTop said:


> *RidRyder*
> The other annoyance is the general attitude of a lot of medics.  It's not just the usual superiority complex when it comes to EMTs, it's the endemic laziness.  I have a company-mandated 7 to 8 minutes to be on-scene after time of dispatch.  Many times I've made it on-scene in, say, 6 minutes, and the medics are just signing on.  They then proceed to slow-boat it over, turning a 4 minute drive into 8, all in the hopes that we'll cancel them before they arrive.



I know where your coming from on that statement all too well, theres one particular medic that loves to do it all the time. Not to mention every once in awhile you get the one who wants to play doctor for one reason or another and one time tacked on an additional 20 minutes to a call where we could have been at the hospital by then. Luckily those are far and few between.



firecoins said:


> NJ EMS sucks because its fragmented. NY EMS has the same exact protocol as NY does for BLS protocols for medications.  I don't really see the problem.  Most places I have been to in Jersey are no more than 5 minutes from a hospital and ALS is available.
> 
> I volley in Rockland COunty, NY. I can actually take people to Pascack Valley Hospital or Englewood Hospital in Bergen County, NJ.



But why would you want to travel so far to do so when there I hope, are closer Hospitals?


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## firecoins

EMTBandit said:


> But why would you want to travel so far to do so when there I hope, are closer Hospitals?



We are on the NY/NJ border.  Nyack hospital is our main E.R. but the hospital lacks cardiac facilities.  Good Samaritan Hospital in Suffern, NY usually get cardiac patients but Pascack Valley Hospital may get them as well if necessary.  Major traumas go to Westchester Medical Center, 15 minutes in the opposite direction of Good Samaritan. Englewood is within 15 minutes as well.  Where we go depends on the needs of the patient.


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## EMTBandit

firecoins said:


> We are on the NY/NJ border.  Nyack hospital is our main E.R. but the hospital lacks cardiac facilities.  Good Samaritan Hospital in Suffern, NY usually get cardiac patients but Pascack Valley Hospital may get them as well if necessary.  Major traumas go to Westchester Medical Center, 15 minutes in the opposite direction of Good Samaritan. Englewood is within 15 minutes as well.  Where we go depends on the needs of the patient.



Gotcha. Didn't realize you traveled so much for each different type of illness/injury. Thanks for clearing it up.


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## Ridryder911

I have to admit I am by far not thoroughly knowledgeable about N.J system, but from what I have read and heard from all levels, it is screwed up. 

However; they are not alone, I have yet seen one state or even service that does not have some form of problems. However; it is recognizing and attempting to eliminate these problems, that counts. 

I agree, like everyone else I too am busy with work and school, rotations etc. and every once in a while like a personal life.. But, for those that are busy, if we could get others that are not, be interested and represent those that are to start a change.... this would be a beginning. 

R/r 911


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## Stevo

i'm sorry to say it also, but it sounds rather screwed up down there fellas. you know the last time i was NREMT was about 16 or so years ago, they gave me this pitch about how the National Registry would pave the way for standards. 

So what happened to that ?  Seems like everyone in ems i talk to points out the need for change, but my a**hole has a better chance of learning latin if the discontent doesn't reach past the people here saying it

let me ask this, we have time to write each other here right? I write my legislators when i have something i feel is important, maybe you NJ fellas should think about dropping them a line. 

the pen is mightier than the red light folks

~S~


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## Ridryder911

Stevo said:


> the pen is mightier than the red light folks
> 
> ~S~



So very true ! .. Even repeated visits after the letter. It is harder for them to lie to your face (albeit they can).

R/r 911


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## ckrump

Start with your state's EMS department if you want help changing your scope of practice.  They have people in touch with your legislators all the time.  Does NJ have any EMS Associations (ie:  MN Ambulance Association) that also keeps close contacts with legislators?

I do what I do because I care about people and want to at least try to make a difference when they are ill or injured.  As I grew in EMS, I took the initiative myself to increase my knowledge base.

NJ - if you are so unhappy with what you are allowed to do--if you can't beat 'em, join 'em--become a paramedic.


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## Mercy4Angels

ReebTop said:


> BLS is allowed to administer oral glucose, but I think it's safe to say that oral glucose is rather limited in its application.  Not useless, just limited.  As for the above poster's squad carrying EPIpens and being allowed to use them with some additional training, I believe they are sadly mistaken.  In NJ, we can assist with oral nitro, assist with albuterol inhalers, and _assist_ in the administration of a patient's prescribed epipen.  However, it must be theirs, the prescription mustbe up-to-date, and technically we aren't allowed to just spike them with it.  So, aside from O2 and oral glucose, we really can't do much of anything with meds.




your right about the epi pen however there has been talk of big brother letting us carry them on the rig. there really arent any contra indications to epi pens besides a REAL bad headace.


