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Panel Proposes Setting Statewide Standards for EMS

NEWARK, N.J. -- Emergency workers who respond to 911 calls in New Jersey would have to meet uniform standards for training and credentialing under a bill proposed by a committee of EMS professionals.

Responding to a report released last year that described the state's EMS system as "near crisis," a committee of the State Emergency Medical Services Council has sent draft legislation to the state health department aimed at raising the professionalism and efficiency of EMS response.

"From Cape May to Newark, people who call 911 need to be able to expect the same standards and provisions," said James Pruden, director of EMS at St. Joseph's Regional Medical Center in Paterson, who helped draft the proposal.

The 500 or so volunteer ambulance squads that provide basic life support services in New Jersey - compared with professional paramedics or for-profit ambulance companies - work without state oversight or consistent standards.

The 171-page report released last fall by the state Department of Health and Senior Services warned that unless improvements were made, the future of volunteer EMS in New Jersey was at risk.

The draft bill would create standards that mandate response times, as well as require two volunteer emergency medical technicians on every ambulance responding to a 911 call. It would bring all emergency services under the jurisdiction of the state health department, while requiring all municipalities to make provisions for EMS service, just as they do for fire and police. The committee did not put a price tag on implementing the recommendations, now under review by state health officials.

Sen. Joseph Vitale (D-Middlesex), chairman of the Senate Health, Human Services and Senior Citizens Committee, said legislative hearings will take place early next year to reach a consensus before a formal bill is introduced.

"There needs to be discussion out in the open," Vitale said. "This is a big step, something we have not done before," he added, referring to past unsuccessful efforts to reform the EMS system.

The state's EMS system has long been a contentious political issue, with the interests of its professional and volunteer members often at odds. Last year's study - mandated by the Legislature - found an EMS system in disarray, with little or no state regulation, a lack of consistent standards and growing staffing problems that threaten round-the-clock coverage in many areas.

"There's no state oversight," said Dave Gruber, senior assistant state health commissioner, who oversaw the study. "We believe, as does the EMS council, that should change."

The review, conducted by an outside firm, made 55 recommendations to improve coverage. While the council's draft bill does not address each one, it does tackle what it considered the major ones.

In a white paper accompanying the bill, committee members - which included fire personnel, volunteer ambulance members, paramedics and emergency room doctors - wrote that response times in some parts of the state "have increased beyond levels considered reasonable."

"The failure of New Jersey's EMS system is not about to happen, it has already begun, quietly worsening each year," the white paper said, calling the collapse of the system "a public health crisis."

New Jersey's EMS system consists of more than 25,000 volunteers and professionals, including first responders, emergency medical technicians, paramedics, nurses and physicians. It is a two-tiered system of volunteers who provide basic life support services and paid paramedics based at hospitals who provide advanced life support, such as cardiac defibrillation.

Each year, nearly 14,000 residents are denied advanced life support care because there aren't enough paramedics, the committee said.

"Everybody has been making a push for better patient care," said Christopher Rinn, a vice president of the New Jersey Association of Paramedic Programs, who was on the subcommittee.

Sue Van Orden, president of the New Jersey State First Aid Council, which represents most volunteer squads, said staffing ambulances with two EMTs would be "quite difficult." Even though squads would have until 2012 to fully comply, the number of volunteers available to work on ambulances has been shrinking and probably will continue to dwindle.

"We are not doing a steady shift of 12 hours," she said. "We're doing a scatter-scramble system in which we are responding when the call comes in, not sitting around in a building waiting for the call."

Some squads may respond to only one call a day, she said, while others are much busier.

"It is better to get to someone in 10 minutes with a driver and EMT than have someone wait 40 minutes just to have two EMTs," she said.

The East Brunswick Rescue Squad, which responded to more than 4,000 calls last year, allows volunteers who have trained in CPR and taken a standard first aid course to work on an ambulance under an EMT's supervision. These trainees also must be working toward an EMT certification.

Mary Kerslake, president of the East Brunswick squad, said she worries that mandating uniform standards would make it hard to keep such volunteers.

"To be quite honest, if I was offered a choice between a newly certified EMT and a first-aider who has been riding on an ambulance for a year, I would take the first-aider because they know what they're doing," she said. "The EMT would have book knowledge, but it's the same as a doctor without having any hands-on experience with patients."


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