Proposed legislation that pitted professional emergency medical service (EMS) units against volunteer ones was passed by the state legislature but conditionally vetoed by Gov. Chris Christie on January 9. At stake was whether volunteer EMS units could handle the burdens of new regulation and who would pay for the $1.4 million of new initiatives in the bill.
The bill, known familiarly as the EMS redesign bill, would have enacted stricter requirements on volunteer units like the one in Glen Ridge, and members of that ambulance squad were steadfastly opposed to the bill. The Montclair Ambulance Unit supported it.
“While this legislation is well-intentioned and suggests several potential changes that seek to create a more coherent regulatory structure for the State’s EMS system,” Christie wrote in his veto message, “I am advised that implementation of the requirements and commitments provided for in the bill would cost the State and municipalities across the State millions of dollars.”
The bill, passed in the Assembly this past February as A-2095 and passed by the Senate on December 17 as S-818, would have set a uniform standard for all EMS units, both volunteer and professional. It would have, among other things, mandated global positioning systems in every EMS ambulance, required the licensing of emergency medical technicians (rather than certifying them), required background checks for all emergency medical technicians, and had all technicians and paramedics in the state licensed under the auspices of the Department of Health and Senior Services (DHSS) rather than a board of peers established under the New Jersey Division of Consumer Affairs. Most of the expenditures in the bill that Christie cited would come in the form of unfunded mandates.
The Montclair Ambulance Unit, a professional EMS unit, supported the original bill as a method of creating a uniform standard of care for patients and increasing efficiency in EMS operations. “What needs to be asked is, will this bill be a benefit to the patient?” said Frank Carlo the Montclair Ambulance Unit’s deputy chief. Carlo believes it would, as he opines that it would set high patient care standards that “will level the playing field for EMS agencies across the state, creating a uniform standard for all.”
Carlo cited similar EMS unit reform that passed in Pennsylvania in the 1980s, which he says has allowed both volunteer and professional EMS units to perform exceptionally, with uniform standards across the board and a higher standard of care.
Chris Landers, captain of the Glen Ridge Volunteer Ambulance Squad, would beg to differ. As both a volunteer in Glen Ridge and a professional EMT in Bloomfield, he sees no benefit to adding more regulations and red tape to meet the standards the bill would set for volunteer units. ”It doesn’t seem like it’s improving anything, it’s just changing it,” Landers said of the bill. ”I don’t see how it makes the system better, it just adds more paperwork.” He also noted that such reforms would be too costly for local governments to implement, adding that the bill left unaddressed whether additional costs would be forced on towns like Glen Ridge or absorbed by the counties or the state.
The New Jersey First Aid Council, which represents volunteer EMS squads, was flatly opposed to this bill because of that very question, concurring with the opinion that it would have placed a cost burden on local governments. Despite exemptions for volunteer units included in the bill, said Ed Burdzy, the New Jersey First Aid Council’s executive director, someone would still have to pay for the services the bill would have mandated. ”There’s no idea how to pay for it,” Burdzy said.
Burdzy cited as an example the proposed mandate for installing GPS units in each ambulance in the state EMS fleet—up to $600 per vehicle, with a total projected cost of $660,000 for 1100 ambulances. He noted that the tab does not include the costs of upgrading the computers that would serve the GPS units.
The chief provisions in the bill that have been controversial are a uniform system of background checks by state police and the requirement to license EMTs as opposed to merely certifying them. Carlo sees the background checking as common sense for re-assuring patients and families. ”I think it would be comforting,” Carlo said, “to know that when [people] call 911 at a point that may be the worst time of their life, the person coming into their home at 3:00 a.m. is not a convicted criminal and has a certain level of training.”
Landers agrees with the need for background checks, pointing out that Glen Ridge has its own background check system; all applicants for EMS volunteer work are routinely screened and cleared by local police. He doesn’t understand why any EMS unit would not run such checks on its own—though he concedes that a regulation requiring centralized, state police-conducted EMT background checks might be a good thing, especially if it in fact is the case that not every volunteer EMS unit performs such checks. For its part, the New Jersey First Aid Council has said it can support such a proposal, so long as it doesn’t cost EMT volunteers and allows EMT training for applicants awaiting background check results.
The dispute between certification and licensing comes down to more than a case of semantics. Carlo has noted that certification is used by non-governmental organizations to give approval to members who operate to the standards of the NGOs to which they belong and to give the public assurance that they have successfully met those standards. ”Licensure, on the other hand, is the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice,” Carlo explains.
While the use of licensing is meant to provide a higher standard, the proposal has sparked a disagreement from volunteers, many of whom find the proposed requirements exclusionary. Landers says that many EMS volunteers would be unable to complete the necessary training in a timely matter owing to commitments to their day jobs, while professional EMTs would have an obvious advantage to get licensed as part of their jobs. There’s also the potential inconvenience to consider. “If they’re going to have everybody licensed,” says Landers, “what’s the timetable for being licensed? If you have to get licensed, do you have to go to Newark or Trenton, or can you get licensed online?” Landers expressed frustration at the idea of possibly trying to find time to go to classes or sessions licensing when day jobs would restrict volunteer EMTs to nights and weekends. He added that EMTs already take classes repeatedly to keep their skills sharp.
The New Jersey First Aid Council, which represents 325 volunteer agencies throughout the state, sees other problems. In addition to the cost of licensing fee that the volunteer EMT would have to pay, the First Aid Council sees no added benefits in terms of training or expertise. Director Burdzy has also stated that he would prefer to see licensed EMTs regulated by the state Division of Consumer Affairs, as medical professionals such as doctors and nurses are, and the council is not happy the idea of EMTs being licensed under the auspices of the DHSS.
The council has noted that the DHSS has consistently refused to support or expeditiously investigate new lifesaving procedures, such as defibrillators, which were delayed till the early 1990s after the DHSS opposed implementing in the late 1980s, and epi-pens, which the council said was delayed by the DHSS for almost four years because of their inability to finalize epi-pen regulations.
Ultimately, money is still the primary concern. Burdzy notes that less affluent communities without professional EMS units would be at a disadvantage, with the costs hampering volunteer units’ ability to answer 911 calls. And one distinction between professional and volunteer ambulance units is that volunteer units don’t charge for services. Landers worries that any new regulations would, by increasing costs on volunteer units, have a negative impact on such units to respond. The Glen Ridge Volunteer Ambulance Squad, which relies on residents’ donations, has come to the aid of not only Glen Ridge residents but has responded to calls in neighboring towns, including two calls in Orange to cover for ambulance units engaged with other calls.
The Montclair Ambulance Unit’s Carlo continues to stress that the fees would be waived as an extension of current regulations that exempt municipal agencies. “They don’t see that in the bill because it you can’t amend a regulation until the legislation is passed,” Carlo said of the bill’s detractors.
Having now vetoed the EMS bill, the governor has recommended that Health and Senior Services Commissioner Mary O’Dowd examine the impact of changes to EMS standards, such as uniform background checks and licensure versus certification, and make recommendations for new legislation in six months.
Meanwhile, State Senator Joseph Vitale, a Middlesex County Democrat and the new chairman of the state Senate’s health committee, has let the bill expire rather than try for an override. Instead, Vitale hopes to “retool” it into a new version for the legislature to consider. The only given is that a new bill will look different from the old one. Both sides will be watching to see how different it will be.