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## Billy Ray

*Hospital based EMS*

I don’t understand this.... A hospital puts up an ambulance to back up yours, and that’s a problem?  Aren't we out there to save lives?   You rather wait for a volunteer ambulance to be paged out 3 times (no one shows up), than another town 3 times (no one shows up) and than another ...while a patient is dying from a hear attack just so a hospital ambulance wont take your patient?  Hospital ambulance systems in NJ could not come at a better time. Recruitment is down, volunteerism is down, and more people are calling 911. The paramedic you quoted should be happy that hospitals have ambulances, now they don’t have to sit on a scene for up to 1.5 hrs waiting for a rig to show up.  This way a hospital ambulance can take the patient and the medic unit can go back in service to respond to other calls.  






EMTBandit said:


> Yea, I can see straight where your coming from. And I have seen a lot of what you just described. Sorry, when I first read what you were saying I must have seen it in a different way. My brother, who is also my Lt. at my ambulance corps was at a FAC meeting last night for our district. And he was saying he's becoming real annoyed at the FAC and some of the things thats going on or with the just the way things are. In Rochelle Park we tend to get a rig out all the time and don't really have a problem with missing calls. But then you have some of the towns around us or a few towns over that constantly miss calls and need paid services to cover them during the day. Which puts us and the other towns around us who get rigs out in a bad light. Because as the saying goes, one bad apple ruins the bunch. All one person needs to see is that if this town cant get an ambulance out, every town must be like that. And as of now, our town and the towns around us are fighting the local Hospital as they are now getting Ambulances and are trying to forcefully take over our 911 calls. And they have on more than one occasion in areas around us, listened to their radios and heard an accident and heard a request for a bus and they "just happened to drive by" and take that call. And we (and other towns) have had numerous confrontations with these EMT's from HUMC who think they are hot stuff because they have HUMC EMS on the back of their shirt. And yet, the Medics who run out of HUMC can't stand those EMT's either. I had one medic tell us and I quote, "It is a disgrace to see these guys have almost the same patch as us, and walk around like they do. They're starting to give us a bad name." I've talked to nurses in the ER who can't stand them either. So we do our best to get rigs out and we are pretty solid on that and have good relationships with our Mutual Aid towns. So if one town calls for an ambulance for mutual aid, we have no problem going to help out. By no means am I saying that paid EMT's such as yourself have this attitude problem, im just saying this Hospital does. So I can see where your coming from and things could/should be drastically different.


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## Mercy4Angels

Billy Ray said:


> I don’t understand this.... A hospital puts up an ambulance to back up yours, and that’s a problem?  Aren't we out there to save lives?   You rather wait for a volunteer ambulance to be paged out 3 times (no one shows up), than another town 3 times (no one shows up) and than another ...while a patient is dying from a hear attack just so a hospital ambulance wont take your patient?  Hospital ambulance systems in NJ could not come at a better time. Recruitment is down, volunteerism is down, and more people are calling 911. The paramedic you quoted should be happy that hospitals have ambulances, now they don’t have to sit on a scene for up to 1.5 hrs waiting for a rig to show up.  This way a hospital ambulance can take the patient and the medic unit can go back in service to respond to other calls.



not sure what town your from but that doesn't happen around here. we page out ONLY 2 times at 10 minute intervals. If for some oddity we cant get 2 people the next town always has someone. rarely does the medics wait. we are usually there before them anyway 9 time out of 10.


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## Jon

Mercy4Angels said:


> not sure what town your from but that doesn't happen around here. we page out ONLY 2 times at 10 minute intervals. If for some oddity we cant get 2 people the next town always has someone. rarely does the medics wait. we are usually there before them anyway 9 time out of 10.


2x ten minutes? When do you guys go to next due? The 10 minute mark? the 15? the 20?

My county gives EMS 7 minutes to go enroute and then Next due is dispatched. Initial Dispatch (Min 0). 2nd Tap (Min 4). Response Check... Response Check (Min 6-7). Tones for Primary and Next due, with Next due dipatched to "cover" X ambulance (Min 7). Then the process of second tap and response check is repeated. There is one part of the county that will have 2 services and occasionally a 3rd service scratch a call... and that requires that 2+ ambulances in that area are already tied up on other calls.

Of course, my squad hasn't missed a call in 17+ years... so we NEVER scratch... (2 crews+ on station 24x7, and 5 rigs always ready to roll) but we are in PA... not NJ... and I like that!


----------



## Ridryder911

Okay, let  me see if I get this straight... you page then if no response page again *after* ten minutes? Then you have a response time .. ? Wow! So in theory a 25 minute response time could occur for a call 6 blocks away? 

