NJ EMS is Awful, and Here's Why

Mercy4Angels

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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.

your right about the epi pen however there has been talk of big brother letting us carry them on the rig. there really arent any contra indications to epi pens besides a REAL bad headace.
 

Billy Ray

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Hospital based EMS

I don’t understand this.... A hospital puts up an ambulance to back up yours, and that’s a problem? Aren't we out there to save lives? You rather wait for a volunteer ambulance to be paged out 3 times (no one shows up), than another town 3 times (no one shows up) and than another ...while a patient is dying from a hear attack just so a hospital ambulance wont take your patient? Hospital ambulance systems in NJ could not come at a better time. Recruitment is down, volunteerism is down, and more people are calling 911. The paramedic you quoted should be happy that hospitals have ambulances, now they don’t have to sit on a scene for up to 1.5 hrs waiting for a rig to show up. This way a hospital ambulance can take the patient and the medic unit can go back in service to respond to other calls.




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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Mercy4Angels

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I don’t understand this.... A hospital puts up an ambulance to back up yours, and that’s a problem? Aren't we out there to save lives? You rather wait for a volunteer ambulance to be paged out 3 times (no one shows up), than another town 3 times (no one shows up) and than another ...while a patient is dying from a hear attack just so a hospital ambulance wont take your patient? Hospital ambulance systems in NJ could not come at a better time. Recruitment is down, volunteerism is down, and more people are calling 911. The paramedic you quoted should be happy that hospitals have ambulances, now they don’t have to sit on a scene for up to 1.5 hrs waiting for a rig to show up. This way a hospital ambulance can take the patient and the medic unit can go back in service to respond to other calls.
not sure what town your from but that doesn't happen around here. we page out ONLY 2 times at 10 minute intervals. If for some oddity we cant get 2 people the next town always has someone. rarely does the medics wait. we are usually there before them anyway 9 time out of 10.
 

Jon

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not sure what town your from but that doesn't happen around here. we page out ONLY 2 times at 10 minute intervals. If for some oddity we cant get 2 people the next town always has someone. rarely does the medics wait. we are usually there before them anyway 9 time out of 10.
2x ten minutes? When do you guys go to next due? The 10 minute mark? the 15? the 20?

My county gives EMS 7 minutes to go enroute and then Next due is dispatched. Initial Dispatch (Min 0). 2nd Tap (Min 4). Response Check... Response Check (Min 6-7). Tones for Primary and Next due, with Next due dipatched to "cover" X ambulance (Min 7). Then the process of second tap and response check is repeated. There is one part of the county that will have 2 services and occasionally a 3rd service scratch a call... and that requires that 2+ ambulances in that area are already tied up on other calls.

Of course, my squad hasn't missed a call in 17+ years... so we NEVER scratch... (2 crews+ on station 24x7, and 5 rigs always ready to roll) but we are in PA... not NJ... and I like that!
 

Ridryder911

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Okay, let me see if I get this straight... you page then if no response page again after ten minutes? Then you have a response time .. ? Wow! So in theory a 25 minute response time could occur for a call 6 blocks away?

We have a 15 second response to go enroute after dispatched and directed by supervisor, unless there is special circumstances and I thought that was too long.

Sounds like your community needs to check the possibility of contracting or placing a full time unit in the area.

R/r 911
 

Mercy4Angels

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15 seconds ? how can we get off our couches, suit up, get in the car, drive there, and call in service by 15 seconds.lol.......

page one at 0 minutes, page two at 5 minutes and at the 10 minute mark they will radio check if no answer then mutual aid. sorry i explained it wrong. and on the normal and this referres to 99 % of our calls we have 2 or more people at the building within 3 minutes. my personal best is one minute four seconds to get to the building and call inservice. yes i time it. :)
 

ReebTop

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Okay, let me see if I get this straight... you page then if no response page again after ten minutes? Then you have a response time .. ? Wow! So in theory a 25 minute response time could occur for a call 6 blocks away?

We have a 15 second response to go enroute after dispatched and directed by supervisor, unless there is special circumstances and I thought that was too long.

Sounds like your community needs to check the possibility of contracting or placing a full time unit in the area.

R/r 911
I hate to bring this thread back from the grave, and I do have a great deal of respect for your obvious knowledge and experience, but sometimes I question the things you say. Obviously a 10-20 min. response time is totally unacceptable, but having just 15 seconds to call en route? Is that a joke?

They give us one minute at work and that's just enough time to write the call location/nature/time/number down and get out to the truck from quarters. Now, if you're posted, that'sa different story, I suppose, but what happens if you miss it? 20 seconds and you're out of service to get yelled at by a supervisor? "That five seconds just killed the patient"? Please. 1-2 min. to call responding and 7-10 to arrive onscene (from time of dispatch, not en route) is our present policy and that seems the most realistic possible.
 

