New Jersey's EMS system, a lifeline for hundreds of thousands of people each year, is in a "state of near crisis" and requires an urgent, fundamental overhaul that should include the creation of a new state division and the transfer of EMS responsibilities to cities and towns, a long-awaited report says.
More than 18 months in the making, the independent report describes an emergency medical services system in disarray, with little or no state oversight, a lack of uniform standards for training and growing manpower problems that threaten round-the-clock ambulance coverage in some areas.
Senior Assistant Health Commissioner David Gruber, in a conference call with members of the state's EMS community yesterday, went even further in characterizing the system's troubles.
"Our basic core principle is, unless we do something, the system is going to collapse," Gruber said.
The Legislature ordered the EMS assessment with a vote in January of last year. At a cost of almost $300,000, the state Department of Health and Senior Services hired Tri Data Corp. of Arlington, Va., to conduct the review.
Health officials had planned to release the report in the next few weeks, after first circulating it to major stakeholders in the debate. They accelerated that timetable yesterday afternoon, posting the document on the Health Department's Web site, after learning The Star-Ledger had obtained a copy.
The 171-page page report paints a grim portrait of the EMS system, describing it as a fragmented conglomeration of squads that have varying levels of training and equipment and are so short-staffed they're hard-pressed to keep pace with the more than 800,000 emergency calls they receive each year.
An internal Health Department summary of the findings warns that without immediate action, "the state will no longer be able to guarantee the responsive pre-hospital and trauma care necessary to avoid death or serious impairment and disability." The Star-Ledger obtained a copy of the summary.
The report includes 55 recommendations, some of them minor tweaks, some of them profound changes certain to invite intense debate and, perhaps, spirited opposition.
Among the major recommendations:
The state should create a Division of Emergency Medical Services, to be headed by an assistant commissioner, that would have oversight of the nearly 25,000 emergency medical technicians and paramedics who work in New Jersey. Currently, the state has no authority over volunteer squads, which make up the bulk of New Jersey's ambulance corps.
The existing Office of Emergency Medical Services would be folded into the new division, which would create uniform standards for training and equipment. Three new regional EMS offices would oversee activities in the north, central and southern parts of the state.
Lawmakers should require municipalities to shoulder the responsibility for EMS service, as they now do for police and fire departments. The report does not address the subject of who would pay.
The state and the New Jersey State First Aid Council, which represents about 18,000 volunteers in 398 squads, should encourage squads to consolidate in some areas.
EMTs and paramedics should be permitted to join the fire and police pension system, sweetening the pot for a group considered generally underpaid and perhaps persuading more people to make emergency services a career path, easing the shortage of workers.
The state should create new standards that mandate response times for ambulances.
The state should continue to use the State Police and three private companies to ferry gravely injured patients to hospitals by helicopter, but it should take better care to send the closest available helicopter to a scene. Private carriers complain dispatchers favor State Police helicopters even when they are farther away.
At the same time, the state should suspend or revoke the licenses of companies that "self-dispatch" to scenes, a response to reports of "air wars" and patient-poaching.
The report notes that to fix the EMS system, the state will have to invest in it, though it offers no dollar figures.
The cost of an overhaul - and particularly the recommendation to shift EMS responsibilities to municipalities - emerged as one major worry yesterday.
"Obviously, EMS is very important for residents, but the cost involved would always be a concern," said Deborah Kole, a staff attorney with the New Jersey League of Municipalities, who had not seen the report. "Any increase in costs to municipalities that is mandated ultimately falls on the taxpayers."
Volunteer squads, too, worry about the price of meeting state mandates to upgrade equipment or training.
Sue Van Orden, president of the State First Aid Council, said she was concerned that basic life support providers - the EMTs she represents - will not have a say in shaping the new system.
"We have a feeling this was all about power and making sure Department of Health employees have jobs in the future," she said.
Gruber, the senior assistant health commissioner, told members of the EMS community during yesterday's conference call that no decisions have been made.
"There is no formal plan right now for what we intend to do," he said. "The feasibility of the recommendations will have to be assessed."
Changing the system is no sure thing. Similar recommendations that were made several years ago by a blue ribbon panel of the state EMS Council met a dead end.
"It's going to take political will," said James Pruden, a former chairman and current member of the State EMS Council, an advisory panel to the state health commissioner. "Very strong political constituents will argue against these recommendations."
State Sen. Joseph Vitale (D-Middlesex), the chairman of the Senate Health Committee and the sponsor of the legislation seeking the EMS assessment, said there will no doubt be "turf battles" as the state moves forward with reform.
He also questioned the need for a new state division and the regional offices that would serve under it, saying it would create "a whole layer of bureaucracy."
Vitale said he believes some of the report's recommendations will be accepted, while others will be rejected.
"It's going to be a long process," he said. "We have to work through it."Staff writer Susan K. Livio contributed to this report. A copy of the report can be found at www.state.nj.us/health/.