Solution to NJ EMS problem?

[scratrat]

3. Keep the ALS Hospital-Based, with dual-medics. With how corrupt county governments in NJ are, I really don't wanna work for them.

3.a Keep the two-tiered system. Frees up ALS for ALS patients.

4. Hold the crappy EMTs and Paramedics accountable for their actions.

4a. Hold the EMS organizations accountable for not keeping the ambulances staffed 24-7. NJ is the most densely populated state in the nation; there is no reason that this can't be done. If it means regionalization of BLS units and providing paid staff, oh well. There are other hobbies out there.

5. Teach the EMTs not to be ALS-dependent for everything. This requires education. If anyone pulls the "well, I'm a volunteer card," take their EMT card away.

Now I wanna see how many people I pissed off.

You didn't piss me off, but I have a couple comments. I feel slightly entitiled since I worked there and had first hand knowledge. I'll reply to your numbers above.

3./ Partly agree. I like having a medic partner instead of an EMT. But the county thing has it's benefits too. I get to retire in 25 years with 75% of my best 5 year average. Can beat that. Jersey was, well, you're on your own.

3a./ Can't agree at all. I came to an all ALS system, but we treat everything including BLS, which can suck. BUT I cannot tell you the number of times I had to hold BLS's hand because of some stupid crap, that because of some stupid reason (age, history, etc), I couldn't leave, but the pt would have been fine to go BLS. Then the MI or cardiac arrest goes out down the street and the closest medic unit is 25 minutes away, if they are even available. So I can't see your logic there. Here, every ambulance is ALS, with one medic and an EMT. Every call is guarenteed a medic unit. A little over effective, but effective. At least if something goes wrong, you don't have to call a medic unit. Can't see your logic on that one. Sorry bud.

4./ THANK YOU!!!!!!!!!!!!! That state could literally care less if you kill someone. You MIGHT lose your job, but the state never investigates. This partly lies in the problem that ER's and squads never report them. Like medics who can't operate equipment and effectively watch a pt die. Someone got fired, but why was this never brought to the States attention by the employers or the ER? Why was this person still allowed to practice as a medic? No intervention at all by the state. That's insane.

4a./ Again, 100%. If they can finance police and a mayor who make more money then we do most of the time, they can finance EMS. Everything down here in Florida is either county or city based. Barely any volunteers. And, I think (but don't quote me), every county has paud 24 hour EMS. Maybe remote in some places, but it's there.

5./ Again, 100%. You worked in Jersey once too right? So you performed a SNR (services not rendered) or triage to BLS or whatever you called it when you evaluate and release the pt back to BLS? I think that when they say, "WE were going to recall you but since you're here...", their squad should get a bill for $250.00 for an ALS exam. Not the pt. When I left, I believe they were toying with the idea of billing pt's for these calls. They didn't request us, BLS did. If BLS can't figure it out, charge them a fee. That'll curb it. Probably create another firestorm where they'll be afraid to call, but at least they will only do it when they know it's warranted.

I'm done now. I just had to comment. Sorry dude.

[mediccjh]

You didn't piss me off, but I have a couple comments. I feel slightly entitiled since I worked there and had first hand knowledge. I'll reply to your numbers above.

3./ Partly agree. I like having a medic partner instead of an EMT. But the county thing has it's benefits too. I get to retire in 25 years with 75% of my best 5 year average. Can beat that. Jersey was, well, you're on your own.

3a./ Can't agree at all. I came to an all ALS system, but we treat everything including BLS, which can suck. BUT I cannot tell you the number of times I had to hold BLS's hand because of some stupid crap, that because of some stupid reason (age, history, etc), I couldn't leave, but the pt would have been fine to go BLS. Then the MI or cardiac arrest goes out down the street and the closest medic unit is 25 minutes away, if they are even available. So I can't see your logic there. Here, every ambulance is ALS, with one medic and an EMT. Every call is guarenteed a medic unit. A little over effective, but effective. At least if something goes wrong, you don't have to call a medic unit. Can't see your logic on that one. Sorry bud.