We have a 15 second response to go enroute after dispatched and directed by supervisor, unless there is special circumstances and I thought that was too long. 

Sounds like your community needs to check the possibility of contracting or placing a full time unit in the area. 

R/r 911


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## Mercy4Angels

15 seconds ? how can we get off our couches, suit up, get in the car, drive there, and call in service by 15 seconds.lol.......

page one at 0 minutes, page two at 5 minutes and at the 10 minute mark they will radio check if no answer then mutual aid. sorry i explained it wrong. and on the normal and this referres to 99 % of our calls we have 2 or more people at the building within 3 minutes. my personal best is one minute four seconds to get to the building and call inservice. yes i time it.


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## ReebTop

Ridryder911 said:


> Okay, let  me see if I get this straight... you page then if no response page again *after* ten minutes? Then you have a response time .. ? Wow! So in theory a 25 minute response time could occur for a call 6 blocks away?
> 
> We have a 15 second response to go enroute after dispatched and directed by supervisor, unless there is special circumstances and I thought that was too long.
> 
> Sounds like your community needs to check the possibility of contracting or placing a full time unit in the area.
> 
> R/r 911



I hate to bring this thread back from the grave, and I do have a great deal of respect for your obvious knowledge and experience, but sometimes I question the things you say.  Obviously a 10-20 min. response time is totally unacceptable, but having just 15 seconds to call en route?  Is that a joke?

They give us one minute at work and that's just enough time to write the call location/nature/time/number down and get out to the truck from quarters.  Now, if you're posted, that'sa different story, I suppose, but what happens if you miss it?  20 seconds and you're out of service to get yelled at by a supervisor?  "That five seconds just killed the patient"?  Please.  1-2 min. to call responding and 7-10 to arrive onscene (from time of dispatch, not en route) is our present policy and that seems the most realistic possible.


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## Ridryder911

Simple, we get toned out, we immediately mark enroute to dispatch after finding out the location or specific unit. We are to immediately to go to the truck, or chances are we are already in the unit. So fifteen seconds maybe even stretching it, chances are we immediately are enroute as soon as the address is given. I can't hardly believe that EMS still allows such delays as 1-2 minutes to just get your body to a truck and find a location? Does your service not require map tests, and geography studies ? One should have at least a general location to start at, and then start responding to then locate specifics while enroute.

1-2 minutes to respond to dispatch that you received the call and mark enroute.. another unit would be immediately dispatched. As a supv, someone would be seeing me in the office on what takes so long to get their arse into a truck. As well, carry a pen and paper or hand and write down the address, this is not rocket science. No need in driving fast to a call, especially if you are eliminating down delays. 

Heck, even on the helicopter we only had 5 minutes to lift off or we were called into the office. 

This is * emergency* services, isn't it ? 

R/r 911


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## Jon

Rid - Are you guys posting in your rigs? Or are you guys carring portables... copying the dispatch, and statusing by portable as enroute as you quickly walk to your ambulance?

My squad's QA standard on the charting program is 2 minutes or less. And we mark enroute once the truck is crewed and we are on the move - remember, we may have to finish up in the bathroom... or pull dinner out of the oven before we run to the rig . Also... we are dispatched by pager, and respond by MDT in the rig. I leave my portable in the truck... I don't need it when I'm in station.


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## Ridryder911

Each person carries a portable, and we are toned out by central communication. Once the tone is dispatched, the Supv. assigns the responding truck and immediately one of the members should acknowledge and repeat the address and mark enroute. We cover over 800 square miles with 3-5 trucks, and assigned areas (if possible) so when the address is given, one will usually know if it is in their region or not. 

Sure, they walk to the unit (which is less than 50') or at night time place jumpsuit on, but you mark enroute as as soon as tone is acknowledged and the information is received. The same way almost all F.D.'s respond, they don't wait around to go their engines.

I have worked in several EMS agencies, and have never been allowed to have an allotted "time limit" to get myself enroute. In fact I have disciplined employees for taking too long, with even them being fired. It has always been naturally assumed once the call is given one moves ASAP and goes and marks enroute. The response time is initiated from dispatch time to arrival time. Anything skewed and prolonged is questioned. 

Remember, the additional 2-3 minutes is possibility of hypoxia as well, and I don't particularly care to "race" to a call to make up that lost time. 

R/r 911


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## Mercy4Angels

we dont carry radios. just pagers. we call inservice when we get in the rig.


