Possibly the most screwed up EMS system in the country...

[Asysin2leads]

All right, all right, class, quiet down, quiet down, we've got a lot to cover today.

Many people have wondered, how screwed up can an EMS system get? Washington DC's EMS system has taken many well deserved hits, but for sheer lunacy, I really think the shore area of New Jersey can't be beat.

The Jersey shore area is a fascinating place to observe how towns must cope with the rapid growth of a population in terms of infrastructure, and as many cynics may note, how to really screw things up.

Up until very recently, the Jersey shore area was made up of small rural towns along the seashore, which relied mainly on seasonal tourism and fishing for its revenue. However, starting in the mid 1990's, population growth rapidly expanded due to the rising prices of homes in the New York metro area. The middle class that once occupied Queens and Brooklyn got pushed down the shoreline into a different state. In addition, because apparently wherever there is sand there is old people, retirement communities were built greatly increasing the population, and also of particular note, a population that would have the greatest chances of needing, and also benefiting from, Emergency Medical Services.

However, as mentioned before, the infrastructure, particularly relating to EMS, did not adapt to a rapidly growing population. Despite the tax bases and population sizes of many of the townships in New Jersey (not just the shore area), they are still served by in large by volunteer squads. Now, when I say volunteer squad, maybe you think of your local friendly volunteer ambulance guys doing a car wash or a bake sale to raise money for your small town. I can tell you, this is not the case with most of these squads. Granted, some of these towns and he related squads are quite small and do not have much money, but for every tiny town that has a problem getting a volunteer ambulance on the road, their is a volunteer service from the adjoining town that is purchasing a new $500,000 ambulance. When you don't pay your employees, the equipment you can buy with available funds becomes very plentiful. The amount of money many of these volunteer squads pull in from donations is really incredible. Of course, all of these volunteer services do not have anybody higher than an EMT-Basic working on the ambulance.

Advanced Life Support on the other hand, is still woefully short staffed due to the monopoly that a handful of Advanced Life Support providers have on the state, which is held in place by a rather asinine piece of legislature known as a "Certificate of Need". Let's say hospital Q wants to run some medics out of its hospital. It has to demonstrate first that its service area is not adequately met by the ALS service already in place. OF course, you have to demonstrate this to a politician, who is usually none to bright and more sympathetic to large corporations eager to keep a hold on its ALS contracts. A recent news piece interviewed the spokesmen for one of these corporations said "The monopoly better serves the public because competiion would drive the costs up." No, he really said that. Another popular reply was "The monopoly is good because otherwise you'd have multiple units fighting over the calls." Now, surely, multiple units fighting over the calls would be a bad thing, but then again, if my loved one was having the big one, I'd rather have multiple ALS units enroute and take whoever got there first rather than waiting for 20 minutes while my loved one succumbs to myocardial ischemia in the $500,000 ambulance.

If that wasn't bad enough, we'll look at the area I first mentioned, the shore area. As mentioned before, the population is growing rapidly, so much so that even the volunteer squads can't meet the demand, particularly in the day time. Because of this, several towns have instituted paid BLS crews during the day time, run as part of the police department. Now, unlike medics, local cops in Jersey are paid very well, and they pay the EMT's on par with the police officers. One of the EMT's who work for one of these services I talked with mentioned he makes around $32.00 an hour. That is far more than I make as a medic here in NYC (which doesn't say much, but anyway), but worse than that, its much, much, much, more than a paramedic makes in New Jersey. Before you try moving and getting one these EMT positions, you should know that getting one is harder than getting into Harvard. To get any sort of well paid cushy job in Jersey, you need at least three uncles on the town council and one cousin who is a cop, at least.

So where does this really interesting mix of volunteers, monopolies, and really nice EMT positions get us? Basically, if you get in a car wreck in Jersey, you'll have some really cool toys and people dying to use them at your side. Just hope you don't need any type of pain management, advanced airway management or IV therapy, because getting a medic to your side might be a little tricky. I actually know a lot of medics in Jersey and a lot of them are great guys who try and do their best with what they're given, but you can imagine if you're treated like crap and the EMT's make more than you you're not gonna last long.

Lastly, if you live in a system like this, pray you don't find yourself in the the unfortunate position of the man who a doctor friend of mine told me about who was brought into the ER while he was attending in New Jersey. The man had an internal defibrillator and a heart condition to go with it. For whatever reason he went into a refractory V-tach/V-fib. The medics took about 20 minutes to get to him, gave him some lidocaine, and he went into a NSR, and was transported without incident. Unfortunately, during those 20 minutes, his internal defibrillator worked very, very well, and delivered electricity to him and the rest of his body no less than 150 times. To most of the general public, an ambulance is an ambulance, its the thing with lights and sirens that takes you to the hospital. This is why New Jersey's system pretty much stays the way it is, because the public would rather have a ride in $500,000 ambulance that looks pretty than in a less cushy ambulance with guys who have slightlly different patches and some more equipment. Then again, to the guy who laid there getting shocked from within 150 times waiting for appropriate care, maybe the difference between BLS and ALS and how exactly his tax money is spent now means something. Class dismissed.

[Ridryder 911]

Very good points Asysin2leads, glad to see you back. I agree, any volunteer agency that is only there for the pleasures of those that serve, not the necessity of the community or location. As well add any EMS that has no "drive" to provide competent care and professional treatment to their employees.

R/r 911

[678 Responding]

Asysin, I can relate 10000% to this, as I live in Southern NJ, not the shore, but close enough. Where I live there is only ONE, yes people only ONE ALS service in the county with roughly 6 units on the road at a time, serving approx 510,000 people everyday. Now this might not seem like a lot of people, but add 2 major cities, and many towns spread across a decent area, then this presents a problem. All too often we have had ALS units come in from the next county over to cover all the ones already tied up. The system is ass backwards, as only a hospital is allowed to run a MICU program, and you are only allowed to petition to start a program, as Asysin noted with the help from a politician.

