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Proposed Bill Would Put All EMTs Under State Control

Establishing a single professional standard, advocates argue, would guarantee that all patients receive a uniform level of care.

The Senate Budget and Appropriations Committee has passed a bill that would hold all of the state's emergency medical services -- including EMTs -- to a single professional standard. It would also put the New Jersey Department of Health in charge of all EMS statewide.

The proposed measure changes the status quo in several ways, requiring, for instance, that volunteer EMTs be licensed and that they pass background checks.

Backers of the bill (S-1650) say it "puts the framework in place so that we can create one standard of care across the board for patients throughout New Jersey," according to Andy Lovell, chief of the Gloucester County Emergency Medical Services.

Nevertheless, the proposed legislation has drawn the ire of some legislators and -- more importantly -- the fraternal order that represents EMTs across the state.

Ed Burdzy, executive director of the New Jersey State First Aid Council (NJSFAC), an organization representing 320 volunteer ambulance squads, said that the council believes the bill would put the "squeeze . . . on volunteer squads," making it easier to replace them with paid professionals,

Burdzy also takes exception to the main thrust of the law, arguing that it is inherently unfair to hold volunteer squads statewide to the same standard.

He raised other concerns, such as who pays for the licensing and background checks, and asserted that the state can't keep up with the background checks it is currently processing. Adding some 27,000 EMTs into the mix would swamp the system.

The bill, cosponsored by Senators Joseph Vitale (D-Middlesex) and Stephen Sweeney (D-Cumberland, Gloucester and Salem), is revised version of one that Gov. Chris Christie vetoed in January, kicking it back to the legislature for more study. It still must be approved by the entire legislature. The corresponding bill in the Assembly is A-2463.

The Unifying Principle

For Frank Carlo, deputy chief of the Montclair EMS, the best part of the legislation is that it establishes a uniform set of regulations for all care providers, from emergency medical responders to paramedics.

"It wouldn't matter what part of the state you were in, you would know that you were getting the same care regardless," said Carlo who is both a volunteer and a career EMT.

Vitale sees another benefit to the legislation he cosponsored. "[P]roviding some continuity and oversight and organization helps us get a better understanding of where we may need some of our volunteers and paid personnel," he said.

But Joseph Pennacchio (R-Morris), one of four legislators who voted against the bill, said that if passed, it would create another layer of bureaucracy.

"I'm conservative. I believe the best government is local government. The further away government gets from people, the less responsible, the less accountable it becomes, and the more expensive too," he commented.

Burdzy has another take on the measure, maintaining that it grants the Commissioner of Health extraordinary powers.

"If she [Commissioner Mary O'Dowd] determines a squad, be it paid or volunteer, does not meet standards she sets, then they can be removed and a new squad put in, without consultation with the municipality they are serving," he said.

Burdzy pointed out that in some rural areas it can take 12 to 15 minutes to reach the most distant part of the coverage area. He noted that if the commissioner requires that a squad reach any patient within nine minutes, she would have the authority to remove the squad and put another in its place.

"In rural areas [a nine-minute response time] would increase the number of facilities and ambulances needed," he said. "We believe there are more prudent ways to address problems which may currently exist in the emergency medical service system."

Burdzy said that the NJSFAC supports Christie’s conditional veto of last session's A-2095/S-818, calling it "reasonable and prudent."

Licensing EMTs

New Jersey's EMTs and paramedics, volunteer and paid, are currently certified by the DOH's Office of Emergency Medical Services (OEMS)

Certified, but not licensed -- and that's an important distinction to Lovell, who said licensing will bring the status of so-called pre-hospital providers on a par with other healthcare providers, such as physicians and nurses.

For Burdzy, it's "a matter of semantics."

"This is not elevating their status," he said, "especially since all other healthcare providers such as physicians, nurses, and physical therapists are licensed by an examining board of their peers, under the Department of Law and Public Safety, Division of Consumers Affairs."

He continued, "It has been our position that should we be required to have licensure, that we should be afforded the courtesy of being licensed by a board of our peers."

Lovell contended that the NJSFAC is not a regulatory agency empowered or authorized to issue credentials, adding, "Yes, it amounts to semantics, but [it] results in recognition of EMS providers as healthcare providers,"

Licensing, according to Burdzy, would accomplish a very different goal, "giving the [OEMS] absolute control over all providers, something that they have wanted for years."

