January 2012

Governor Christie has conditionally vetoed this bill and the sponsors have chosen to withdraw it. Thank you Governor Christie! NJSFAC will work with legislative leaders to draft a bill that addresses EMS concerns without compromising our ability to deliver quality service.

The NJSFAC cannot support New Jersey Bill A2095 / S818, which revises requirements for emergency medical services delivery, as currently written. The amended bill continues to include many clauses that we believe would be detrimental to the EMS system in New Jersey.

Rather than include further amendments as promised, the Senate has adopted and passed the Assembly version of the bill A-2095.

To read bill A-2095, click here.

A2095 / S818 Amendments

*1A The Highway Traffic Safety Act (Sections 26, 27 & 28) – This Act must remain unchanged. The only change we would consider is one that would more clearly define that the municipality has control over who provides their local EMS service. The Act already clearly states that it is the local town that annually certifies the volunteer squad that serves the town. Unfunded costs

*1B Lead Agency Statement (Section11) – We oppose this since what is noted in new Section 11 is more an organizational goal / philosophy then something that should be law. In addition, it gives the department sole and complete control over any and all facets of EMS in the state including some that are already overseen by other groups i.e. 911 overseen by the Office of Technology Services, police training overseen by the Police Training Commission, etc. In order to make amendments, even one that would place a responsibility in a department other then the DHSS would require that this section be eliminated.

Unfunded costs

*2 Mandatory GPS In Ambulances (Section 15) - We cannot support mandatory GPS in the ambulances. These units can and will be used to enable certain dispatch agencies to locate and send volunteer squads to provide mutual aid to municipalities who in many cases may have paid EMS services. Volunteers do not join their local volunteer EMS organization to respond routinely to other towns that are not even contiguous to their own town. They join to serve their community knowing that on occasion they may respond into a contiguous community to assist them. To force volunteer squads to respond to 911 calls in towns where they do not routinely respond and / or who they do not have a written mutual aid agreement with will not be something the volunteers will support. In some cases, it could also be a significant safety issue if suburban squads are responding in urban areas to situations where they have little or no experience; i.e. no police on scene, gangs, etc. It could well result in volunteers being unwilling to remain on their local volunteer squads.

We would be willing to consider an anti theft device like LoJack which would make it easier to locate stolen ambulances. This has often been given as the reason why GPS units should be installed in ambulances. GPS units can be thrown out; LoJack units can be mounted out of sight of anyone in an ambulance making it less likely that a thief could disable it. Funding would have to be provided for the LoJack units and their installation in volunteer squad ambulances.

Unfunded costs

*3A EMT Licensure (Section 2) – Licensure of EMTs doesn’t appear to improve anything for the EMT. The only thing we see is that there would be a licensing fee that the EMT would have to pay. We might be able to support licensure provided we were given information that clearly outlined the supposed benefits for our review. It would need to be done under the following parameters:

1.    Licenses are issued under Consumer Affairs where all other licenses are handled.

2.    It’s done by the Board of Medical Examiners with a sub-committee comprised of EMTs. The majority of seats on the sub-committee to be appointed by the NJSFAC

3.    There must be no cost to volunteer EMTs and that must be written into the law so it can’t be changed in the future by regulation.

We have already learned that nearby states are not going to license their EMTs for the same reason noted above; they see no benefit to it. In addition, it’s been said by those who support the bill that being licensed will make it easier to introduce new EMT practices and equipment. This is not true.

Every EMT in this state has been regulated by the DOHSS since 1987 and they still refuse to support and investigate in a timely manner new lifesaving procedures i.e. Defibrillation (delayed till the early 90s after being opposed by the DHSS in the late 80s), Epi-Pens, advanced airways (pilot LMA project being done in Hunterdon County for over 7 years and not expanded beyond that county), aspirin, CPAP (being done in Pa by EMTs) blood glucose test. The implementation and use of the epi-pens by EMTs was delayed almost 4 years by the failure of the DHSS to complete regulations, not because EMTs weren’t licensed. Unfunded costs

* 3B Ambulance Licensing (Section 8, 15) –  In order to support ambulance licensing there would need to be a clear objective procedure outlined in the bill. The local town would do the actual licensing. Inspections by the NJSFAC would have to be accepted and recognized as equal to the DHSS inspection.  The volunteer squads must incur no cost. It must be the local municipality that has the final authority for licensing the EMS agency(s) that serve the community. This might be accomplished by having the town complete a form from the municipality acknowledging and accepting the training and inspections as performed. This form could then be forwarded to the state agency selected to maintain the records. This would result in significant savings for both the state and local towns. If this becomes law, then we need to make sure the bill includes language that would make the process clearly an objective one.

Unfunded costs

* 3C Background Checks (Section 6) - We can support background checks based on the following:

1.    There must be no cost to volunteer EMTs for any background checks and this must be included in the actual law.

2.    No person will be barred from attending an EMT Basic course because his or her background check isn’t completed.

3.    Any person who successfully completes the EMT course will be issued a provisional certification if the results of their background check has not been received by the time they have taken and passed their EMT test.