This state, for some reason, has a grudge against pre-hospital providers, ever since the start of EMS in the state. EMTs in certain places make way more than medics do, and they wonder why there is such a hardship in finding medics to staff the trucks.

As for the volunteer squads, even though I am a member of a volunteer squad on the side for "shits and giggles", I am beginning to wonder the value of them. Time after time, I hear an "All Call" get toned out, or even 2 squads at a time, because after all, one of the two will respond. This scares me, as 8+ minutes before a squad can even respond let alone arrive on location with BLS services to work a code. Its a sad situation, the state is corrupt from the bottom up. The law makers and politicians don't care about what service people are getting, only what the hospital monopolies are making and what they can shove in their pockets from the lobbyists.

I'm sorry, but this is a PERFECT example of how NOT to run an EMS system, unless that is if you don't care about your citizens and rather rake in the profits from your own monopoly without competition and unfair rules and regulations

[mediccjh]

678, you must be talking about Virtua.

The vollies in Jersey need to go. The First Grade Council needs to go.

I'll stay in Newark, thank you.

[Asysin2leads]

Yeah, I should qualify, the EMS in Newark, Jersey City, Elizabeth, I'm not talking about them. Those guys are cool, and they go through shit that would turn a lot of us white. And anybody who responds to areas like Camden, parts of Atlantic City, Trenton for that matter, hell, even Asbury Park, hats off to them. I know what 678 is referring to in terms of toning out calls. I speak from experience about this issue because I used to work for a company that did 911 back up for a township in the area. They'd give it to the vollies, then if no one responded, they give it to us. So it was like "Attention available squads, abdominal pain XYZ Avenue..." No response, we'd get it. Then "Attention available squeads, chest pain, QPR Street..." No response, we'd get it. But somehow, magically, When it was "Attention available squads, cool looking motor vehicle accident, QPR and XYZ Street," like squads would fall out of the sky, I swear. Anyway, don't run EMS that way. Peace out.

[rescue25]

Just as a sidenote, New Jersey does not allow volunteers to be ALS providers, correct? I thought I read that when looking into reciprocity with NJ.

[678 Responding]

Just as a sidenote, New Jersey does not allow volunteers to be ALS providers, correct? I thought I read that when looking into reciprocity with NJ.

Correct, there are MANY BLS volunteer providers, but all ALS must be PAID and HOSPITAL based. No if ands or buts.

[Dustdevil]

Correct, there are MANY BLS volunteer providers, but all ALS must be PAID and HOSPITAL based. No if ands or buts.

Ooooooooh! Something I actually like about New Jersey! I never thought I'd see the day!

But Springsteen still sucks. :wink:

[EMT001]

Yeah, I should qualify, the EMS in Newark, Jersey City, Elizabeth, I'm not talking about them. Those guys are cool, and they go through Ca Ca that would turn a lot of us white. And anybody who responds to areas like Camden, parts of Atlantic City, Trenton for that matter, hell, even Asbury Park, hats off to them. I know what 678 is referring to in terms of toning out calls. I speak from experience about this issue because I used to work for a company that did 911 back up for a township in the area. They'd give it to the vollies, then if no one responded, they give it to us. So it was like "Attention available squads, abdominal pain XYZ Avenue..." No response, we'd get it. Then "Attention available squeads, chest pain, QPR Street..." No response, we'd get it. But somehow, magically, When it was "Attention available squads, cool looking motor vehicle accident, QPR and XYZ Street," like squads would fall out of the sky, I swear. Anyway, don't run EMS that way. Peace out.

Asysin:

I know exactly what you are talking about. I work for one of the paid squads outside of Atlantic City. I cannot tell you how many times we have to send one of our duty trucks into a volunteer town because they cannot get a crew out for an abdominal or chest pn. call. Yet somehow, when the MVA goes out 5 minutes later, they have a crew.

Similarly, because the coverage area of each ALS unit is so large, they normally get recalled before they can get on scene. As a result, a majority of their day is spent just driving around the county.

Fortunately, most of the BLS squads (in the bigger townships and cities) are either already paid or are on the way to being paid.

[Dustdevil]

I cannot tell you how many times we have to send one of our duty trucks into a volunteer town because they cannot get a crew out for an abdominal or chest pn. call. Yet somehow, when the MVA goes out 5 minutes later, they have a crew.

This is not just an indictment of volunteers. It is an indictment of basics.

After they get past the initial rush of graduating and thinking they are prepared to save lives, basics soon realise that the ugly truth is they aren't prepared for anything more than first aid. The realisation kicks in that there isn't a thing they can do for nearly ninety percent of their patients except drive them to the hospital. They get bored. Sick calls isn't what they paid $500 dollars for EMT school for. They signed up for the action they saw on "Turd Watch" and now they feel cheated. And they simply don't want to be confronted with patients who require something that they cannot provide. Nobody likes feeling helpless. It causes burnout to set in very quickly. So they just don't respond at all unless they think they'll get a chance to bandage or splint, which is about all they are good for.

Organisations should watch the statistics and follow the trends. Those who are skimming should be dismissed immediately.

And, of course, idiots like McGreevey and his corrupt cronies aren't smart enough to figure out what they are doing to their state with such lunacy. And they're too afraid of stepping on the toes of the good 'ol boys who run the volunteer monopolies in the state and have political pull. Why in the world anybody would choose to live there is beyond me. But I guess it beats them all moving down here. :?