4./ THANK YOU!!!!!!!!!!!!! That state could literally care less if you kill someone. You MIGHT lose your job, but the state never investigates. This partly lies in the problem that ER's and squads never report them. Like medics who can't operate equipment and effectively watch a pt die. Someone got fired, but why was this never brought to the States attention by the employers or the ER? Why was this person still allowed to practice as a medic? No intervention at all by the state. That's insane.

4a./ Again, 100%. If they can finance police and a mayor who make more money then we do most of the time, they can finance EMS. Everything down here in Florida is either county or city based. Barely any volunteers. And, I think (but don't quote me), every county has paud 24 hour EMS. Maybe remote in some places, but it's there.

5./ Again, 100%. You worked in Jersey once too right? So you performed a SNR (services not rendered) or triage to BLS or whatever you called it when you evaluate and release the pt back to BLS? I think that when they say, "WE were going to recall you but since you're here...", their squad should get a bill for $250.00 for an ALS exam. Not the pt. When I left, I believe they were toying with the idea of billing pt's for these calls. They didn't request us, BLS did. If BLS can't figure it out, charge them a fee. That'll curb it. Probably create another firestorm where they'll be afraid to call, but at least they will only do it when they know it's warranted.

I'm done now. I just had to comment. Sorry dude.

No need to apologize. I came from the EMT-Medic system in PA, and it has its pros and cons. I currently work f/t in Jersey, and I like having a dual-medic truck. I also worked NYC which was dual-medic, and I enjoyed it. Don't get me wrong, I didn't mind having an EMT as long as he/she was smart and could keep up with me (my last 2 f/t partners were able to and are now both medics), but I hated having some stupid EMT with me where I was basically working by myself on a crictical patient.

As far as number 3, I do have a state pension (crap, I just gave away where I work). The reason I prefer hospital-based systems is because if it's a good system with good medical control, the possibilities of paramedicine are limitless, with progressive "protocols" and more importantly, accountability for crappy providers.

[scratrat]

True.

The hospitals will fire you, but still, they never report anyone to the State, or at least it's very infrequent. That's another problem I guess.

[Eng542ine]

Mediccjh...

Point-by-point here...

1. I could not agree with you more... Maybe we can have them all just deploy themselves to Liberty State Park for an undetermined period of time...??

2. AMEN!!!

3. I somewhat agree... On the medical side of things, the hospital is the place for us... BUT unless you're at UMD or another state facility, the pension is more myth than reality and Lord knows being part of a hospital also means that if your signature doesn't end in "RN" or "MD" they really don't want to pay you much more than housekeeping... Oh, and as far as corruption in NJ goes, the counties are only practicing to become the state's equal... Just ask anybody with time in Police and Fire Retirement System about that one... they took it hard and dry...

3a. I will buy into this whole-heartedly if "4a" were to become a reality... IF...

4. AND 4a. Yet another AMEN!!!

5. Agreed... Or fine the dispatch center who confused their Guide Cards with their Tarot Cards and just determined that the job "sounded ALS"... and never bothered to tell anyone the Medics have been requested...

My additions...

6. Take the Epi-pen AWAY...

7. NEVER EVER, EVER think about BLS LMAs or CombiTubes... Dear God, I've seen the damage they can do with an OPA...

8. Ok... give them glucometers... Why not? Worst case... they prick their own finger... Imagine, no more "he's got a diabetic history"

9. Annual skill and equipment proficiency exams... so they know how to work the $4000.00 DeWalt powered electric "I'm a lazy-ass" cot that they put into their brand-new shiny "rig"... Not to mention so they know how to treat the patient strapped to that cordless drill on steriods once they finally get them into the "rig"

10. BAN THE WORD "RIG"!!!

Anyone with more input or suggestions???

[mediccjh]

9. Annual skill and equipment proficiency exams... so they know how to work the $4000.00 DeWalt powered electric "I'm a lazy-ass" cot that they put into their brand-new shiny "rig"... Not to mention so they know how to treat the patient strapped to that cordless drill on steriods once they finally get them into the "rig"

10. BAN THE WORD "RIG"!!!

I think I just fell in love with you, even though you're a volunteer.