4.    The Commissioner of Health & Senior Services will receive the results of the background check, not the fingerprints or paperwork requesting the check. This information will be held only by the appropriate law enforcement agencies as permitted under state and federal law.

            Unfunded costs

*4 Legal Protections For Squads and Squad Officers Must Be Restored (Section 10)

Section 8 of P.L., c. 146 (C.26: 2K-14) has been amended in the bill. As amended, it removes legal protections previously granted to volunteer squads and their officers.

Unfunded costs

*5 EMCAB – If it is included in the bill, the NJSFAC must retain the same 4 seats on EMCAB that it currently has on the EMS Council.  Also see below for concern with amendment that was made.

Unfunded costs

*6 Agency Medical Directors (Section 8) – We do not see the need for every agency to have its own medical director. The costs would be prohibitive to volunteer squads. If this is left in the bill, then there must be a way noted in the bill to pay for their services to volunteer squads.

Unfunded costs

*7 NJSFAC’s EMT appointment to the EMS for Children Advisory Council. (Section 22) The NJSFAC must retain the right to make this appointment. The Council has been removed in the bill even though an organization that represents far fewer 911 EMS agencies has been added to appoint a representative.

*8 Volunteer Squad Definition - We recommend that the definition of volunteer squad be changed to reflect the actual coverage time provided by volunteer crews.  At least 51% of the time a squad provides EMS coverage, it must be provided with volunteer crews in order for a squad to be considered a volunteer squad for purposes of this bill.

 *9 Leave the word “volunteer” in any section of the bill where it has been removed. Leave in the word “nonvolunteer” where it is removed in Section 4 of P.L. 1987. c.284 (C.27:5F-21) (4) on page 12 of the bill.

 *10 EMT List Posted On The Internet (Section 2– We can't support the posting of EMT names and addresses on the Internet. This action will leave all EMTs open to harassment (or possibly worse) from disgruntled members of the public.  In fact there are already recorded instances where EMTs have been harassed and attacked. Making our physical addresses available to the public will only make it more likely that such occurrences will occur here in New Jersey. This action will make the addresses of police officers, fire fighters, doctors, nurses, business executives and many others public. Many of these people have very valid reasons for not wanting their home addresses known to the public.  Even a list that shows what squad they ride with could also leave the volunteer EMT open to harassment.

*11 EMT Testing (Section2) – There must be a requirement that the DHSS conduct testing in every county in at least 2 locations at least 3 times a year not just 2 times as is noted in the bill. There are at least 3 distinct training periods every year; the Fall, Winter/Spring and Summer programs. If testing is held only 2 times, one of these program periods won’t have testing available to the students upon completion of the EMT –B program.

* Under all circumstances, there can’t be any cost to EMS volunteer agencies or their EMS volunteers with respect to the implementation of any sections of these bills or the regulations that come as the result of the bills.  

AMENDMENTS MADE ISSUES

Of the amendments made, there needs to be language changes to 3 of them. Otherwise, these amendments will not accurately reflect what the Council was promised and the DHSS could create regulations that will circumvent the intended and promised intent.

*1) EMCAB

Amendment that was made & the concern with it.

RIGHT TO VOTE ON EMCAB

Language about the President of the First Aid Council on the EMCAB should be changed to ensure that the president is a voting member and that the president can designate an Alternate. Since volunteers have full time employment, they often need to have an alternate at meetings.  Section 13(2)(b) lists the President of the NJ State First Aid Council as an ex officio member.  NJSFAC requests the language read “The President of the NJ State First Aid Council, Inc, or their designee, as an ex officio voting member.”  

We are also continuing to address the issue that the Council has 4 seats on the current EMS Council and we are only given 1 on EMCAB, apparently a non-voting seat.

*2) 2 EMT Mandate - We cannot support a mandatory 2 EMTs in an ambulance. While we always strongly recommend that our member squads respond with 2 EMTs on a crew, there are times when this is not possible. Therefore we recommend that at a minimum, a volunteer crew consist of 1 EMT who will be responsible for patient care and 1 certified driver. A certified driver will be a person who has successfully completed:

1.    A CPR Professional class

2.    A recognized EVOC / CEVO class

3.    A complete review of the squad’s equipment and procedures by a designated squad member / preceptor.

This information will be maintained in a file at the squad and be available for review by the NJSFAC inspection team as requested.

Amendment that was made & concern with it.

ONE EMT WHILE TRANSPORTING PATIENTS

Section 28 currently states that ambulance must respond with one EMT while in service.  We would like to see it changed to one EMT while transporting patients.  Many squads can have a driver respond with the ambulance and meet an EMT on scene.  Most volunteer squad members have radios and advise that they are responding directly to the scene.  If an EMT is required to ride the ambulance from the squad building, it would delay the ambulance response.  As we understand it, services that bill, by regulation, are not permitted to respond without having 2 EMTs on the ambulance before it leaves the station. If this isn’t clarified, the same type of regulation could be imposed on the volunteers.