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## ReebTop

Ridryder911 said:


> Each person carries a portable, and we are toned out by central communication. Once the tone is dispatched, the Supv. assigns the responding truck and immediately one of the members should acknowledge and repeat the address and mark enroute. We cover over 800 square miles with 3-5 trucks, and assigned areas (if possible) so when the address is given, one will usually know if it is in their region or not.
> 
> Sure, they walk to the unit (which is less than 50') or at night time place jumpsuit on, but you mark enroute as as soon as tone is acknowledged and the information is received. The same way almost all F.D.'s respond, they don't wait around to go their engines.
> 
> I have worked in several EMS agencies, and have never been allowed to have an allotted "time limit" to get myself enroute. In fact I have disciplined employees for taking too long, with even them being fired. It has always been naturally assumed once the call is given one moves ASAP and goes and marks enroute. The response time is initiated from dispatch time to arrival time. Anything skewed and prolonged is questioned.
> 
> Remember, the additional 2-3 minutes is possibility of hypoxia as well, and I don't particularly care to "race" to a call to make up that lost time.
> 
> R/r 911




Fired?  This is ridiculous.  Precisely how are you dispatched?  Do they just tone you and give you an address or do they send the full job to you?  When I say 1-2 minutes, that's from the stated time of dispatch, which is generally from the beginning of the full message, which is the "code" (2 for BLS only, 1 for BLS + ALS), the location, the nature, the time, and our call number, followed by a repeat.  Again, our dispatch time is when they start telling us all that.  We have about a minute from that time to get in the truck and get moving.  I don't call responding until I'm sitting behind the wheel and am certain the vehicle will move, because sometimes they just want to crap out on us.  Hell, one of our trucks has to be left running or it simply won't turn back on without someone beating the stuffing out of the starter with a hammer.  Because stating that you're en route when you really aren't is pretty much the same thing that I do, except I'm not lying.  Where do you work that has such needlessly stringent policies?  How often are we in situations where 45 seconds is the difference between life and death?  I can confidently say that neither myself nor any of the other dozens of professional EMTs I know have ever been in that situation.  In fact, if that's the case and the patient is circling the drain that fast, then there is likely little to nothing we could do anyhow.

Before you use that to claim that I'm negligent, lazy, or incompetent, I'm simply stating a matter of fact.  Even in ideal situations, it is spectacularly unlikely to achieve success with treatment of critical patients.  With properly applied CPR, defibrillation, and ALS medicinal interventions, for example, there is something like a 30% chance you'll bring the patient out of cardiac arrest.  There is a significantly reduced chance once you move the patient.  I realize it's dumb to argue over the internet, especially about varying company policy, but your assertions, that any policy other than "two breaths and you'd better be on the way" is inappropriate, are offensive.  I'm sure anyone with half a brain could manage to call en route in about 15 seconds, but it certainly adds an unnecessary level of agitation to catching a job, which is already nervewracking (to a degree) to begin with.


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## Ridryder911

All I can say is "hold your breath for 2-3 minutes" and then tell me it does not matter. I agree there is no reason to get killed enroute, this is reason for rapid deployment. Does your fire service stand around awaiting all the information ? 

For as beating your unit to get it started, I would be the first to call the license bureau at the state and report it. Sorry, I've worked for shi*ty EMS before and never will again. Too much liability for me and risks for my patient's. Until, EMS attitude changes of preventive maintenance and upkeep then EMS is and should be considered a joke. Continuation of working for such an employer is only contributing to the problem. 

As well, I usually work for a professional service that monitors and logs all radio transmission per seconds. Some have had GPS on board systems so when you mark enroute, your unit better be rolling in a few seconds. 

My professional opinion is if you can justify the delay in court so be it, I sure would make an incident report & copy every time I had to "beat" my unit to start. Just because it was the EMS and the norm, does not eliminate you from responsibility and liability. 

Good luck!
R/r 911


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## ReebTop

Ridryder911 said:


> All I can say is "hold your breath for 2-3 minutes" and then tell me it does not matter. I agree there is no reason to get killed enroute, this is reason for rapid deployment. Does your fire service stand around awaiting all the information ?
> 
> For as beating your unit to get it started, I would be the first to call the license bureau at the state and report it. Sorry, I've worked for shi*ty EMS before and never will again. Too much liability for me and risks for my patient's. Until, EMS attitude changes of preventive maintenance and upkeep then EMS is and should be considered a joke. Continuation of working for such an employer is only contributing to the problem.
> 
> As well, I usually work for a professional service that monitors and logs all radio transmission per seconds. Some have had GPS on board systems so when you mark enroute, your unit better be rolling in a few seconds.
> 
> My professional opinion is if you can justify the delay in court so be it, I sure would make an incident report & copy every time I had to "beat" my unit to start. Just because it was the EMS and the norm, does not eliminate you from responsibility and liability.
> 
> Good luck!
> R/r 911