Ridryder911

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Simple, we get toned out, we immediately mark enroute to dispatch after finding out the location or specific unit. We are to immediately to go to the truck, or chances are we are already in the unit. So fifteen seconds maybe even stretching it, chances are we immediately are enroute as soon as the address is given. I can't hardly believe that EMS still allows such delays as 1-2 minutes to just get your body to a truck and find a location? Does your service not require map tests, and geography studies ? One should have at least a general location to start at, and then start responding to then locate specifics while enroute.

1-2 minutes to respond to dispatch that you received the call and mark enroute.. another unit would be immediately dispatched. As a supv, someone would be seeing me in the office on what takes so long to get their arse into a truck. As well, carry a pen and paper or hand and write down the address, this is not rocket science. No need in driving fast to a call, especially if you are eliminating down delays.

Heck, even on the helicopter we only had 5 minutes to lift off or we were called into the office.

This is emergency services, isn't it ?

R/r 911
 

Jon

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Rid - Are you guys posting in your rigs? Or are you guys carring portables... copying the dispatch, and statusing by portable as enroute as you quickly walk to your ambulance?

My squad's QA standard on the charting program is 2 minutes or less. And we mark enroute once the truck is crewed and we are on the move - remember, we may have to finish up in the bathroom... or pull dinner out of the oven before we run to the rig :). Also... we are dispatched by pager, and respond by MDT in the rig. I leave my portable in the truck... I don't need it when I'm in station.
 

Ridryder911

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Each person carries a portable, and we are toned out by central communication. Once the tone is dispatched, the Supv. assigns the responding truck and immediately one of the members should acknowledge and repeat the address and mark enroute. We cover over 800 square miles with 3-5 trucks, and assigned areas (if possible) so when the address is given, one will usually know if it is in their region or not.

Sure, they walk to the unit (which is less than 50') or at night time place jumpsuit on, but you mark enroute as as soon as tone is acknowledged and the information is received. The same way almost all F.D.'s respond, they don't wait around to go their engines.

I have worked in several EMS agencies, and have never been allowed to have an allotted "time limit" to get myself enroute. In fact I have disciplined employees for taking too long, with even them being fired. It has always been naturally assumed once the call is given one moves ASAP and goes and marks enroute. The response time is initiated from dispatch time to arrival time. Anything skewed and prolonged is questioned.

Remember, the additional 2-3 minutes is possibility of hypoxia as well, and I don't particularly care to "race" to a call to make up that lost time.

R/r 911
 

Mercy4Angels

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we dont carry radios. just pagers. we call inservice when we get in the rig.
 

ReebTop

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Each person carries a portable, and we are toned out by central communication. Once the tone is dispatched, the Supv. assigns the responding truck and immediately one of the members should acknowledge and repeat the address and mark enroute. We cover over 800 square miles with 3-5 trucks, and assigned areas (if possible) so when the address is given, one will usually know if it is in their region or not.

Sure, they walk to the unit (which is less than 50') or at night time place jumpsuit on, but you mark enroute as as soon as tone is acknowledged and the information is received. The same way almost all F.D.'s respond, they don't wait around to go their engines.

I have worked in several EMS agencies, and have never been allowed to have an allotted "time limit" to get myself enroute. In fact I have disciplined employees for taking too long, with even them being fired. It has always been naturally assumed once the call is given one moves ASAP and goes and marks enroute. The response time is initiated from dispatch time to arrival time. Anything skewed and prolonged is questioned.

Remember, the additional 2-3 minutes is possibility of hypoxia as well, and I don't particularly care to "race" to a call to make up that lost time.

R/r 911

Fired? This is ridiculous. Precisely how are you dispatched? Do they just tone you and give you an address or do they send the full job to you? When I say 1-2 minutes, that's from the stated time of dispatch, which is generally from the beginning of the full message, which is the "code" (2 for BLS only, 1 for BLS + ALS), the location, the nature, the time, and our call number, followed by a repeat. Again, our dispatch time is when they start telling us all that. We have about a minute from that time to get in the truck and get moving. I don't call responding until I'm sitting behind the wheel and am certain the vehicle will move, because sometimes they just want to crap out on us. Hell, one of our trucks has to be left running or it simply won't turn back on without someone beating the stuffing out of the starter with a hammer. Because stating that you're en route when you really aren't is pretty much the same thing that I do, except I'm not lying. Where do you work that has such needlessly stringent policies? How often are we in situations where 45 seconds is the difference between life and death? I can confidently say that neither myself nor any of the other dozens of professional EMTs I know have ever been in that situation. In fact, if that's the case and the patient is circling the drain that fast, then there is likely little to nothing we could do anyhow.