EMTs and Paramedics

The current law defines two levels of emergency medical technicians, Burdzy explained, the basic EMT and the paramedic.

Basic EMTs are required to complete 250 hours of training. To be certified as a paramedic, EMTs must complete another 1,500 hours of training. That enables them to assume greater responsibilities, such as inserting intravenous lines. They are also able to administer medication under the supervision of their "medical control," typically an emergency room physician from the hospital they work for.

Burdzy concluded, "There currently exists two levels of training under the control of the OEMS, EMT and EMT-Paramedic. Therefore the OEMS already clarifies the differences, requirements, and responsibilities statewide."

Lovell drew another distinction.

EMTs generally are provided by community agencies or commercial agencies and staff what are known as "basic life support (BLS) ambulances," he said.

Paramedics are employees of acute-care hospitals holding a Certificate of Need from the DOH. They usually respond in nontransport vehicles and treat patients in the BLS ambulance with the assistance of EMTs.

The training requirements for EMTs and paramedics will remain unchanged, asserted Lovell "These are currently set by New Jersey administrative code based upon U.S. DOT standards." He noted that the legislation proposes no changes to these requirements.

Continue reading on NJSpotlight.com.

NJ Spotlight is an issue-driven news website that provides critical insight to New Jersey’s communities and businesses. It is non-partisan, independent, policy-centered and community-minded.

Jake October 23, 2012 at 11:25 AM
The government does not have a very good record at running things so I would say we should leave things as they are. If the government wants something to do they should be working on lowering our taxes.
Jack October 24, 2012 at 03:08 AM
Well it's about time. Most states have been regulating EMS since the inception of modern EMS in the early 1970's. It insures a better level of patient care and excellent patient care provided by highly trained providers should be the goal of everyone. I know the volunteer squads are concerned but I have seen volunteer and POC paramedics and EMT's provide excellent care on a daily basis. Many of these organizations have been doing it for over 40 years.
raymond Weis October 24, 2012 at 01:54 PM
While I agree with much of the bill as presented I also disagree with a lot of it. It tries to be one size fits all. Would Nike survive if they only made one size sneaker. We have a state comprised of urban, suburban and rural areas. We also have paid EMS and volunteer EMS and sometimes combination of the two. The one thing they have in common is that all the EMTs are trained to the same standard. Mandating a response time is great if you can guarantee the calls will be spaced out accordingly but unfortunately you can wait all day for a call and then get three or four in five minutes. Realizing that whenever someone calls an ambulance they feel they really need one right away, we have to try and cover the most serious first. For instance if you fell and thought you broke your wrist and at the same time your neighbor had a stroke we would have to take care of your neighbor first as theirs is life threatening so we would have to go to backup for you which may take longer. We really wish we could cover each call in ten minutes but it is not always practical and passing a law will not change that. Now imagine a small rural town say in Salem county. The Town is too small to have a full time EMS staff so they may combine several towns for EMS coverage thereby also increasing response times. I really wish there was a one size fits all but in the meantime we are doing our best to make the system better but I don't think this legislation is the answer.
Dan jones March 21, 2013 at 09:19 PM
Enough already! Ems in NJ is broken and has needed to be fixed from day one. Once the politicians cow towed to the " volunteers" who circled the capital with their ambulances afraid that the higher level paramedics would steal "their patients" it was over. The NJSFAC learned a good lesson that day...there is power in numbers. The NJSFAC has stifled progress in EMS ever since for their own self serving needs. Of course they are against the bill, it sets standards that they would now be accountable like a minimum level of training for those who respond to your home and mine. Yes some squads will need to adapt or possibly fold. Why should EMS be held to a lower standard just because the NJSFAC and members want things to stay the same. NJ DOH paid a million dollars (several years ago) to fund a comprehensive study on EMS in our state by a co. called TRy-Data. It recommended 50 sweeping changes (along with saying our system is severely broken) not one of which has been enacted. It's broken and needs to be fixed now. Moving from a system that basically says you will get an ambulance if some one happens to be home or not playing golf that day to a system that sets a standard of care for every resident no matter where you live is a step in the right direction. This is 2013 not the 70's , the public demands the same standard of care for police , fire and EMS.

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