I like how you take my figure of 45 seconds (the difference between your mandated time and mine) and stretch it to "2-3 minutes."  I also would still like to know what environment it is that you work where all of the trucks are pristine.  I work in a tightly packed urban population center in New Jersey.  My agency covers two cities.  We answer thousands of calls on a monthly basis with a "fleet" of 8 vehicles, two of which are designated transport units to give newbies something to cut their teeth on.  That leaves us with 6 vehicles and that just so happens to be the number required to fulfill our 911 contracts.  Given the fact that there is little to no money in 911 EMS, particularly for a private service attached to a private hospital that runs in the black by the grace of God alone, those 6 EMS trucks are all we have.  We have 3 other vehicles which aren't in service (10 is an old piece of garbage that we've given up on, 4 was hit while en route to a call and flipped but should be back soon, and 11 has crappy electrical and a bullet lodged in the "C" of ambulance on the hood) and no capital to purchase new vehicles.  It's very nice that you can ride the brand-newest stuff on the road, but those of us in the trenches in a state which has zero fondness for paid EMS make do with what we can afford.  I don't like the fact that 12 requires beatings when it turns off, but such is the case, and what are we gonna do?  Violate our contracts?  Add to the workloads of the other crews while delaying patient care?  If it will run, it runs, because there are no other options.

We too log our radio communications and they are reviewed by our Chief, along with our call reports and official time logs, to verify that we are holding to company policy and proceding in a timely fashion.  However, we cannot afford a GPS system as yet, and given that the city (while heavily populated) is only 4 square miles, GPS is not absolutely required.  As an aside, it bothers me that things like GPS systems and CAD systems are viewed mostly as a way to "make sure those damn EMTs are doing their jobs" and not primarily as a way to increase our safety in the field.

It greatly upsets me that you consider EMS a joke.  Perhaps you ought to pursue a different career if you simply can't fathom us being taken seriously.  It's not due to a lack of maintenance on our vehicles that we're a "joke," it's because we're the forgotten child of the system.  Police and fire get top billing and EMS gets screwed.  We're not glamorous enough, or not seen as heroic, or what have you.

I recommend coming down from your ivory tower from time to time to see what we mere mortals in the world of EMS have to put up with.

Also, my fire service is volunteer, so I can't speak to that as much as I can EMS.  However, we recieve tones, county dispatches the location and the nature, we get to the station, suit up and call in service when we're rolling out the door.  To do otherwise misinforms dispatch as to your actual disposition and confuses anyone who may be awaiting your arrival.


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## ffemt8978

All I can say is that there IS a difference between acknowledging the page and going in route.  To put yourself in route as soon as you receive the page, unless you're physically behind the wheel of your vehicle, seems like an obvious attempt to improve your response times for NIFRS and other reporting systems.

As far as "hold your breath for 2-3 minutes" goes, just how long do you think they're on the phone with 911 before you're actually paged?


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## Ridryder911

What is amazing, is that nearly every EMS forum has a post about N.J. EMS system and the problems that it has, however; I have yet seen any article describing introduction of legislation of changing laws, or even EMS associations and organizations lobbying against the current situation. 

I personally do not know what the real N.J. system is like, only from what I have heard and read from medics and basics that work there. Then yet again, from your previous posts, it just reinforces the speculations. 

I don't work in an ivory tower, rather started in EMS nearly 30 years and have continued so in the field to make improvements and changes. My first ambulance was a converted bread truck, and low top station wagon and yes we we provided ALS in those antiquated units. Yes, I am very familiar of poor management and upkeep of EMS units, that jeopardize patients and staff. One night all three acting units broke down on one call. 

Instead of whining and complaining, I took action and with others had legislation bill introduced into a Public Health & Safety Act that mandates EMS units be working at all times 24 hours a day. They are subject to spot inspection and if found dangerous, are subject to be fined or closed down. EMS personnel and even their units are expected to be able to provide safe and optimum care 24 hours a day, not doing so in legal terms is called negligible. The same idea and complaint of mine, not having a trauma center in my state. Instead of complaining, I went and obtained multiple degrees and experience to change such. After years as a full time trauma consultant and with other dedicated persons, we now have a Level I. So yes, change can occur.

There are successful EMS services out there than run half the calls and have more travel and distance than others and still succeed and even make profit. Some are even to place money as profit or reinvestment into the company to prevent such occurrences as you described. If you are not receiving at least 30-50% of your billing payments, then something needs to be investigated. The joke I describe is not of being funny, rather embarrassing that our so called profession has not yet taken action to become one. Embarrassing, that medics still has to tolerate such problems and do so without taking any action. 

