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State of New JerseyDepartment of Health and Senior ServicesOffice of Emergency Medical ServicesEMS System ReviewAugust 2007Submitted by:TriData, A Division ofSystem Planning Corporation
THE STATE OF NEW JERSEYEMS SYSTEM REVIEW, DHSS, OEMSSubmitted to:Dr. Fred Jacobs, MD, JD, Commissioner of Health and Senior ServicesMr. David Gruber, Senior Assistant CommissionerThe State of New JerseyDepartment of Health and Senior ServicesTrenton, NJ 08625Submitted by:Mr. Phillip Schaenman, PresidentTriData, a Division of System Planning Corporation1000 Wilson Blvd., 30th FloorArlington, VA 22209(703) 351–8300September 2007
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewTable of ContentsACKNOWLEDGEMENTS. 1EXECUTIVE SUMMARY . 3I. INTRODUCTION. 7Tasks .8Basic Structure of New Jersey EMS.9Political Structure of the State .10Overview of New Jersey EMS Organizations .11Methodology.12Data Analysis Methods.15Follow-Up Meeting with DOH and OEMS.16Meeting with the Mayors.16Formulation of the Draft Report .17Limitations .17Organization of the Report .18II. INTERJURISDICTIONAL COMPARISONS . 20Connecticut .20Delaware .21Maryland.22Ohio .23Virginia .24Comparison of State Systems .26Conclusion .26III. EMS SYSTEM ASSESSMENT . 28Current State of EMS System.28Identification of Top Priorities .49IV. RECOMMENDATIONS FOR CHANGING EMS LEGISLATION ANDREGULATION . 69Legislation – Chapter 2K: Emergency Medical Services.69Rulemaking Process for Mobile Intensive Care Programs (N.J.A.C. 8:41) .72Legislation – Chapter 5F: Highway Safety.72Regulation – Chapter 41: Advanced Life Support Services .74Additional Legislation, Regulations, or Protocols to be Considered.79TriData, a Division ofSystem Planning CorporationSeptember 2007
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewV. THE NEW JERSEY STATE EMS SYSTEM . 81Regional EMS System .88Information Systems .90Response Time Analysis.91Summary.95VI. AIR MEDICAL EMS (JEMSTAR) . 96Air Medical EMS Response .96Response Issues .100Financial Issues.103VII. ADVANCED LIFE SUPPORT DELIVERY. 106Current ALS System.106Emergency Medical Technician-Intermediate.115Potential Provider Organizations .116Summary of Findings.119VIII. EMS WORKFORCE . 121Career EMS Providers .121Volunteer EMS Providers.124APPENDIX A: LIST OF RECOMMENDATIONS . 130APPENDIX B: FOCUS GROUP-STATE ASSESSMENT . 133APPENDIX C: FOCUS GROUP PRIORITIES . 146APPENDIX D: PARTICIPANTS IN THE NEW JERSEY EMS FOCUS GROUPS . 159APPENDIX E: SWOT ANALYSIS FOR NEW JERSEY EMS. 165TriData, a Division ofSystem Planning CorporationSeptember 2007
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewACKNOWLEDGEMENTSIt is impossible to list every member of the New Jersey EMS system that assisted us withthis monumental effort. The EMS professionals listed below were especially instrumental inhelping us complete this assessment. Many of these personnel unselfishly gave their time andtraveled significant distances in an effort to be of assistance. Their efforts exemplified the NewJersey EMS System. Special accolades are in order for Thomas Starr, NJOEMS, who served asthe Project Manager for NJOEMS. He was instrumental in providing liaison with TriData and insetting up the focus groups. We especially thank the Allentown Rescue Squad who allowed us toconduct the focus groups at their facility and provided meals and hospitality for a veryreasonable price.Dr. Fred Jacobs – Commissioner, NJDHSSDavid Gruber – Senior Assistant Commissioner, NJDHSSDr. Joseph Tricarico– Assistant Commissioner, NJDHSSKaren Halupke– Director, NJOEMSDr. Mark Merlin – Medical Director, Robert Wood Johnson EMSDr. Jennifer Waxler – Chair, New Jersey State EMS CouncilDr. James Pruden – Immediate Past Chair, New Jersey State EMS CouncilVincent Robbins, President, MONOCScott Kasper – Director, Virtua Health System EMSDr. Joseph Hummel – Medical Director, Virtua Health System EMSDr. Steven Marcus – Director, New Jersey Regional Poison CenterBryan Fischberg– Robert Wood Johnson EMSSusan VanOrden – President, New Jersey State First Aid CouncilJulie Aberger – Editor, Gold Cross Magazine, NJSFACRuthie Bertagni - Captain, Allentown First Aid SquadThomas P Canzanella1 – President, New Jersey Professional Firefighters AssnMickey McCabe – President, New Jersey Medical Transportation AssociationLouis Sasso – Director, Robert Wood Johnson EMSJames C. Davidson, President, New Jersey Fire Chiefs AssociationDr. James Leva – Medical Director, New Jersey EMS-C1It is with deep regret that TriData acknowledges the untimely death of Thomas P. Canzanella. His contribution tothe project was extremely valuable and his absence will be felt by New Jersey EMS.TriData, a Division ofSystem Planning Corporation1September 2007
