Mix of Hope, Doubt Surrounds N.J. EMT Switch

July 13--If all goes as ordained by New Jersey lawmakers, six months from now Camden will be served by a fleet of brand-new ambulances and emergency vehicles staffed by paramedics and medical technicians working for Cooper University Hospital.

Cooper, a teaching hospital and a designated Level 1 trauma center, was authorized to take over these services in legislation signed by Gov. Christie last week.

Will Camden residents needing emergency care be better off?

They will be, Cooper officials promise and some EMTs cautiously hope.

The EMTs currently work for Newark-based University Hospital, which reportedly wants out of Camden.

Supporters of the Virtua health system, which has been performing paramedic services in the city for 38 years, say there was no need for the change, and Virtua officials have threatened litigation.

A state advisory panel made up of emergency-medicine professionals recommended last month against the legislative switch. Members said Cooper should have gone through a comprehensive application process that would have taken months, whereas lawmakers approved the switch barely two weeks after it was proposed.

Ryan Kelly, 32, a Virtua paramedic for more than a decade, said he and other paramedics also were concerned that Cooper's takeover of emergency medical services did not go through the normal regulatory process.

"Many of us would have probably been open to an idea of change if it was presented properly," he said.

Cooper officials said they could not yet say much about their plans, as they were still being developed and would be subject to review by the state Department of Health. But Dan Fee, a spokesman for Cooper board chairman George E. Norcross III, said the hospital would improve response times and overall care.

The Camden County Department of Public Safety has said that in about one-quarter of cases so far this year, Virtua's paramedics needed more than eight minutes to respond to emergency calls.

"The response times will be dramatically improved," Fee said.

While the eight-minute benchmark is sometimes used as a performance measure for paramedic squads, not all conditions require such a rapid response, said James Augustine, a board member for the American College of Emergency Physicians.

The eight-minute standard was developed by the American Heart Association specifically for paramedics responding to cardiac arrest, said Augustine, an emergency physician at Fairfield Medical Center in Lancaster, Ohio. Some other conditions, such as a broken bone, can wait longer, if paramedics need to devote resources to a more pressing call, he said.

Physicians say some patients can do without paramedic care entirely, provided they get to a hospital quickly -- a reasonable goal in a city where no address is more than two or three miles from one.

As elsewhere in New Jersey, Camden currently uses a two-tier system to respond to emergency calls. Emergency medical technicians, employed by University Hospital, arrive in an ambulance and are trained to provide basic life support, including CPR.

In cases where advanced life support is needed, such as intubation and the administration of intravenous fluids, Virtua's paramedics also respond to the scene in a second vehicle.

University Hospital was losing $1 million a year in providing basic life support in Camden and wanted out, Cooper officials say. University Hospital declined to comment.

Now Cooper will assume both roles -- basic and advanced life support -- allowing for a smoother operation and more coordination of care, Fee said.

Christie's office declined to comment on why he signed the bill, but he said beforehand he would base his decision on what would result in "service to the people of Camden."

Currently, 69 percent of advanced life-support cases in Camden are taken to Cooper, 29 percent go to Our Lady of Lourdes Medical Center, while others go to a satellite Virtua facility in Camden.

Virtua declined to make an official available for an interview. A spokeswoman said the health system had not received any information about how the transfer would take place, and was considering whether to challenge the move via litigation.

Adam Hennessey, an emergency physician at Lourdes, said he had been very pleased with the Virtua paramedics.

"There's been an incredibly high level of care that Virtua's been providing for more than 30 years now," Hennessey said. "We don't see a need for that to change."

Alexander J. Hatala, president and CEO of Lourdes Health System, expressed concern at a news conference late last month that a Cooper takeover could deprive his hospital of patients and shut it down.

If Cooper controls EMS, Hatala asked, "are they going to make the right decision on behalf of the patient, or are they going to make a decision that benefits their organization?"

Cooper officials have promised they would work with the other Camden hospitals and continue to distribute patients as done now.

Two Camden EMTs, who spoke on condition of anonymity because they were unsure of Cooper's plans, said the takeover might benefit the EMT service and the patients it serves.

They said University Hospital had left them with old ambulances that occasionally break down.

One EMT said equipment was sometimes lacking. He said the Camden EMTs, unlike those in some other towns, don't carry continuous positive airway pressure equipment, which pushes air into a patient's lungs if they have filled with fluid.

The two EMTs expressed hope that Cooper would provide better tools and more training on lifesaving techniques.

As for who would get to perform these techniques, that remains unclear. The hospital has not announced whether current EMTs and paramedics would be rehired.

"Am I concerned about a job? Absolutely," one EMT said. But he added: "I embrace this change to Cooper. It's probably one of the better changes from a BLS perspective."

Another EMT said he and others expect Cooper will hire some, if not most, of the current EMTs, given their experience in Camden.

"It would be a shame to get rid of the experience level," the EMT said.

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