I am sure if that service lost it's contract, someone will take over. Possibly someone that can place more units and actually can operate without "banging on it" to get it to run. Your right, I see no humor in that at all. This is 2007, and patients deserve better and so does EMS personnel that depend on that equipment to respond and transport safely. Apparently, your management has never heard of risk management. Law suits occur frequently on equipment failure and poor response times because of such.  

 If your service gets treated like a step child, how much action has your service attempted to change relations? Does your fellow EMT's attend city council meetings, get to know representatives personally? Have you invited them to tour and possibly ride, demonstrating the needs? 

The reason the P.D. and F.D. is popular because they are "essential" in community leaders eyes. P.D. is needed for protection and F.D. is needed for ISO ratings. EMS is a nice thing to have. It is the EMS responsibility to attempt to change that mindset. 

So from one that has been in the trenches and even been in the "ivory tower" things can change, it just takes action and persistence, then continuation, no it is not easy. EMS always and will always have problems, it is our responsibility to meet those needs.  

R/r 911


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## BossyCow

Oh, come on Rid.... you certainly aren't suggesting personal responsibility for change?  That would make complaining so much less fun!!!


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## Mercy4Angels

seems to work fine for us, dont know what everyones problem is. i like that we are all BLS and ALS is from a different source (hospitals). mixing the two here now after so long would cause HUGE issues. the system works just fine for us in my town. BLS is never long to get on scene and I have a choice of 3-4 hospitals with MULTIPLE ALS units at my disposal.

like just last night i needed them for a patient with a heartrate of 167. they hooked him on a 12 lead and one said to the other "he's sinus" they gave him meds in the back of the rig to stop his heart and restart it sort of to reset it. kinda cool stuff. i was driving but my partner gave me the info after the run.


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## CFRBryan347768

Recycled Words said:


> EMT-Bs are nothing more than glorified First Responders in NJ in that they give us a big truck with flashy lights and let us deal with BS calls on our own. We can't do anything on real calls without calling for medics.
> 
> Supposedly they had something in the works to let us do more stuff, but that's never going to happen....[/QUOT
> 
> Ill take a big truck with flash lights and deal with BS calls=D


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## NJN

CFRBryan347768 said:


> [/QUOT
> 
> Ill take a big truck with flash lights and deal with BS calls=D



Come down to NJ, especially my squad, we'ed love you here


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## JPINFV

I'm just wondering,  since this thread has been revived, what exactly do EMT-Bs want to do extra that can be justified by a 110 hour training course?


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## MAC4NH

I also work (and volunteer) in NJ and the problems here run deep.  The paid services blame the First Aid Council.  The volunteers blame the Department of Health.  The politicians ignore the problems until a situation makes the news or until they find a way to personally gain from it (those of you from other parts of the country need to understand that this is NJ and the Sopranos was not a drama but a documentary).  The public at large does not want to think about us at all (kind of like whistling past the graveyard).  

I have a really radical suggestion.  Why don't the paid groups join together with the First Aid Council?  This is not as crazy as it sounds.  The FAC's leadership at this time are the smartest, best educated and most open-minded group I have ever seen in the organization.  The FAC does realize that the days of volunteers in this state are numbered (though they won't admit it openly).  They do have a large organization that has access to the politicos in Trenton.  An alliance between the professional and volunteer EMS systems might have enough clout to actually change something in Trenton.  What has to happen first is communication because there is and will be a lot of mistrust from the rank and file of both groups.  The main benefit to both groups is that they can then go to Trenton and tell the politicians the solution that we as providers think will work.  Otherwise we will have a bunch of potentially crooked individuals who know nothing about EMS imposing on us a system worse than the one we have (and anyone who works in Jersey knows that it will be worse).


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## firecoins

MAC4NH said:


> (those of you from other parts of the country need to understand that this is NJ and the Sopranos was not a drama but a documentary).


The mob does not exist.:glare:


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## Artttom

*I worked Essex Valley in 1988..*

I saw your post about EMS in NJ and I was laughing. I worked Essex Valley in 1988 so I probably know the people who wrote those old call sheets you mentioned in your post about ems service being crappy.  Even back then we were frustrated by poor funding and we would routinely borrow stiffneck collars and backboards from University and other places, just to have enough to complete a run.  I remember so many crazy stories about working my first paid ems job after leaving the Marines, I still remember interviewing for the job.   I only worked there for about six months and then went to UMDNJ for a few months until I moved to Los Angeles to become a cop.  I went to Google maps to look for our old quarters but couldn't find it, it probably was torn down years ago, it was in an old fire house a few blocks from the hospital.  If you get this fire me back a note it would be funny to hear from a current employee...assuming you're still there.


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## DrParasite

wow, talk about bumping an old thread....