Before you use that to claim that I'm negligent, lazy, or incompetent, I'm simply stating a matter of fact. Even in ideal situations, it is spectacularly unlikely to achieve success with treatment of critical patients. With properly applied CPR, defibrillation, and ALS medicinal interventions, for example, there is something like a 30% chance you'll bring the patient out of cardiac arrest. There is a significantly reduced chance once you move the patient. I realize it's dumb to argue over the internet, especially about varying company policy, but your assertions, that any policy other than "two breaths and you'd better be on the way" is inappropriate, are offensive. I'm sure anyone with half a brain could manage to call en route in about 15 seconds, but it certainly adds an unnecessary level of agitation to catching a job, which is already nervewracking (to a degree) to begin with.
 

Ridryder911

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All I can say is "hold your breath for 2-3 minutes" and then tell me it does not matter. I agree there is no reason to get killed enroute, this is reason for rapid deployment. Does your fire service stand around awaiting all the information ?

For as beating your unit to get it started, I would be the first to call the license bureau at the state and report it. Sorry, I've worked for shi*ty EMS before and never will again. Too much liability for me and risks for my patient's. Until, EMS attitude changes of preventive maintenance and upkeep then EMS is and should be considered a joke. Continuation of working for such an employer is only contributing to the problem.

As well, I usually work for a professional service that monitors and logs all radio transmission per seconds. Some have had GPS on board systems so when you mark enroute, your unit better be rolling in a few seconds.

My professional opinion is if you can justify the delay in court so be it, I sure would make an incident report & copy every time I had to "beat" my unit to start. Just because it was the EMS and the norm, does not eliminate you from responsibility and liability.

Good luck!
R/r 911
 
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ReebTop

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All I can say is "hold your breath for 2-3 minutes" and then tell me it does not matter. I agree there is no reason to get killed enroute, this is reason for rapid deployment. Does your fire service stand around awaiting all the information ?

For as beating your unit to get it started, I would be the first to call the license bureau at the state and report it. Sorry, I've worked for shi*ty EMS before and never will again. Too much liability for me and risks for my patient's. Until, EMS attitude changes of preventive maintenance and upkeep then EMS is and should be considered a joke. Continuation of working for such an employer is only contributing to the problem.

As well, I usually work for a professional service that monitors and logs all radio transmission per seconds. Some have had GPS on board systems so when you mark enroute, your unit better be rolling in a few seconds.

My professional opinion is if you can justify the delay in court so be it, I sure would make an incident report & copy every time I had to "beat" my unit to start. Just because it was the EMS and the norm, does not eliminate you from responsibility and liability.

Good luck!
R/r 911
I like how you take my figure of 45 seconds (the difference between your mandated time and mine) and stretch it to "2-3 minutes." I also would still like to know what environment it is that you work where all of the trucks are pristine. I work in a tightly packed urban population center in New Jersey. My agency covers two cities. We answer thousands of calls on a monthly basis with a "fleet" of 8 vehicles, two of which are designated transport units to give newbies something to cut their teeth on. That leaves us with 6 vehicles and that just so happens to be the number required to fulfill our 911 contracts. Given the fact that there is little to no money in 911 EMS, particularly for a private service attached to a private hospital that runs in the black by the grace of God alone, those 6 EMS trucks are all we have. We have 3 other vehicles which aren't in service (10 is an old piece of garbage that we've given up on, 4 was hit while en route to a call and flipped but should be back soon, and 11 has crappy electrical and a bullet lodged in the "C" of ambulance on the hood) and no capital to purchase new vehicles. It's very nice that you can ride the brand-newest stuff on the road, but those of us in the trenches in a state which has zero fondness for paid EMS make do with what we can afford. I don't like the fact that 12 requires beatings when it turns off, but such is the case, and what are we gonna do? Violate our contracts? Add to the workloads of the other crews while delaying patient care? If it will run, it runs, because there are no other options.

We too log our radio communications and they are reviewed by our Chief, along with our call reports and official time logs, to verify that we are holding to company policy and proceding in a timely fashion. However, we cannot afford a GPS system as yet, and given that the city (while heavily populated) is only 4 square miles, GPS is not absolutely required. As an aside, it bothers me that things like GPS systems and CAD systems are viewed mostly as a way to "make sure those damn EMTs are doing their jobs" and not primarily as a way to increase our safety in the field.

