ALS around the country

[Devilz311]

Are there many states that have the same ALS restrictions that NJ does?

For anyone thats not familiar, NJ Paramedic Programs must be hospital-based. (Virtua Health Medics, Atlanticare paramedics, MONOC, etc...)

I really like how other states allow municipal or county-bases ALS programs... It must be nice having the first fire-truck on scene being able to initiate IV access, advanced airway, etc...

I know there has been several Municipal BLS programs trying to push the state to de-regulate ALS in NJ...

Anybody from NJ have opinions?

 

[JPINFV]

Are there many states that have the same ALS restrictions that NJ does?

California doesn't have any restrictions like that. Paramedics are free to work for ambulance companies and fire departments. I don't feel that it's the same as being attached to a base hospital/resource hospital (Resource hospital is the 'base hospital' for the city fire department in my home county that has comprehensive standing orders since base hospitals are also involved with CMEs and QA).

 

[Jon]

I'm across the river in PA, but my transport co's trucks are all NJ certified. I occasionally end up working in NJ for routine transports.

NJ's EMS system has some positives and some negatives. It is a great thing that the EMS agency actually does spot checks and field inspections, to ensure that the ambulances are properly stocked and staffed year round... not just for the state inspection.

However... the hospital-based, dual provider ALS responder units is something that DOESN'T EXIST in most other places. Most places are moving to P/B ambulances, and fire-based EMT-P/FF's.

It also doesn't help that there are 2 sets of standards for BLS units... the First Aid Council and the state OEMS... the state OEMS vehicle certification is only required if you are a paid company. This creates a double standard, and a schism between vollie and paid that shouldn't exist.

 

[Devilz311]

It also doesn't help that there are 2 sets of standards for BLS units... the First Aid Council and the state OEMS... the state OEMS vehicle certification is only required if you are a paid company. This creates a double standard, and a schism between vollie and paid that shouldn't exist.

I know, it drives me nuts that a volunteer squads have no real standards besides the NJFAC "guidelines." Technically, a volunteer squad can run calls without even having an EMT on board.

Personally, I would love it for Volunteer agencies to fall under NJ OEMS reg's...

 

[Ops Paramedic]

That is truly sad, i believe. Out in SA we have free reign protocols. By that i mean we do not have to go through anyone prior to doing anything that is in our protocol. There is one advantage of going through medical control: Should the shi.. hit the fan, well hey, you were told to do so. Saying that, it means that we are on our own, and the guys and girls stick to what is published, barring the one or two that you will always get!!!

Make no mistake in thinking though that we are not regulated at all. We annualy have to register with our proffesions board, a body of SA's Health Profession Council of South Africa (HPCSA). This body then aplies with the health ministry for new and updated protocols. The are also the public watch dog, and should a member of public complain, you can be sure they will come knocking on your door. Also taking into consideration that it is a very close community (There are only SO many places you can do your training), we all look out for each other and our profession, hence should someone step out of boundries, without reason, some is bound to take action.

We as Paramedics (ALS), together with the ILS are registered as independent practice, where as a BLS will recieve this status after being registered for 2 years.

Just some info from out this side.

 

[Ridryder911]

New Jersey... enough said. Not heard of anywhere else in the U.S. that still have "first-aid" squads and prefer to provide lower, inadequate care. Much of the care is based upon the providers ego and tradition rather than the needs of the patient.

I have to admit I prefer EMS being with associated with hospitals. Fire Service are for rescue, haz-mat, and providing first responder care. Very few have interest in EMS as needed to be, there is only so many "hats" one can wear and be proficient in.

EMS is medical and that is where it needs to be. Period.

Either with hospital or third party, where the entire focus will be upon EMS alone.

R/r 911

 

[firecoins]

FDs should have nothing to do with EMS.

 

[Katie]

we're part of FD here. it seems to work pretty well

 

[rmellish]

The FD in my hometown requires all members to be paramedic certified within three years of being hired. Problem is, many of them want to be FF first, medics second, which is fine with me, I just think that a medic who does not want to be a medic, can very easily be a lousy medic.

Plus they can't fully staff both their ambulances and apparatus at the same time, but thats another issue.

 

[firecoins]

I want to work in a part of Florida as a medic but I am not willing to be a FF. So pretty much I am doing transfers or working the ER. Nothing is wrong with transfers or the ER but I enjoy doing at least some 911. If i work in the ER, i might as well get the PA or RN.

 

[reaper]

What part of FL are you wanting?

 

[paramedix]

FDs should have nothing to do with EMS.

Every firefighter here in SA is at least BLS qualified. I dont have a problem with FF having an EMS qualification. Think about it, when you need some extra hands, you can use them for something on scene...

 

[synchromedic]

The NJ EMS Report card stated a similar view earlier this year. The recommendation was to get rid of the duel medic system and ride either a single medic in the chase which would double the amount of available medics or the hospital would have the option to have a medic/basic truck. Currently the only approved medic/basic trucks running are out of UMD Newark. It also proposes that the squads will have medics riding and to get rid of the hospital based MICU programs all together since they are not cost effective to the hospitals.

I do think it will be several years until we see a trial of the guidelines in Jersey. How many years has the LMA trial been going on in Hunterdon and still nothing has been achieved by it.

I do know alot of the medics do not like the idea of riding with the EMT's and are not excited about the idea of having to go to the bls calls. If the state does a trial it will not be for a couple of years due to the FA council vs DOH standards.

If you want to check out the state report card here is the link http://www.nj.gov/health/ems/documents/ems_study_report.pdf

 

[Jon]

How is a 2-ALS provider fly car NOT a waste of resources? Almost all the time, the 2nd medic drives along after the BLS truck and just follows them in... That medic is unneeded. I think EMT-B/EMT-P paired ambulances are a great thing, but you need a WHOLE LOT MORE ALS ambulances than you do with ALS fly cars, because the ALS ambulances will be taking BLS and ALS patients. There also needs to be a way for AS providers to get an extra medic when needed (codes, bad CHF, etc)... this could be a supervisor in a fly car, or a 2nd ambulance responding.

 

[synchromedic]

The problem in Jersey is that medics are solely hospital based. It is illegal for squads and other companies to operate a MICU. There are many times that both medics do ride in the truck. The problem with converting is that now all the little first aid squads will have to either hire medics and lose the first aid guidelines or find volunteer medics.

Another problem is going to be the lack of medics currently available. Education is run very differently since there is only three programs licensed in the state through two community colleges. In order to get accepted into medic school you need to apply to the hospital to get sponsored. These sponsorships are where you will do your clinical time in your second year. The education system is set in order to keep the education the same for every student graduating.

Or you could do what I'm doing and go to medic in pa or ny and apply for reciprocity.

 

[Jon]

I've worked with medics from Jersey who got their certs in PA, and then had a difficult time getting reciprocity in NJ, and then couldn't find a job because they didn't go to the "right" medic school.

Maybe the state will see the light. Probably not.

 

[synchromedic]

It's all about who you know.