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewCraig Reiner – Director, New Jersey Office of Emergency Telecommunications ServicesWilliam Dressel – Executive Director, New Jersey League of MunicipalitiesShai Jaskoll – EMS Coordinator REMCS, NJ University of Medicine & DentistryRoger D. Sarao – Assistant Vice-President, New Jersey Hospital AssociationNew Jersey State Office of EMSRobert Dinetz – Chief, EMS TrainingJames Mondoro-Public Health RepresentativeNancy Kelly-Goodstein – EMS for ChildrenJames Sweeney – EMS TrainingDon Roberts – LicensingWilliam Duffy – Air Medical Services and LicensingTriData StaffThe following TriData staff and consultants contributed to this project:Philip Schaenman – President of TriData, Corporate OversightDr. Harold C. Cohen – Project ManagerHollis Stambaugh – Director, Center for Public ProtectionShania Flagg – Research AnalystTracy Tisbo – Data AnalystJoseph Laun – Research AnalystJeff Dyar – Senior ConsultantGregg S. MacDonald – Senior ConsultantDr. John Parham – Senior ConsultantMichael Armacost – Senior ConsultantR. Brent Meadows – Senior ConsultantMaria Argabright – Administrative ServicesTeresa Copping – Administrative ServicesSusan E. Martin – Manuscript PreparationTriData, a Division ofSystem Planning Corporation2September 2007
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewEXECUTIVE SUMMARYIn 2006, the State of New Jersey decided to conduct a study to assess its EmergencyMedical Services (EMS) system. The study was mandated by the New Jersey State Legislature toreview the current EMS system and determine immediate and future needs. The State of NewJersey Department of Health and Senior Services (DHSS) selected TriData, an internationallyrecognized emergency service consulting firm to conduct the study. This study provides 55recommendations for New Jersey to consider.OverviewNew Jersey has a two-tiered EMS system that provides basic and advanced life supportservices. Factors such as the system’s financial structure, decline in volunteer membership, lackof comprehensive legislation, and a weakened Advanced Life Support (ALS) system have placedthe EMS system in a state of near crisis. The New Jersey EMS systems consists of more than25,000 volunteer and career providers, including first responders, emergency medical technicians(EMTs), paramedics, nurses, and physicians. The New Jersey’s Office of EMS (OEMS)maintains the certification of 1,500 paramedics, 22,000 emergency medical technicians (EMTs),and the licensure of more than 3,000 vehicles, including mobility assistance vehicles,ambulances, mobile intensive care units, specialty care transport units, and air medical units.The population density differs greatly between the northern and southern regions of NewJersey. This variation affects the demand and delivery of EMS services throughout the state. Atpresent, New Jersey has no state EMS medical director nor does it have a regional EMS system.The lack of statewide medical direction results in a loss of transparency that has led tofragmentation of EMS medical oversight, especially between ALS and Basic Life Support (BLS)services. New Jersey’s State oversight is highly centralized and with little coordination betweenstate, regional, local, and volunteer agencies. TriData suggests that New Jersey restructured theirEMS system by creating a regional approach that will decentralize daily management of EMS bycreating three geographical regions.Project Scope and MethodologyThis study addressed each component of the EMS system based on the NHTSA EMSAgenda for the Future. To analyze the EMS system, TriData conducted a four-phase analysisthat included interviews of key leaders, 13 focus groups of organizational and providerconstituents, interviews with NJOEMS officials, and the triangulation of data.Inter-jurisdictional ComparisonsInter-jurisdictional comparisons are helpful in identifying techniques and ideas that havemet with varying success in other areas. In this study, the structure and organization of NewTriData, a Division ofSystem Planning Corporation3September 2007
State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewJersey’s EMS system is compared to those of five other states (i.e., Ohio, Virginia, Maryland,Delaware, and Connecticut) asse
This study provides 55 recommendations for New Jersey to consider. Overview New Jersey has a two-tiered EMS system that provides basic and advanced life support services. Factors such as the system’s financial structure, decline in volunteer membership, lack of comprehensive legislation, and a weakened Advanced Life Support (ALS) system have placed the EMS system in a state of near crisis .
