NJ EMS is Awful, and Here's Why

ReebTop

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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.
 

Nycxice13

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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.
 

ReebTop

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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.
 

firecoins

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

Recycled Words

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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....
 

Stevo

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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~
 

markdk86@hotmail.com

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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 !
 

Medic's Wife

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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).
 

Guardian

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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.
 

Stevo

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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~
 

Ridryder911

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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

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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

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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!
 

TKO

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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.
 

Ridryder911

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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
 

fm_emt

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"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.
 

Mercy4Angels

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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

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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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