*3) EMT Training Fund

Amendment Made

All mention of the Training Fund was removed from the A2095. There will be no changes and it will remain for volunteers only. Funding For DHSS remains the same.

*4) Under all circumstances, there can’t be any cost to EMS volunteer agencies or their EMS volunteers with respect to the implementation of any sections of these bills or the regulations that come as the result of the bills.

Amendment that was made & concern with it.

FEES TO LICENSE AMBULANCE AND VOLUNTEER SQUAD

Squads and ambulances must be licensed in the bill and there is no mention that they will not be charged a licensure fee. 

While volunteer EMTs will not be charged for background checks, fingerprinting or licensing the same is not true for volunteers certified as first responders.  In addition, the AGs office has advised us that there is a federal fee that cannot be waived so if volunteers are not going to be billed, then a state appropriation has to be made in the bill. Unfunded costs

Conclusion

The New Jersey State First Aid Council is deeply concerned that the changes proposed in A-2095 / S-818 will result in a decline in the number of volunteers in EMS services throughout the state, and an explosive financial burden to municipalities. This could be avoided by addressing recruitment and retention issues and creating a process to coordinate a blended system of paid and volunteer first aid and rescue. Not only will it effect the day-to-day operations of local EMS agencies, it will also have a significant negative effect on disaster readiness and response if the number of volunteer squads is significantly reduced.

The NJSFAC has demonstrated their importance in mass-casualty incident responses. Faced with our nation's heightened state of alert, it is more critical now than ever for New Jersey to have an established, reliable volunteer EMS base. Non-volunteer services, whether municipal based or private, will not have the resources to call upon in the event of future catastrophic events like September 11, Hurricane Katrina or an event like the Haiti earthquake. On 9/11, New Jersey volunteers responded with over 400 ambulances to the disaster. Simultaneously, volunteer squads staffed over 300 other ambulances to ensure that "regular" 911 emergency response service was not interrupted in local communities.

With an $8.2 Billion dollar budget deficit looming in the 2011 state budget, the fiscal crisis will be worse then in FY2010 when the EMT Training Fund was depleted. If the property tax system were forced to finance paid services in what are now volunteer systems, the impact would have grave consequences to the health and economic well-being of not only municipalities, but also the State as a whole. The impact of adding potentially billions of dollars to New Jersey's property tax base as the result of losing our volunteers is a burden that this State's economy should not have to shoulder.

New Jersey's volunteer EMS system provides three core benefits. Specifically, it:

• Makes available highly trained EMTs for rapid mass-casualty incident response both within the state of New Jersey and throughout the northeast region
• Helps to alleviate an otherwise crippling financial burden on New Jersey municipalities, and
• Provides New Jersey's communities with much-needed, capable, and dependable medical assistance around the clock.

Currently, in more than 80 percent of New Jersey, when someone calls for an ambulance, volunteers respond. The New Jersey State First Aid Council represents more than 20,000 EMS volunteers affiliated with hundreds of first aid and rescue squads throughout the state. According to the Council, NJSFAC-affiliated EMS personnel in 2007 dedicated almost 3 million hours responding to more than 400,000 calls. Without the commitment of these volunteers, the municipalities they serve would have no choice but to foot the bill for emergency services.

The NJSFAC previously distributed a Position Paper which included a Plan of Action with two main goals in mind for maintaining volunteer emergency services- (1) stem the tide of decreasing volunteerism by facilitating the recruitment and retention of qualified and motivated individuals, and (2) enable EMS organizations to become more efficient and maintain or improve their level of effectiveness irrespective of recruitment numbers. The Plan consists of six components:

• Identify Questionable Mandates and Regulations
• Join the Effort to Recruit and Retain Volunteers
• Identify More Options for Producing Revenue
• Share Information on Efficiency and Creative Ideas

Consideration of these and other issues of volunteer first aid would assist in reducing the financial burden on the state and would preserve scarce resources needed to address other important aspects of the "paid" side of emergency services. We must work together toward a blended system that takes advantage of the best facets of both paid and volunteer services so that we can best meet the needs of our residents. The NJSFAC stands ready to work with Governor Christie, the Legislature, New Jersey municipalities and the Department of Health and Senior Services to serve New Jersey citizens.

New Jersey has been the recipient of over 80 years of high quality "free" first aid and rescue (as well as fire services) delivered by citizens willing to donate their time and energy to community service. What volunteer EMTs have received in return, is the satisfaction that comes from saving a life, delivering a baby, or responding to the many crises that have arisen in the past and will continue to occur in the future. NJSFAC members hope that common sense will prevail and we will continue to serve our communities into the future.