Chief Mazza: New Jersey EMS ‘Close to Collapse’

By James Careless

New Jersey’s Emergency Medical Services are in such a dire state, that they’re “damn close to collapse.” That’s the warning being issued by Chief James Mazza, Chief of Emergency Medical Services at the Montclair Ambulance Unit. It is a nonprofit organization that is independent of the township of Montclair, NJ, with a paid staff of 45-plus EMS professionals.

The reason New Jersey’s EMS agencies are in such trouble is because they’re not considered to be an essential service by the state. “Police, fire, sanitation, health, animal control, those are all required by statute to be provided to the citizens of each municipality,” said Chief Mazza. “Yet there is no statutory requirement within the state of New Jersey that EMS be provided to its citizens."

Because EMS is not an essential service in New Jersey (while animal control is!) agencies like the Montclair Ambulance Unit receive minimal government support.

As a result, “Approximately 75% of our budget comes from insurance billings, while the remaining 25% comes from grants and other forms of fundraising — everything from direct mail to running CPR classes to charging for events, standby, and things like that,” Chief Mazza said. “In turn, 75% of our budget covers our payroll costs and everything associated with it such as payroll, health insurance, and taxes. The other 25% covers everything else, like vehicle maintenance, medical supplies, medical equipment, and toilet paper. Even though we're a nonprofit, just like any other nonprofit, we have to pay for toilet paper.”

“Here’s the problem: The public expects us to operate on a public safety model like police and fire, being funded by tax dollars to provide service,” said Chief Mazza. “However, we're only funded on a healthcare model. This means we only get paid by the insurance companies, not the government, if we provide treatment to patients — in New Jersey specifically, only if we then transport them to a hospital. If we don't transport them to a hospital, we're not getting paid. It just doesn't work as a business model when it comes to 911 ambulances.”

It doesn’t help that New Jersey hasn’t raised its Medicaid payments for years and that a bill to raise them is stalled in the State Assembly. “Right now, our rate is among the lowest in the country,” he told EMS World: “For an emergency BLS transport, it is $58 a call and $1.50 per mile. No other state for emergency transport is that low, and that rate was set in 1994. To put it in context, I was in second grade in 1994 and Christie Todd Whitman was the governor. Worse yet, it appears that in 1993 it was actually 20% higher, but it was deemed that we needed to make New Jersey's Medicaid payments more in line with the rest of the country. So they lowered it by about 20% in ‘94 and this has sat at this number for the last 30 years. We transport 1000 individuals that have Medicaid as their primary insurance, and on average we're going to lose over $300 a call every time we transport one of those individuals.”

Making matters worse is the chronic understaffing problem affecting the EMS sector. “The whole system has been dealing with staffing problems, and COVID has just made that worse,” Chief Mazza said. “For example, in our location, we are responding to more mutual aid calls than ever on a daily basis. What that means, from a number standpoint, is that we were on 200 mutual aid calls in 2022, which doubled to 400 mutual aid calls in 2023, and we are going to blow past that number this year. And we're going into other communities, passing ambulances sitting idle that either are not staffed or they don't have enough staffing, which is why we are going into those communities!”

Meanwhile, the lack of government funding is affecting the Montclair Ambulance Unit’s ability to keep vehicles on the road. “We have five ambulances,” said Chief Mazza. “One of them is out of service permanently due to an engine failure. We have to take out a loan to replace it because we can't just raise taxes for it. So we have to do a traditional loan and need to show revenue to make that traditional loan happen — but how do you really show revenue in a business that really shouldn't be making revenue to begin with? We also don't have a capital budget, so if anything breaks, we have to fix it out of our operating funds. We had to apply for a grant for ballistic vests and defensive training for our EMTs. Just this last year we've had three separate shootings in our town and that's within 2024. In 2023, we had six of our EMTs assaulted. So this is necessary equipment and training.”

The bottom line: New Jersey’s EMS agencies need to be funded as an essential service, if this sector is to be viable going forward. This means giving this state’s EMS agencies access to funding and grants from all levels of government, regularly.

“This shouldn't be run as a business,” Chief Mazza said. “It needs to be run as an essential public service with adequate and reliable funding. We can't just say EMS is essential without funding it as such. That's like management throwing a pizza party during EMS Week, and doing nothing else.”