I'm a currently NJ EMT (probably working in the same area as you used to), and think that when you have crappy private EMS sevices (Essex Valley happens to be one of the crappiest), which isn't part of the government in any way, that's what happens: remember, if management can cut down on expenses, not do repairs to trucks, limit supplies, and pay their EMTs poorly, it means higher profits for them.  Can you now see what they did it?

and the first aid council sucks and should be disbanded.  worst thing to happen to NJ EMS ever.


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## Bullets

Seriously, was this needed to be dragged up? We all know the NJSFAC is a mess, and the squads are realizing it. My volunteer squad has left the the NJSFAC after deciding we are tired of sending them money for nothing and their refusal to help advance the profession. Some squads, especially those with large life membership will remain until the current members can out vote them, but it is happening. If you look in the Gold Cross supplement 2-3 squads resign a month. 

We have 4 squads in my town, 2 have left, 2 are still stuck in the past, their old members keeping them in it. There used to be a time when the NJSFAC was good, when they helped the volunteers, but that time has passed. The current president is a milquetoast who wont do whats right, only what the board and the most vocal members demand. If you go to the convention, it looks like a casualty clearing station, everyone is over 40, most over 80, and they look like fools.


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## Devilz311

DrParasite said:


> and the first aid council sucks and should be disbanded.  worst thing to happen to NJ EMS ever.



:beerchug:


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## medicsb

When was the NJFAC ever for progress?  Their opposition to anything progressive dates back to the 70s when they fiercely opposed the up-start of paramedic services, twice organizing massive protests in Trenton and Newark.  Look at articles from the 70s and early 80s and compare them to what they were saying opposition to S818 - little has changed.  They are a pox on the face of EMS everywhere.


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## Bullets

medicsb said:


> When was the NJFAC ever for progress?  Their opposition to anything progressive dates back to the 70s when they fiercely opposed the up-start of paramedic services, twice organizing massive protests in Trenton and Newark.  Look at articles from the 70s and early 80s and compare them to what they were saying opposition to S818 - little has changed.  They are a pox on the face of EMS everywhere.



The District were functional, and i think in many cases they were able to bring together squads who otherwise didnt work with each other or had no relationships.


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## Pinksock

Hi, I'm not too  sure how long the state recognized EMT-I and A's for. I do know that those levels were discontinued in 96. I was certified as an emt-b in 97 and had to take a separate course to be certified for defribrilation. For a short period of time I had to sign emt-d on my sheets and redo my patches with the emt Defib then revert back to the regular and patch about  a yr later. I also remember way back when the oems started to run a l.m.a. pilot trial in rural counties like hunterdon  and Sussex due to the er eta and based on the results the state was supposed to implement lma training for emts in both rural and urban settings. That fell by wayside. But yes all in all nj has some real good emts but the state and fac and other factors can't get past their egos and allow the smart emt s to advance and have the not so smart ones just drop off naturally.


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## akflightmedic

Nice resuscitation attempt. Not a record, but very nice effort.


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## RobertAlfanoNJEMT

ReebTop said:


