By Tom Baldwin
Asbury Park Press
Copyright 2007 Asbury Park Press
TRENTON, N.J. — You’re down and you can’t get your breath.
Select one: A) You want two well-trained paramedics to arrive and tend to your crisis. Or, B) You’d prefer to have just one paramedic assisted by a less-schooled emergency medical technician.
That is one of the debates currently afield in New Jersey health care circles as professionals and politicians mull an in-depth and largely critical report on the state’s systems of emergency medical services, or EMS.
The study said New Jersey’s EMS system is in “near crisis” condition — hurt by needs for money, gaps in coverage and the increasing and worrisome lack of volunteers, among other flaws.
In New Jersey, where bustling urban centers exist less than an hour’s drive from rural backwaters, EMS is a stew of different arrangements. There are paid municipal systems, all-volunteer systems, and then the hybrids — volunteers in the evening, private services from dawn to dusk.
The study, by emergency-services consultants TriData, a division of System Planning Corp. of Arlington, Va., suggests 55 changes.
One that directly affects the imperiled, gasping fellow lying on the sidewalk is the idea of allowing advanced life-support ambulances to be staffed by one emergency medical technician and just one paramedic, rather than the two paramedics now required.
“It wouldn’t affect us at all,” said Bob Pfleger, director of the 5 Squad Association, where emergency services are pooled among neighboring communities of Middletown, Leonardo, Port Monmouth, Lincroft and Fairview.
“Many paramedics and medical directors like the two-paramedic system,” said the report. “Unfortunately, these beliefs have not been quantified in New Jersey or anywhere else.”
Scott Kasper of Mount Laurel, president of the New Jersey Association of Paramedic Programs, said an emergency medical technician receives 110 hours of training in basics, while paramedics receive in excess of 1,500 hours of more-detailed responsibilities. “A paramedic brings the emergency department to the patient,” Kasper said.
The benefits of the one-paramedic system, said the report, include that “a limited number of paramedics will allow these providers to develop and maintain the skill expertise needed to provide effective care.”
Chris Rinn of Fair Haven, vice president of the New Jersey Association of Paramedic Programs, said, “We understand the motivation of sending one paramedic, and it does work” in some areas.
Rinn said, “With most critically injured patients, it is better to have two paramedics, two sets of eyes, two sets of experiences.”
Not all paramedics agree — though it’s unpopular for some to admit. One paramedic who did not want to be quoted by name asked: “If you are having brain surgery, do you want a surgeon who has done three procedures or many? You want the person with the most experience. By radically expanding the number of paramedics in the system, we are going to dilute the system of expertise.”
Other paramedics privately say the state’s 1,450 engaged paramedics may not be enough, so the solo system might be acceptable until more are trained.
Speaking for the American College of Emergency Physicians, Dr. Juan Fitz of Lubbock, Texas, who is also medical director of the local emergency medical technician program, said, “One paramedic on board? That is normal.”
John Tweed, executive director of the New Jersey Medical Transportation Association, speaking for non-hospital ambulance operations, disagreed, saying New Jersey’s density and road systems lend themselves toward more dramatic crashes, collapses and other crises requiring EMS.
“Many of the people we hire are paramedics,” Tweed said. “They say there is often a need for that second paramedic, for that second pair of hands. Here in New Jersey we seem to have a high incidence of more dramatic trauma.”
The state Department of Health and Senior Services is reviewing the study before reacting with a plan of action.
“They made a lot of recommendations to improve the system. I wouldn’t go as far as to say the present system has shortcomings,” said state Deputy Health Commissioner Dr. Joseph Tricarico, whose mandate includes emergency services.
“They are going to be looked at very carefully,” Tricarico said of the report’s suggestions, noting that advisory groups will examine the study, make suggestions to health commissioner Dr. Fred Jacobs, who would then go to Gov. Corzine and the Legislature, or take departmental steps where possible.