The Cost Of Saving Lives: A Paramedic Speaks

WALL, NJ — It's a question and a complaint you hear often: someone calls 911 because a family member has had a heart attack or a serious injury at home, and paramedics respond and deliver the family member to the hospital ... then deliver a bill, often expensive, for service several days later.

Tracy Connellan of Wall Township, a paramedic and lifetime volunteer with nearly 25 years of service with her local squad, took to Facebook Tuesday to explain why those bills cost a pretty penny. It's a message that's resonating with many in the EMS community and has been shared nearly 70 times, including a share by the Professional Firefighters Association of New Jersey.

Connellan, 46, has given the Patch permission to reprint her commentary:

"I, like many others, have devoted our lives to the health and safety of those we serve. Paramedics in this state are the most necessary yet misunderstood public safety entity in New Jersey and yet we continue to walk the fine line of life and death every day.

"Instead of asking the question 'I have to pay what?' let's ask the question: “Why do I have to pay for the paramedics to treat and transport me with another agency?

"This may seem like a relatively easy question, but it is actually the absolute antithesis.

"In the state of New Jersey, you pay homeowners taxes which go to provide necessary services such as police and fire services, education, road improvements, quality of life, etc. No tax dollars are designated under any homeowner subsidy for EMS. In EMS we are not considered a necessary service.

"Did you know that there is no law in this great state that mandates if you call 911 with a medical emergency you are to get an ambulance? NONE. It is a moral and ethical assumption of duty by towns to attempt to get EMS to you to render aid.

"I once had the pleasure of speaking with former NJ Governor Corzine after his life-changing motor vehicle accident. He asked what my perception of the problems with EMS are in NJ. My statement was clear. Our EMS system is broken and in desperate need of overhaul.

"In New Jersey, our EMS is divided into two categories, Basic Life Support (BLS) and Advanced Life Support (ALS). The BLS has two main components, volunteer and paid services. There is no state regulation or oversight of volunteer organizations. They are self-regulated or pay an annual fee to another organization (comprised of volunteers) to provide guidelines for care and transportation.

"There is no state requirement for any training of volunteer EMS. In other words, you don't need any certification to ride on an ambulance, no EMT (Emergency Medical Technician). While most volunteer squads, mine included, took it upon themselves years ago to require EMT training to be a volunteer, most do not as it is perceived as a hardship. These EMS agencies to not bill for their services.

"To be an EMT in NJ, you are required to attend an approximately 140-hour program over the course of a few months. The paid BLS services can either be public (police and fire) or private (MONOC BLS would be an example). The police and fire EMS agencies, while they do not directly receive tax subsidization to operate, they fall under the blanket of their respective agencies' budgets for general operating costs, yet they still bill for their services and often are able to waive the insurance copay to their respective residents.

"Private agencies, such as MONOC do in fact bill also for EMS services rendered and are usually contracted by facilities and towns to provide a service. This is because the town cannot afford the start up of an EMS agency due to low call volume or budgetary constraints.

"Regardless of a BLS agency being private or public, there are still two fine lines of BLS care being delivered. Some career agencies have gone above and beyond what the state of NJ has drawn as their guideline and function as a well-oiled machine, providing aggressive and pertinent care. Some, however only provide the minimum required. There is no consistency.

"In any town, in any part of this state, when you call 911 and request services for a medical emergency, depending on your geographic (area) you could get any one of the above mentioned … or nothing at all. It's not a necessary service.

"The only state required programs, through Certificates of Need, designated by NJ Department of Health and Senior Services OEM (Office of Emergency Management) is the paramedics. As paramedics, we are required to be up and running 24/7/365 regardless of weather conditions, natural disasters or states of emergency. Very similar to police and fire.

"As paramedics, our level of training is significant, lengthy and very costly. It is at minimum a two-year program from start to finish and can cost well over $10,000. As paramedics, the medicine we practice as well as our training is governed by Administrative Law. We are required to go through rigorous annual training which is provided by our employer at a great cost to them. We then have to prove to the state of NJ DOHSS OEM our competency in written, oral and hands-on testing in order to continue to practice. Yearly.

"There are only a few paramedic programs in NJ that receive any subsidization.

"Most however. like MONOC, are user-based. This means, quite simply, if you are suffering from a significant life-threatening illness or injury, and we the paramedics are dispatched and render care, you are going to get billed for it. If you don't use us, you pay no municipal or state taxes to keep us up and running.

"If at any time you call 911 and meet ALS dispatch criteria, you will get a Mobile Intensive Care Unit-certified paramedic. They may work for MONOC or another agency, but if they wear that patch, you will get the same advanced level of care anywhere within the state of New Jersey.

"The MICU (Mobile Intensive Care Unit) paramedic brings with it the advanced care you would find at most of the acute care hospitals in NJ. We have the ability to view and read the electrical activity in your heart and correct it if necessary. We have the ability to view and detect if you're having cardiac ischemia (heart attack MI) as well as the ability to start the treatment and begin the reversal process. Paramedics have the ability to identify the different “strokes,, aggressively treat them and start the reversal process. We have the ability to protect your airway if you are unable to breathe appropriately, including inserting an ET Tube (endotracehal tube) or a surgical airway (which requires cutting a hole into your trachea to place a breathing tube).

"Paramedics have a myriad of pharmacology at our disposal to treat and correct hundreds of life threats. We have dozens of physicians a phone call away to provide direction if necessary as well as join up with us in the 'continuum of care' to ensure a quick, seamless and effective approach to a patient's needs while enroute to the receiving hospital.

"The paramedics have been on the front line of the heroin epidemic in NJ for decades. Long before celebrities attempted to bring the magnitude of this addiction process to light with the catch phrase “epidemic.” Before police, fire and EMS were able to deliver the life-saving antidote to an opiate overdose, the paramedics were there saving innumerable lives.

"Until such time as private Advanced Life Support agencies in New Jersey receive subsidization for providing their legally necessary service, billing for the care we provide will be a problem.

"The problem is not the agencies that bill for a user-based system.

"EMS in New Jersey needs a total overhaul, to provide consistent and appropriate care within every service line, beginning with the 911 call for help and both basic and advanced life support.

"State and municipal subsidization is provided to all necessary service agencies other than MICU ALS, who deliver care to the most sick and vulnerable residents and transients in New Jersey. Instead of continually singling out one agency on their billing practices, get involved to make EMS better in New Jersey. Find out how to help us provide exceptional care while meeting our operational costs to ensure we have the medicines our patients need.

"Most importantly, the next time you see a paramedic, smile, say hi, introduce yourself, shake their hand and find out the story behind their patch, ask them their badge number. Each paramedic's badge number is unique to them and only them, after having proven they are worthy to hold the title paramedic on both a state and national level. Maybe share with them a cup of coffee and a selfie.

"As paramedics, we will faithfully and dutifully be here if and when you need us.

Tracy J. Connellan, MICP 2326

CPR, U.S. Navy Photo by Mass Communication Specialist 3rd Class Samantha J. Webb