Some of the sharpest and most politically aware EMS leaders I know grew up as New Jersey paramedics. These paramedics are hospital-based and work on non-transport Mobile Intensive Care Units (MICU) staffed with 2 paramedics responding into a convoluted home-rule patchwork of ambulance transportation that is frighteningly variable in promptness and competence. And now, 20% of these paramedics will lose their jobs on April 1st.
Here is an excerpt from an email sent from President Jeff Behm, president and CEO of the Monmouth Ocean Hospital Service Corp. to their employees last week:
We have seen a decline in service participation from our members. As these healthcare systems grew and acquired their own EMS programs, the need for MONOC to service them diminished. While we have focused on our core business of the MICU program, a hospital cooperative model, such as MONOC, cannot survive with reduced participation.
With that said, the MONOC Board of Directors have voted unanimously to dissolve MONOC and transfer the MICU program to the patron-hospitals. This will ensure continued viability of MICU services in all of Monmouth and Ocean counties, as well as the designated municipalities within Bergen, Essex, Hudson, Passaic, and Union counties, currently provided by MONOC.
April 1, 2020, will see the end of a 42-year run of the Monmouth Ocean Hospital Service Corporation. MONOC is a non-profit provider of paramedic and medical transport services in New Jersey. About 250 paramedics and 70 other caregivers, dispatchers and staff are impacted by the closure.
An Ugly and Stressful Transition
The first week after the announcement has been profoundly stressful for MONOC employees. The transition plan seems to have produced blunt and cruel workplace situations. Every workday through March 31 is a “key” day – call out and you will not get paid – no sick leave or PTO will be granted.
In addition, with the closure of MONOC you may lose all of your accumulated leave.
Zachary Weiss, a paramedic who is organizing a union at Robert Woods Johnson Mobile Health Services, responds to the WARN letter, MONOC emails to employees, and conference call with MONOC leadership.
It is a detailed 28-minute response to MONOC President Jeff Behm, IAFF Local 4610 – Professional Emergency Medical Services Association of New Jersey, and Director Scot Phelps, NJ Office of Emergency Medical Services.
Opportunity To Quickly Change Policy In Response to Crisis
I spent two-and-a-half years working at a New Jersey hospital as a contracted interim EMS executive director. The hospital was changing owners and we had to operate under a complex set of federal and state regulations during the transition. While every state is different, I found New Jersey’s EMS regulations most unique.
But, apparently, the state EMS regulations are able to be ignored when it is politically expedient to do so.
For example, the state quickly authorized Narcan use by law enforcement. The Office of EMS procedure for new medications was ignored. The accelerated process resulted in a period of time when police officers were authorized to use Narcan but my paid EMTs were not.
I had to report an “incident” to State EMS because, at a chaotic overdose scene, local law enforcement handed their second Narcan kit to my paid EMT to use on a patient. That EMT was authorized to use Narcan as a member of a volunteer rescue squad, but not as my employee. The hospital needed to have completed training of all EMTs, full-time and per-diem, before we were authorized to administer Narcan. We were still training.
That was small potatoes when compared to an abrupt change of paramedic providers in Camden.
Will New Jersey MICUs become 1 Paramedic-1 EMT units?
Last-minute state legislation in the summer of 2015 authorized Cooper Hospital to take over paramedic services in Camden, abruptly replacing Virtua who has been the paramedic service provider since 1977. This authorization by-passed the state-required MICU certificate of need process for new paramedic services.
Part of the change also allowed Camden to assign paramedics to transporting ambulances. At peak times, Cooper Hospital deploys 6 EMT and 3 paramedic ambulances.
The law, S2980, also allowed Cooper to combine advanced life support (ALS) calls that use paramedics with basic life support (BLS) which runs the ambulances that take patients to the hospital. The change was designed to make the services more efficient.
Zachary Weiss suggests in his video that the transition of paramedic service back to the host hospitals will be a failure. He points out that, under the existing system, MONOC has difficulty staffing all of the MICUs serving Barnabas and Robert Woods Johnson.
Initially, the hospital hiring process appears unprepared for the transition. Experienced MONOC paramedics are being told that they are “not qualified” when they apply to work as a paramedic at the hospital site they have been covering for years. There appears to be an active effort to fix this problem.
My experience is that it takes more than a month to get an experienced paramedic on-boarded as a hospital employee – THEN we start the EMS orientation. I do not think there will be 100% hospital-provided MICU staffing on April 1st.
Weiss suggests that this staffing crisis will provide the opportunity to eliminate the 2-paramedic requirement for MICUs. A proposed staffing change in S617 Paramedic Bill Staffing Model has “Advanced Paramedic & Paramedic Assistant” as a MICU staffing option.
The proposed staffing changes in S617 are interesting. It creates a clinical career ladder for paramedics, including paramedics providing mobile integrated healthcare. I fear that an ineffective transition from MONOC to host hospitals will create a MICU staffing crisis that would lead to changing the staffing regulations – allowing a MICU to operate with 1 MICU paramedic or MICU Nurse and 1 EMT.
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Livio, Susan (2015 July 06) “Christie signs bill giving EMS contract to hospital chaired by power broker Norcross.” NJ.com. Accessed 01 Feb 2020 https://www.nj.com/politics/2015/07/christie_signs_bill_giving_cooper_hospital_ems_con.html
Stainton, Lilo H. (2016 August 29) “Ambulance Wars: New Jersey appellate court rules in favor of Cooper [Updated].” WHYY. Accessed 01 Feb 2020 https://whyy.org/articles/ambulance-wars-new-jersey-appellate-court-rules-in-coopers-favor/
Hurdle, Jon (2019 March 6) “Camden city EMS reports more calls, quicker response times in 2018.” WHYY Accessed 01 Feb 2020 https://whyy.org/articles/camden-city-ems-reports-more-calls-quicker-response-times-in-2018/
Featured Image: (2016 April 6) MONOC ambulance hit by tractor trailer, three injured. app.com. USA Today Network