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."
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.
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