Legislature Takes Second Look at Regulating Emergency Medical Services

Andrew Kitchenman | January 28, 2013 | Health Care
Opponents argue that bill would put excessive financial burden on volunteer EMT squads

Howard Meyer, president of the New Jersey State First Aid Council.
For the second time since taking office, Gov Chris Christie may have a chance to sign a bill that increases state oversight of emergency medical technicians and paramedics.

The measure (A-2463), requires that ambulance workers be licensed by the state and undergo criminal background checks.

The legislation comes at a time when the state’s longtime reliance on volunteer ambulance squads is under threat from several quarters, including increased regulation, tougher training requirements, and a general decline in volunteerism.

“EMS is in crisis in New Jersey,” said Mary Daley, president of the state EMS union. — the Professional Emergency Medical Services Association. “A lot of the volunteers are falling by the wayside, a lot of it is going commercial and paid.”

Supporters of the bill argue it makes much-needed changes, adding that the current state of affairs — in which volunteer squads don’t even have to register with the state — must end. They also say the state must take action now to ensure that local departments maintain necessary standards.

Opponents maintain that the bill will force more volunteer units to shut their doors..

Christie conditionally vetoed an earlier version of the bill two years ago, saying it needed further study.

The volunteers who oppose the bill are hoping that the governor again calls for further study. Supporters contend that Christie’s staff didn’t have time to study the issue then, and that now is the time to move forward with more state oversight.

The state’s largest emergency medical volunteer organization is the chief critic of the proposal. Howard Meyer, president of the New Jersey State First Aid Council, said the increased costs from state licensing and background checks put too much financial strain on volunteer squads.

“On top of Sandy and everything else, I don’t think it’s any secret that New Jersey has financial issues,” said Meyer, a volunteer with the Berkeley Heights Volunteer Rescue Squad and Hoboken Volunteer Ambulance Corps. He has 40 years experience and has instructed volunteer EMTs for more than 20 years.

The nonpartisan Office of Legislative Services forecasts that the bill will increase costs, but didn’t put a price tag on the increase. The legislation specifies that the costs won’t be borne by the volunteers themselves, but opponents said costs could be pushed onto cash-strapped squads.

“Where’s the money coming from?” Meyer asked, adding that his organization estimates that the bill will cost $30 million to $50 million annually.

That number is disputed by bill supporters, who noted that the State Police already conduct background checks for police and firefighters, as well as for emergency squads that request them.

Meyer said Christie took the correct approach in his 2011 conditional veto, in which he called for a review by state officials of the financial impact of the measure. The Legislature did not act on the veto before the end of this past session.

“That would have been a very reasonable thing to sit down and do,” Meyer said.

Meyer said ambulance services do need changes, including adding a requirement that all ambulances receive inspections and that all patients be guaranteed that an EMT is traveling with them in an ambulance.

“There’s ways of doing that without costing millions, that would be of little or no additional cost to volunteer squads,” Meyer said. He said private ambulance agencies and hospitals are pushing out volunteer squads.

“We believe it’s going to make it more difficult for volunteer squads be able to recruit, to be able to provide services,” Meyer said of the bill.

First-aid training programs have increased their requirements in recent years, while the state fund for this training has been exhausted. Meyer added that shifting the state from certifying to licensing EMS is a means of raising costs.

“I think the goal here is to make it more difficult and bureaucratic for volunteer squads until the people who run the squads say, ‘You know what? We’ve had enough,’” Meyer said.

Meyer noted that volunteer emergency responders have been crucial in responding to large-scale disasters.

Not all volunteers agree with the first-aid council’s position, including Michael Bascom, a volunteer captain with the Shark River Hills First Aid Squad for 20 years. Bascom is also chief financial officer for Neptune and Sea Bright and EMS coordinator for Monmouth County and Neptune.

“There’s been a lack of direction of EMS in general and there’s a need for standardization across the board, for volunteer and career [services],” Bascom said.

The Shark River captain said that the current state of affairs allows volunteer squads to function with inadequate response times and training.

“Most volunteer EMTs and career EMTs are very professional and very qualified in what they do and very dedicated, but a few bring it down,” Bascom said. He added that mandatory background checks are needed for personnel who enter residents’ houses and can be alone with patients.

“You would want to have some comfort level that that person is an upstanding individual,” Bascom said.

Bascom said one path forward for volunteer squads is to regionalize. By grouping together, volunteers will be able to share infrastructure.

“The strong squads will survive, the weaker will not,” Bascom said.

Bascom contends that the bill will not significantly raise costs for squads. Instead, there should be a focus on increasing state funding for training. “I don’t believe there will be a big cost to go along with this, I think that’s a scare tactic. “

Bascom said bill opponents are trying to link broader changes that are affecting the number of volunteers — such as increased regulation and training requirements — to a bill that has nothing to do with these changes.

“They point to the bill as [including] everything that’s changing EMS,” Bascom said. “This bill doesn’t talk about that at all.”

“There’s a need of a set of standards that [they] should have to follow,” he said.

Daley, another backer of the bill, said that it doesn’t go far enough in setting requirements. The head of the state EMT union, Daley said the law should specify that every life-support ambulance must have two paramedics, while every commercial ambulance should have two EMTs. Paramedics receive more training and can provide more medical services than technicians.

Daley added that Ocean County has the same number of ambulances as 20 years ago, while the population has increased sharply.

“I believe that the volunteers have a difficult road ahead of them, volunteerism is waning while the volunteer requirements” are growing, said Daley, who has served as a volunteer EMT for Pleasant Plains Volunteer First Aid Squad in Toms River, has been a state-certified paramedic for 29 years, and is a registered nurse.

The Assembly is scheduled to vote on the bill on Monday. The Senate has already passed its version.