[Medic2588]

Mediccjh,

Just one correction on what I consider an otherwise perfect Manifesto:

They do hold EMTs and Paramedics accountable for actions and the State does investigate complaints. HOWEVER: you REALLY have to screw up and kill someone in an impressive way (do we remember the Trenton incident with the head injury patient?). There just needs to be a much better way to follow up on complaints, such as more staffing in DHSS.

Otherwise, preach on brother!

Devin

[678 Responding]

Hahaha, this is great. I have to agree 10000000% with all of this. Burn the First Grade Council to the ground!!!! As for holding people accountable, isn't that what everyone else does? I mean, if someone pokes themselves in the eye with a spoon, we don't give them a spoon again, right? hehehe. But as they say, you cant cure stupid. Please please, keep on going people. I'm just waiting for the FAC jolly volley people to come on here and start whining. I'm biting the bullet for a little bit, then plan on leaving the state some way or another. There are just way too many corrupt, medically conservative minded, politically motivated, self absorbed free loading pricks in this cursed state for anything that would benefit people in a good way to get done. But like I said, keep on going people.

[Medic2588]

There are some of us who are trying to change things for the better. I would say thanks to the Task Force EMS is much better prepared for potential specific events (terrorism on the Port Authority trains, maritime emergencies, etc). But even then we meet with resistence from several organizations in the state (I'll be politically correct and leave names out).

Its frustrating, but I'm convinced every state has their problems. Jersey just seems to be more vocal about it.

Devin

[Eng542ine]

Medic2588...

You know... I find it heart-warming that we are prepared for catastrophic events which may never occur in this state... YET, they still refuse to change the laws necessary so as to guarantee a BLS ambulance on everyday jobs!!!

3- Step solution--

1) MANDATE that municipalities provide EMS

2) REGULATE the EMS that is provided... training/equipment/response times

3) INVESTIGATE problems and correct them as they occur

THEN you can worry about a task force to respond to the glory-jobs...

Talk about backwards priorities... we can't make peanut butter and jelly sandwiches BUT we're gonna invest in a gourmet kitchen... wtf... typical NJ... who is the "task-farce" buying their equipment from and whose cousin IS he???

[Asysin2leads]

I think that's because the state feels that we are volunteering and should not have to pay $500 for an EMT class on top of giving up our time for free. I'm a volunteer EMT and I take about 20-25 calls a month, so I don't think that money was wasted. With your logic we should pay for doctors and nurses to go to school too, I mean after all they're going to do this for their career. You have to spend money to make money. I think that volunteers are even sometimes more dedicated then the paid people because when you go paid you think of it more as a job, not treating real people with real care and compassion. But that of course doesn't apply to everyone. I don't really have complaints about EMS in NJ, but we have quite a few rigs and 5 ALS providers within 10 miles of us, so we can pretty much get things done.

As my esteemed colleague Mr. Dustdevil pointed out, many communities do in fact provide incentives and grants for doctors, nurses, and even paramedics to go to school. You see, if you take money and give it to people to actually go to school and learn someting, rather than throw it away on the bitchin' ambulance with the custom airbrushed eagle on the side, you not only get trained, qualified people seving their community, but also you get some of that money back when you get to get increased income tax from their higher salaries, or you get money back from them spending their increased money in your community at local business and such if you don't believe in the whole income tax route (that one there was for you, Dust).

So, anyway, ummmm, yeah, if you bothered to read any of the other posts on this subject, you would have read some intelligent and thoughtful articles on why this notion of volunteers being some how more dedicated than paid, professional providers is complete and utter crap. All you volunteer squads in NJ are doing is causing countless numbers of cardiac victims to lose myocardial tissue, or have trauma victims suffocate in their own blood while you desperately try to BVM them, all because ALS is stretched paper thin in New Jersey, and all because the State of New Jersey doesn't want EMS, they want First Aid Squads. But hey, so long as you get to be heroes, you MUST be doing good, right?