NJ EMS is Awful, and Here's Why

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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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.
 
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
 
By far I am not for "socialized medicine" and a staunch Republican; but, as the old saying you get for what pay for.
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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
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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~
 
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.
 
By far I am not for "socialized medicine" and a staunch Republican
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I knew there was a reason I liked you! :D

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?
 
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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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"-
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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.
 
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.
 
Jon said:
I think the comment was comparing NJ State BLS care with other states... Do you have protocols for oral glucose?
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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.
 
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.
 
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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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?
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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
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ask the 45 million have-nots about that Jon, i gaurantee you'll widen that NJ perspective

~S~
 
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.
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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.
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But why would you want to travel so far to do so when there I hope, are closer Hospitals?
 
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EMTBandit said:
But why would you want to travel so far to do so when there I hope, are closer Hospitals?
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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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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.
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Gotcha. Didn't realize you traveled so much for each different type of illness/injury. Thanks for clearing it up. ;)
 
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..:D 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
 
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~
 
Stevo said:
the pen is mightier than the red light folks

~S~
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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
 
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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