It greatly upsets me that you consider EMS a joke. Perhaps you ought to pursue a different career if you simply can't fathom us being taken seriously. It's not due to a lack of maintenance on our vehicles that we're a "joke," it's because we're the forgotten child of the system. Police and fire get top billing and EMS gets screwed. We're not glamorous enough, or not seen as heroic, or what have you.

I recommend coming down from your ivory tower from time to time to see what we mere mortals in the world of EMS have to put up with.

Also, my fire service is volunteer, so I can't speak to that as much as I can EMS. However, we recieve tones, county dispatches the location and the nature, we get to the station, suit up and call in service when we're rolling out the door. To do otherwise misinforms dispatch as to your actual disposition and confuses anyone who may be awaiting your arrival.
 

ffemt8978

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All I can say is that there IS a difference between acknowledging the page and going in route. To put yourself in route as soon as you receive the page, unless you're physically behind the wheel of your vehicle, seems like an obvious attempt to improve your response times for NIFRS and other reporting systems.

As far as "hold your breath for 2-3 minutes" goes, just how long do you think they're on the phone with 911 before you're actually paged?
 

Ridryder911

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What is amazing, is that nearly every EMS forum has a post about N.J. EMS system and the problems that it has, however; I have yet seen any article describing introduction of legislation of changing laws, or even EMS associations and organizations lobbying against the current situation.

I personally do not know what the real N.J. system is like, only from what I have heard and read from medics and basics that work there. Then yet again, from your previous posts, it just reinforces the speculations.

I don't work in an ivory tower, rather started in EMS nearly 30 years and have continued so in the field to make improvements and changes. My first ambulance was a converted bread truck, and low top station wagon and yes we we provided ALS in those antiquated units. Yes, I am very familiar of poor management and upkeep of EMS units, that jeopardize patients and staff. One night all three acting units broke down on one call.

Instead of whining and complaining, I took action and with others had legislation bill introduced into a Public Health & Safety Act that mandates EMS units be working at all times 24 hours a day. They are subject to spot inspection and if found dangerous, are subject to be fined or closed down. EMS personnel and even their units are expected to be able to provide safe and optimum care 24 hours a day, not doing so in legal terms is called negligible. The same idea and complaint of mine, not having a trauma center in my state. Instead of complaining, I went and obtained multiple degrees and experience to change such. After years as a full time trauma consultant and with other dedicated persons, we now have a Level I. So yes, change can occur.

There are successful EMS services out there than run half the calls and have more travel and distance than others and still succeed and even make profit. Some are even to place money as profit or reinvestment into the company to prevent such occurrences as you described. If you are not receiving at least 30-50% of your billing payments, then something needs to be investigated. The joke I describe is not of being funny, rather embarrassing that our so called profession has not yet taken action to become one. Embarrassing, that medics still has to tolerate such problems and do so without taking any action.

I am sure if that service lost it's contract, someone will take over. Possibly someone that can place more units and actually can operate without "banging on it" to get it to run. Your right, I see no humor in that at all. This is 2007, and patients deserve better and so does EMS personnel that depend on that equipment to respond and transport safely. Apparently, your management has never heard of risk management. Law suits occur frequently on equipment failure and poor response times because of such.

If your service gets treated like a step child, how much action has your service attempted to change relations? Does your fellow EMT's attend city council meetings, get to know representatives personally? Have you invited them to tour and possibly ride, demonstrating the needs?

The reason the P.D. and F.D. is popular because they are "essential" in community leaders eyes. P.D. is needed for protection and F.D. is needed for ISO ratings. EMS is a nice thing to have. It is the EMS responsibility to attempt to change that mindset.

So from one that has been in the trenches and even been in the "ivory tower" things can change, it just takes action and persistence, then continuation, no it is not easy. EMS always and will always have problems, it is our responsibility to meet those needs.

R/r 911
 

BossyCow

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Oh, come on Rid.... you certainly aren't suggesting personal responsibility for change? That would make complaining so much less fun!!!
 

Mercy4Angels

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seems to work fine for us, dont know what everyones problem is. i like that we are all BLS and ALS is from a different source (hospitals). mixing the two here now after so long would cause HUGE issues. the system works just fine for us in my town. BLS is never long to get on scene and I have a choice of 3-4 hospitals with MULTIPLE ALS units at my disposal.

like just last night i needed them for a patient with a heartrate of 167. they hooked him on a 12 lead and one said to the other "he's sinus" they gave him meds in the back of the rig to stop his heart and restart it sort of to reset it. kinda cool stuff. i was driving but my partner gave me the info after the run.
 
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CFRBryan347768

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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....[/QUOT

Ill take a big truck with flash lights and deal with BS calls=D
 
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