NJ EMS is Awful, and Here's Why

TKO

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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.
 

TKO

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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.
 

Stevo

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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~
 

TKO

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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

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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.
 

Stevo

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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~
 

Glorified

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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.
 

Stevo

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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~
 

Medic's Wife

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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?
 

TKO

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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 :D
 

EMTBandit

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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

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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.
 

Jon

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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.
 

ReebTop

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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.
 

EMTBandit

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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

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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"-
 

Airwaygoddess

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Welcome to the Tribe!!:)
 

ckrump

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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.
 

Ridryder911

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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
 

Stevo

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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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