COURT HOUSE – The landscape for emergency medical services (EMS) is rapidly changing. The function, once dominated by long-standing volunteer departments, is increasingly confronting financial, recruitment, and training issues.
In 2021, Lower Township disbanded its rescue squad in favor of a contract with a nonprofit, Inspira Health Network of Vineland. As 2022 began, Inspira completed the purchase of Belleplain Emergency Corps and took on responsibility for providing basic life support transport for Dennis Township and Woodbine. Middle Township put out a request for proposals (RFP) for EMS functions as part of a comprehensive review of the future of such services in the municipality.
Emergency medical services are provided in a variety of ways across the county. Purely volunteer groups still operate, as do a combination of volunteer and career operations.
Upper Township maintains a municipal EMS division, with the volunteer Upper Township Rescue Squad in backup status. EMS are part of career fire protection departments in Ocean City and Cape May, among others.
Change in how municipalities provide these services is not new. Difficulties in recruiting and retaining volunteers, rising costs of equipment and medications, increased training requirements that interfere with family and job commitments, and the growing inability of volunteers to afford to live in the community they support all contribute to pressure on the volunteer system.
A New York Times study in 2016 concluded that 25% of EMS organizations were now run by for-profit firms. A mixture of volunteers, municipal emergency medical technicians (EMTs), and private providers has emerged, creating inconsistent methods of providing the service from town to town, inconsistencies that can intrude on mutual aid arrangements where patients may not understand they are subject to different rates and insurance arrangements when a mutual aid ambulance arrives.
In New Jersey, EMS is a tiered function with first responders, basic life support EMTs, and advanced life support personnel. What many citizens do not understand is that EMS is not an essential service in New Jersey. Even though in the popular mind, the triumvirate of emergency response includes police, fire, and EMS, only police and fire are considered essential.
To best understand this, one must put the expanded pandemic use of the term essential services to the side and consider essential services from a non-Covid perspective.
Services designated essential by the state are services municipalities must offer either through direct financial commitment or through some other arrangement. Police and fire services are prime examples. Since EMS is not an essential service in the state, municipalities are able to vary the support and attention given to it. This results in a variety of methodologies for providing EMS across the state.
EMS is also not a federally defined essential service, meaning it does not qualify for the same level of federal financial support through grants as do those functions deemed essential.
Only 11 states currently designate EMS as an essential service, including neighboring Pennsylvania, Delaware, and Connecticut. Legislators in New York have recently introduced bills to designate EMS as an essential service.
Yet, almost all states and the federal government have routinely increased the training requirements, placing volunteer departments in situations where the high cost of training and the time commitments are likely to reduce the ability to recruit and retain personnel.
The New Jersey Office of Emergency Medical Services certifies roughly 26,000 EMTs with basic life support credentials, 1,700 EMT paramedics, and 4,500 EMS vehicles. Emergency medical transport and basic life support services represent a large complex network of providers with varying response times, billing arrangements, and insurance mandates.
EMS services have traditionally lived off the fees for ambulance transport to fund operations. Even the recent contract between Lower Township and Inspira is predicated on a relatively modest payment from the township of $35,000 annually, with the rest of the revenue expected through fees for transport.
In Cape May County, this kind of arrangement has hampered some EMS providers given the high use of Medicare and Medicaid insurance coverage where reimbursements are lower than what is often provided by private coverage.
Some legislators in Trenton believe it is time for EMS to stand for essential/emergency medical services. Bills have been floating around but lack the urgent push to move them through the hierarchy of committee consideration to state Assembly and Senate votes.
To contact Vince Conti, email vconti@cmcherald.com.
