In mid 2006, it was brought to the attention of the Gloucester County Board of Chosen Freeholders that not all county residents were receiving Emergency Medical Service (EMS) in a timely fashion. Some municipalities within the county were providing around the clock coverage with career staffing, but a majority of municipalities were providing coverage through agencies staffed by volunteers. The Board of Chosen Freeholders, under the direction of Freeholder Director Stephen M. Sweeney, decided that an in depth review of the current operation was needed before any changes or improvements could be considered.
An EMS Committee was commissioned by the board, whose members consisted of all the “stakeholders” in the delivery of EMS within the county. Representatives were obtained from the Gloucester County Volunteer Ambulance and Rescue Association, the Gloucester County Career EMS Chiefs Association, the Mayors Association, the local hospitals, the Municipal Administrators, the Administrator’s Office of the County of Gloucester and the public.
The first item on the agenda was to analyze EMS responses within the county to determine if a problem existed, and if it did, the size of the problem. To everyone’s amazement, the committee discovered the seriousness of the problem with EMS. This situation, which is not unique to Gloucester County or to New Jersey, is that some patients wait an inordinate and unacceptably long time to receive EMS services in their time of need because it is not supplied reliably within their municipality. In the County of Gloucester it was noted that over 800 responses were eventually sent to neighboring municipalities because the “home town” squad was unable to respond.
The causes of these delayed responses have been well documented. The bottom line is: an ever increasing call volume and a decreasing number of available volunteers has stretched the EMS system beyond its ability to provide efficient, reliable, professional and timely service to the
citizens in their time of need.
The next step in the committee’s work was to survey each municipality within the county to determine how EMS was currently being provided (volunteer, career or a combination of both), the true cost to provide this service, and to determine an inventory of current ambulances, equipment, and EMS stations within the county.
The Freeholders believed that there was both a moral obligation to provide EMS and an expectation on behalf of the residents to receive it in a timely manner, regardless that New Jersey does not presently require a municipality to provide EMS.
In an effort to meet this obligation, the Freeholders resolved to supply EMS on a regionalized basis to any municipality within the County of Gloucester requesting service. To avoid duplication of costly assets, the county requested the ability to lease municipally owned ambulances, equipment and stations from participating municipalities. The county assumed the cost to maintain, insure, operate and replace these assets as needed.
By bringing a multitude of existing EMS agencies under one umbrella, expensive administrative duplication could be eliminated, training and operational considerations could be standardized and improved, and resources could be shared across municipal borders eliminating the “have” and “have not” municipalities.
A presentation was made to the governing body of each municipality describing the proposed EMS system and answering questions. The results of the EMS Committee were published frequently on the county’s website in an effort to keep the residents and the stakeholder groups appraised of the progress.
Initially, 10 of 24 municipalities signed up for service. A target start date of September 30, 2007 was selected and the County Administration then began to recruit the necessary administrative staff to direct the new department. Approximately 450 Emergency Medical Technicians (EMTs) applied for the 150 positions available within the department. Feeling strongly that volunteers should be able to continue to provide service, a robust volunteer program was created as well.
Just prior to the initiation of service, the New Jersey Department of Health and Senior Services, Office of Emergency Medical Service released the Tri-Data EMS Study (results of which are detailed elsewhere here). Among the recommendations made was a strong recommendation to regionalize the provision of service where economic or geographic factors would permit.
Gloucester County EMS (GCEMS) began to provide service at 5:00 am on September 30, 2007. In the first year of operation, 2 additional municipalities requested and received service. The average response time within these 12 participating municipalities at the end of the first year of service was an astounding 5 minutes and 58 seconds, well below the Board of Chosen Freeholders goal of 8 minutes and 59 seconds, 90 percent of the time. The “9 in 90” standard as it is often referred to, originates with the Commission on Accreditation of Ambulance Standards. The average response time of 5 minutes and 58 seconds becomes even more astounding when this includes municipalities that frequently had response times that exceeded 30 minutes.
One way that GCEMS is able to provide such rapid response is a process referred to as dynamic staging. Rather than each staffed ambulance remaining in its assigned station (there are currently 11 in the GCEMS system), ambulances are routinely reassigned to “post” in specific areas within the GCEMS service area. “Posts” are assigned based upon calls in progress, historical call volume and other factors. The benefit of this dynamic staging process is not that the first call within a participating municipality is answered rapidly, but the second, third, fourth and sometimes fifth call are all answered rapidly, seamlessly and efficiently.
GCEMS is a budgeted line item within the county budget, subject to the same budgetary pressures as any other department. Approximately 50 percent of the operating cost is offset by reimbursement received for services provided from the patients’ insurance carriers. A reimbursement contractor was hired to provide this service and is paid a percentage of the fees recovered. As GCEMS continues to grow, additional efficiencies are realized as the administrative expenditure is further spread. Currently, the operation of GCEMS represents approximately one cent on the County of Gloucester tax rate.
In 2008, participating municipalities realized a savings of over $2,600,000 in their municipal budgets.
Already in 2009, 2 additional municipalities have joined the GCEMS “family” bringing the total to 14 of the 24 municipalities within the County of Gloucester. Several of the non-participating municipalities have already indicated their intention to participate in 2010.
Andy Lovell is Chief of Gloucester County EMS and Gloucester County EMS Coordinator. Chief Lovell previously served as Logan Township’s EMS Chief and is currently a
paramedic with Virtua Health Systems in Burlington County.
This article was originally published in New Jersey Municipalities magazine. Vol. 86, No. 5, May 2009