> As I mention regularly, I'm a paid EMT working in East Orange, NJ.  East Orange is a hard town with a high call volume but no money, so the proverbial belts tend to be drawn tight up here.  Old vehicles that are falling to pieces, old equipment, crap pay, and long hours with the stong potential of no relief showing up are more than commonplace, they're almost hallowed traditions at this point.  I was hired shortly after the new directors (or Chief and Assistant Chief, if you prefer) came on from NYC EMS and OEM.  They've tried to fix things but it isn't easy, thanks again to the utter lack of funding.
> 
> I have two gripes about Jersey EMS; one is more of an amusing anecdote and the other will likely infuriate some people, but both relate back to the same issue.
> 
> New Jersey has a terrible tendency to believe that volunteer organizations can handle all fire and EMS, except in major urban areas where the call volume is simply to high to expect the FFs/EMTs to maintain "day jobs".  This is rapidly proving to be an outmoded concept.  Volunteerism, at least in EMS, was beginning to become obsolete in the late '90s, in my view.  Fire departments in suburban and rural areas, while call volumes are increasing, are still usually receiving no more than 2 calls a day.  EMS is wildly different, with call volume only growing as immigrant populations increase and the "indigenous" population ages.  Many volunteer agencies have taken to hiring paid EMTs (usually) during the weekday, leaving nights and weekends to the volunteer corps.  Some municipalities have opted to go fully paid, while others hire private companies, most notably MONOC, to cover their EMS 911.  The state has no direct regulation over the agencies which remain volunteer, as they are under the jurisdiction of their municipality and that is usually only in a cursory role.  Volunteer agencies, particularly in sparsely populated regions with few riding members, are well-known to allow non-certified individuals to ride and function in a BLS capacity.  As these individuals aren't paid, there are no real repercusions for whatever action they may take, as it isn't a case of getting one's cert. revoked and losing their job.  If they have a cert, losing it doesn't always guarantee that they will cease riding.
> 
> BLS scope of practice in NJ is laughable, which only compounds the problems raised by increasing volume and decreasing volunteerism.  I've heard medics complain about those of us BLS folks as being totally dependent upon them, which is not by our choice.  We function as either just a taxi service to the hospital or just as muscle for the medics.  There is truly no middle ground.  We are incapable of operating on our own in the simplest of emergencies; while other states allow BLS to provide baby aspirin, albuterol, nitroglycerin, activated charcoal, etc. etc., the state of NJ allows us to administer only one medication: oxygen.  There is nothing between EMT-B and EMT-P in this state.  It's all or nothing.
> 
> All of these problems, while not necessarily caused by, are certainly exacerbated by the First Aid Council, which is essentially a union/lobbying group for the volunteer corps.  Whenever a new treatment has been brought up as a possibility for BLS to exercise, the FAC has blocked it, because it would have forced them to allow the state oversight on their agencies.  Due to their ubiquitous nature, many municipalities consider paid EMS a pointless expenditure, having the concept of "why pay for something you can get for free?"  This attitude is quickly showing itself to be foolish, totally without merit, as response times suffer and the quality of care plummets.  However, the volunteer agencies and the local politicians are unwilling to give up their ground or admit defeat.  The end result of all this is that those 911 agencies which do pay their EMTs are generally only in the most difficult areas to work (i.e. high-crime areas or areas with great distances between patients and the hospital) and get away with underpaying them for the trouble.
> 
> As for the aforementioned anecdote, my partner was nosing around in our dispatch room the other night and discovered a folder full of old run reports.  From 1987.  Just for a goof, we started leafing through these 20-year-old reports; I found myself getting depressed, and said so to my partner.
> "These are making me kinda sad, bro."
> "Why's that?"
> "Nick, these are 20 years old, right?"
> "Yeah?"
> "We could be using the exact same paperwork right now, man.  There's absolutely nothing on the brand-new sheets that isn't on these ancient ones.  EMTs have had nothing new to do in Jersey for at least 20 effing years."
> "Yep, Jersey sucks, man."
> 20 years with not a single advancement or improvement to the system.  20 years of training EMTs, not with caution or quality, but with speed, simply to put warm bodies on trucks.  Thanks a lot, FAC.


I can feel the fists quenching if volunteers right now 😂😂 I don’t get why volunteers want to hold on to it so long why would you not want to be paid! Let it go! Sign all of you ambulances on to a county service or something! And this is coming from a volunteer..


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## DrParasite

Why would the volutneers clench their fists?  the OP is a paid EMT, working for a crappy hospital based EMS system in a crappy city.  He's complaining about a system (And this was only 12 years ago).  He's actually complaining about the system that pays his bills.  He's not a paramedic, so all those limitations apply directly to him.  He's not a volunteer (although it wouldn't surprise me if he used to be one) and a lot of what he's saying is, quite honestly, wrong, and based on inaccurate urban legends that have spread through paid EMS agencies for years.  

The last time I was an EMS volunteer in NJ was 2007 or so, so while you are willing to work for free, I decided 8 years was enough for me.  I started my paid EMS career in an urban city in 2005.  Did we have some idiots on my squad, who refused to move the profession forward?  yep.  Did we have some idiots at my job that I couldn't figure out how they hadn't been fired due to gross incompetence?  more than you would like to believe.  And if you do work on the paid side of EMS, you see you have the same people who are also volunteers, but they are now getting paid an hourly wage to do the job.

Going paid is not the solution, because simply providing a salary for the people on the ambulance won't fix all the systemic problems.  There are plenty of understaffed and underfunded career EMS agencies (including the one where the OP worked).  County services sound like a great idea, until all of your ambulances are in other areas, and a resident in your town has to wait 20 minutes for an ambulance to show up.  I have since left NJ for a state with cheaper taxes and nicer people, and live in an area that has a county wide service.  extended response times are common, low availability of units is common, and other counties frequently rely on mutual aid because they don't have enough ambulances to handle the call volume.  Units are frequently OOS due to no staffing.  So a paid, county-wide system has not solved the problems caused by poor management.

Fix the funding problems, fix that staffing issues, raise the education standards.... and remember many paid EMTs only have a high school diploma, and their EMT certification.  Many of those volunteer EMT have an EMT certification, a high school diploma, and associates degree, and bachelors degree (which is important, because there is a push for all paramedics to have degrees, well, many of your volunteers already have completed that requirement).

NJ EMS has plenty of issues;  I have yet to find a state that has no issues with their EMS system.


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