Administration and Leadership, Cardiac & Resuscitation, Patient Care

Specialized EMS Crews in Jersey City Improve Patient Care

Issue 2 and Volume 37.

This issue features an in-depth profile of the Jersey City (N.J.) Medical Center EMS (JCMC EMS) system—a high-call volume system that was in need of redesign and optimization seven years ago; one that had not advanced its equipment and processes with the times. Its dedicated crews provided the best care possible with the equipment and resources they had in America’s most ethnically diverse city, but they knew they could do better and accepted massive changes implemented in their system.

Their success is an example of what can be accomplished when a hospital administration puts trust, finances and support behind an EMS management team. And an example of what can be accomplished when the crews providing the care on the streets are patient, understanding and supportive of change.

“Patience” is an important word because the changes began in 2005 and are still underway. But the patience and dedication of the crews is paying off because, within the past 18 months, JCMC EMS achieved what no other system in America had achieved: accreditation, certifications and national recognition by five of the most rigid and challenging organizations in the EMS industry.

When I visited JCMC several years ago, I was intrigued with their processes and impressed with the attitude of the providers running the calls. I was allowed full access to their system, and the crews welcomed me along on their calls each time I visited.

So I decided to follow JCMC EMS closely and team up with consultant Jonathan Washko to develop an article that would present the processes followed to revamp the Jersey City system. It’s a good case study that many EMS systems, struggling to improve, can benefit from.

I had never been to Jersey City before, only passing by its freeway exits on my way to Newark airport. My images of this diverse city were much like those shown on the opening of the Sopranos as Tony Soprano drove across the bridges of New Jersey and New York and all you could see were industrial buildings, smokestacks and water.

But I discovered several things through my experiences in Jersey City that I want to share with you.

First, when I rode with the crews and supervisors on multiple day and night shifts, I discovered that Jersey City was a vibrant, redeveloping city, a city that’s home to the Statue of Liberty, Ellis Island and beautiful Liberty State Park, which offers visitors the most magnificent waterfront views of New York City across the Hudson River.

I also discovered how well the BLS and ALS crews worked together as a team, had genuine respect for their patients, and trusted their managers, supervisors and communications center to “train them and aim them.”

There’s a lot of merit to that “team” thing because the deployment of resources, and the resuscitation results, are clearly better when a more focused team approach is used. The combined first response engine/ALS ambulance crew approach works well in many systems, but there are clear improvements seen when everybody on a critical case specializes in EMS and is truly engaged in all phases of care and resuscitation.

The specialized BLS and ALS approach used in Seattle, Boston and Jersey City is what I’m talking about when I refer to the focused team deployment model, systems where ambulance EMT-specialists respond in tandem with a few ALS paramedic-specialists positioned strategically throughout a system.

In these BLS/ALS ambulance systems, there’s roughly double the number of BLS to ALS ambulances deployed at any time. In Jersey City, the deployment is based on historic call volume and a demand analysis tool built by Washko and Associates.

In Jersey City, this means that almost every critical case gets a first response engine with an AED from Jersey City Fire Department (with a crew of four that’s trained by JCMC EMS staff), a JCMC BLS ambulance (with two EMT specialists) and two paramedics in one of only a few strategically placed ALS units that manage a high volume of critical calls each shift. That means that these high-acuity cases get a coordinated “all hands on deck” team of eight, and cardiac arrests receive mechanical CPR, quick EZ-IO establishment and therapeutic hypothermia in the field.

If you don’t think all this makes a difference, look at the results. After redesign and implementation of this team approach, return of spontaneous circulation rates jumped from 18% in 2005 to an incredible 46% in 2011, with 17% of their patients discharged neurologically intact from the hospital. That’s on par with results in the Seattle Fire Department and Boston EMS systems.

Why are they so similar? In my opinion, it’s because of how they deploy and use their BLS/ALS resources (lots of sharp BLS ambulance teams), how they approach patient management on scene and the way their crews work together in a unified, almost choreographed manner. These systems triage and accelerate (or peel off) resources as necessary. It’s a deployment approach worth studying. JEMS

This article originally appeared in February 2012 JEMS as “The Crews Are Key: Specialized EMT & paramedics team deployment yields best results.”