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 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.
