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.
Burdzy raised another objection, contending that licensing is inherently more expensive than certification. Currently, paid EMTs or their agencies are charged a licensing fee. Volunteer squads do not have to pay for a license.
“Under this legislation,” he argued, “all ambulance corps, first aid, and rescue squads would also be required to be licensed,” Burdzy said.
Paid providers, he noted, shell out approximately $1,500 for their initial license and $500 for each ambulance.
“If volunteer ambulance corps, first aid, and rescue squads are licensed.” he questioned, “who will assume these costs — the squad, the municipality, or the state?”
He continued, “Adding approximately 340 to 360 volunteer squads and 1,100-plus ambulances will cost the OEMS money. “Who pays?”
Lovell responded that there are no fees currently charged in the certification process and no fees are proposed for the licensing process.
The proposed legislation requires background checks for all emergency medical technicians and paramedics, to ensure the safety of the EMS patient and the public.
Lovell indicated that this is virtually identical to an existing requirement for all other healthcare providers.
He added that currently there is no universal requirement for background checks, although some EMS agencies run them on their staff. Background checks may be carried out by the local municipal police department, the County Sherriff’s department, or by MorphoTrak, the state contractor.
At present, S-1650 does not specify who should carry out background checks, but Lovell explained that once the bill is passed the “DOH would propose the methodology for background checks after consultation with EMS stakeholder groups.”
Burdzy has two problems with background checks: Who will pay for them and can they be processed efficiently by existing resources.
“Many of our member squads currently conduct background checks through their local police department, he said. “It’s going to need clarification. Is it going to come out of the state budget? If so, say it in the bill and appropriate the money for it.”
Burdzy is concerned that the municipalities or the rescue squad itself might have to pick up the tab. “The legislation, he said, “does not exempt the organization,” adding that he would like to see the DOH conduct a new study, and include what the fiscal impact of this bill would be on taxpayers, local municipalities, the volunteer system, and the state budget.
Pennacchio is also concerned that the local towns will have to bear the financial brunt of licensing and background check.
“There is nothing in the bill that says the state is going to pay for it. It needs a lot more vetting.”
Burdzy raised another issue regarding background checks. He said the state police have indicated that this is a labor-intensive process and they currently have backlogs — without having to deal with some 27,000 EMTs and paramedics.
He also pointed out that the state only has four licensed fingerprinting facilities and they are 9-to-5 operations.
“Most volunteers work during the day and would be unable to get their fingerprints taken without taking a day or a partial day off from work,” Burdzy said, adding that the state should ensure that the background checks are made more available to volunteers.
Burdzy said that four years ago proponents of the bill were given the opportunity to address the delegates at NJSFAC’s annual convention and that many questions went unanswered.
“The delegates did not see fit to change the Board of Trustees decision to oppose the bill as written,” he stated. He noted that since then there have been three NJSFAC midyear meetings and three conventions (the most recent on October 4-7, 2012) where the legislation was discussed and no motion was made to change the position of the New Jersey State First Aid Council.
“The bills are almost identical to the ones passed in the previous legislative session. One difference is that our seat on the proposed Emergency Medical Care Advisory Board has been removed. We believe this was punitive due to our opposition to the legislation,” Burdzy said.
Lovell said that the NJSFAC had six representatives in the group that participated in the 18 months of discussions that led to the drafting of the legislation, more than any single stakeholder group. “Only after the legislation was drafted and the NJSFAC viewed it as a threat to their existence,– which it is not — did they protest,” he concluded.