By Russell Ben-Ali
Star-Ledger
HACKENSACK, N.J. — Three generations of Hackensack rescue workers are inked into the underside of Michael Tompkins’ forearm.
The tattoo bears the badge numbers of his grandfather, Walter Tompkins Sr., a Hackensack firefighter from 1950-1978, and his father, Walter Tompkins Jr., a fire department emergency medical technician for 26 years.
It also includes his own badge number as a fire department EMT.
But Tompkins’ own mark on the family legacy could be short-lived. The city recently informed him and its seven other EMTs to look elsewhere for work.
“This is my lifelong dream to follow my family, my father and my grandfather,” said Tompkins, 35, a city EMT for seven years. “I don’t know what I’m going to do. This is all I’ve been brought up to do — help the public and serve the city I grew up in.”
As towns and cities across New Jersey grapple with rising costs, shrinking state aid and, in some cases, a dearth of volunteers, they have begun taking severe steps when it comes to emergency services. Some, like Hackensack, have shifted the burden to local hospitals or private firms. Others have worked with county officials to set up regional systems.
In Hackensack, shifting the work to an area hospital with a private ambulance service is expected to save the city $600,000 a year with no evident loss of emergency service to residents, said city manager Stephen Lo Iacono.
The move has prompted vociferous street protests. And organized union resistance has beaten back similar efforts at privatization across the state.
The statewide battle over how emergency services are handled intensified last year after an independent report said the state’s EMT system is broken.
The report, commissioned by the state Department of Health and Senior Services, found New Jersey’s emergency medical services in a “state of crisis,” grossly understaffed and manned mostly by a shrinking pool of volunteers. It called for urgent overhaul — including a recommendation that lawmakers require municipalities take responsibility for EMS, the way they do for police and fire protection.
Senior Assistant Health Commissioner David Gruber called it a key recommendation.
“When you call 911 for EMS, you have someone in distress, life and limb,” Gruber said. “To not have them on par with fire and police is unexplainable.”
However, the report gave no suggestions for how cash-strapped municipalities could make the change. Some towns have moved to private vendors. Others have tried but have been thwarted by well-organized local squads.
“The gut-wrenching decision being made in every town hall across the state is how are we going to provide for emergency services and do it without driving our property taxpayers and our business ratables out of the town?” said William G. Dressel Jr., executive director of the state League of Municipalities.
Regional Solutions
While towns may shed a growing budget item by privatizing EMS, there can be a downside for patients, because it means they or their insurance carrier have to pay the price of the ambulance ride.
In growing Gloucester County, some towns have joined a new regional EMS service, paid for by county taxes. Half the county’s 24 towns joined the service, started last September after it was discovered that 846 emergency medical calls were missed in the county in a recent year.
Calls are no longer missed, and response times have fallen below the national average, even during an ice storm last February that brought 20 auto accidents in one day, said Stephen M. Sweeney, the county freeholder director.
Glassboro, with 15 paid EMS employees, was among those to sign up, saving the borough about $200,000 per year, Sweeney said.
“So they basically took a headache and handed it over to the county,” Sweeney added. “It was a big win. They didn’t lose any level of service, and they stopped paying.”
The countywide service expects Woodbury to join in January. Woodbury pays $140,000 to a private service that also gets to keep money collected from third-party billing for ambulance rides, Sweeney said.
Bergen County also is creating a regional EMS, and Hackensack officials have advised its EMTs to apply.
East Orange, the second-largest city in Essex County, chose to outsource EMS service about a decade ago to East Orange General Hospital.
“It just got to be too expensive,” said Mayor Robert L. Bowser, who also serves as president of the state League of Municipalities. “Plus you have the liability insurance that goes along with it.”
Bowser said many towns and cities bracing for steep cuts in state aid in the 2009 budget have to consider cuts in staff, including emergency workers.
The state mandates the same training and qualifications for providers of basic and advanced life support — be they municipal workers, private contractors or volunteers.
Outsourcing such costly services is nothing new in New Jersey or nationwide, where there are severe and growing shortages of EMT volunteers.
For decades, cities have increased reliance on outside service providers to help with things like police, fire, public works and building and safety, according to the Reason Foundation, which publishes an annual report on privatization.
Shrinking budgets are not the only reason people are changing the way EMS is handled, however. Many departments are run by volunteers, and there are fewer of them around.
“People don’t have the long hours that one needs to devote to filling a volunteer shift on an emergency medical service,” said John Becknell, executive director the National EMS Management Association. “And generally speaking, demand around the country is increasing.”