The Pennington First Aid Squad in curly text



BLS Training Standards In New Jersey

By: Rick Heller, J.D., LL.M.1

One question that is often asked here in the great State of New Jersey is who in New Jersey sets the training standards and minimum crew configurations for volunteer ambulance basic life support crews? In order to reach that decision, the first question that must be answered is what is meant by the term "volunteer"? This article will attempt to answer that question and the basic question presented regarding training standards and crew configuration.

Executive Summary

     Issue: In New Jersey, who sets the training standards and minimum crew configurations for volunteer ambulance basic life support2 ("BLS") crews?

     Answer: Pursuant to state statutes, the New Jersey State First Aid Council, Inc. (NJSFAC) sets minimum training standards for volunteer ambulance BLS crews. (N.J.S.A. 27:5F-22)

     Issue: In New Jersey, who is responsible to certify that volunteer ambulance BLS crews are certified and meet appropriate standards?

     Answer: The officers of each volunteer BLS squad are responsible for training its members and the governing body of the squad's municipality (or local government) shall certify each member as meeting the standards for training promulgated by the NJSFAC and that individual members are qualified to provide emergency medical services in conjunction with the operations of the squad. (N.J.S.A. 27:5F-27)

Discussion

The Role of the NJSFAC in Setting Training Standards for Volunteer Squads

In the State of New Jersey, there is a bifurcated statutory and regulatory scheme between volunteer ambulance squads and non-volunteer ambulance squads. Only nonvolunteer squads fall under the regulatory umbrella of the Department of Health and Senior Services (DOH). Accordingly, it is critical to determine whether a squad has volunteer or nonvolunteer status under New Jersey law.

The only statutory definition of volunteer and non-volunteer first aid, rescue and ambulance squad found in New Jersey Law is NJSA 27:5F-20 (New Jersey Highway Traffic Safety Act of 1987)("NJHTSA"). NJSA 27:5F-20.f. provides:

"Volunteer first aid, rescue and ambulance squad" means a first aid, rescue and ambulance squad which provides emergency medical services without receiving payment for those services.

NJSA 27:5F-20.g. provides:

"Nonvolunteer first aid, rescue and ambulance squad" means a first aid, rescue and ambulance squad which provides emergency medical services on a paid basis.

The NJSFAC has obtained a letter opinion 3 from the Attorney General's office. N.J.S.A. 27:5F-20(f) is quoted as the controlling definition for volunteer first aid, rescue or ambulance squad. The Attorney General opines:

Therefore, it appears that whether the squad receives payment for its services is the critical factor in determining its status, rather than whether the squad has paid members. [emphasis added]

The test for determining whether or not a squad is volunteer is applied at the squad level and not the member level. If a squad bills for service, it is not a volunteer squad regardless of whether or not its personnel are volunteer. Therefore, under the law, paid EMTs who work for a squad that does not bill for services are working for a volunteer squad.

A second category of emergency care is advanced life support4 (ALS). In New Jersey, mobile intensive care paramedics5 , who are certified and regulated by the DOH, provide ALS services. All ALS paramedic requirements and standards are promulgated and maintained by the DOH. These ALS units are hospital-based and generally work in conjunction with both volunteer and non-volunteer BLS providers that have the primary job of patient transportation. ALS units bill for service, are not considered a volunteer service and do not fall under the direction of the NJSFAC.

At this point, a little history may be helpful to understand New Jersey's unique statutory landscape. Prior to 1971, the State left it to local municipalities to determine the nature and content of the basic first aid training course given to members of local volunteer ambulance squads as well as who could serve on the volunteer squad. Most volunteer squads used the training program that had been developed by the NJSFAC.

In 1971, in order to obtain federal grants for highway traffic safety, the Legislature passed and the Governor signed the New Jersey Highway Traffic Safety Act of 1971. Three provisions of that Act, which were reenacted in the New Jersey Highway Safety Act of 1987 (1987 HTSA), continue in effect to this day. The Act provided: (1) the uniform basic first aid training program for voluntary rescue/ambulance (2) squads would be that of the NJSFAC,6 and (2) the decision as to who was (3) qualified to serve on a local squad (including the determination that the required (4) basic course requirement had been satisfied) was to be made by the squad (5) officers and the local municipal government.7

The third relevant section is most unusual. So determined was the Legislature to preserve local control of voluntary rescue/ambulance squads (subject to the uniformity of the NJSFAC's training program) that it included language which not only prohibited further regulation of voluntary rescue/ambulance squads by any governmental entity, but also included language that required specific repeal of the section before its prohibition could be altered or removed by new legislation.8

The 1987 HTSA requires NJSFAC training programs to comply with federal standards but not federal suggested guidelines.9 In 1987, the federal standard was the EMT Training Program. This standard was to be followed by the NJSFAC in its training programs. Under the 1987 HTSA, the Office of Highway Traffic Safety is charged with the responsibility to certify that New Jersey training programs comply with federal standards.10 In the 1987 HTSA, the DOH is not mentioned or given any authority over BLS training standards or volunteer rescue/ambulance squads.

In 1989, the federal government changed the federal EMT training standards to guidelines. The 1987 HTSA only requires adherence to federal training standards. Currently, there are no federal training standards, only guidelines.

The Legislature reaffirmed their commitment to the emergency service training program for volunteer rescue/ambulance squad personnel found in the 1987 HTSA11 when they enacted the emergency medical technician/first responder cardiac defibrillation bills.12 N.J.S.A. 26:2K-46 provides:

"[n]othing in this act shall be construed as interfering with an emergency service training program authorized and operated under the provisions of the "New Jersey Highway Traffic Safety Act of 1987," P.L.1987, c.284 (C.27:5F-18 et seq.).

The NJSFAC adopts training standards applicable to all volunteer rescue/ambulance squads.13 The NJSFAC's Bylaws state in part at ARTICLE IX, SECTION 2:

***Any addition or elimination of training requirements shall be a recommendation from the [Education and Training] committee and have concurrence of the majority of the Squads. Squads will vote at the District level. The District officers, within 30 days of notification of the proposed changes, will bring the District's voting results to the Board of Trustees to be tallied on a Squad vote basis. ***

The NJSFAC publishes their approved training requirements in their annual directory. A copy of the current training standards is attached hereto as Exhibit A. These training standards allow an ambulance crew to consist of several configurations including:

Two EMTs;

One EMT and one First Responder; and

One EMT and One Driver with CPR and an approved driving course.

Based upon the clear language of the statutes, the NJSFAC is required to adopt acceptable training programs for volunteer rescue/ambulance squads.14 Nothing in New Jersey Statutes changes that statutory scheme. Nowhere in the New Jersey Statutes is the responsibility for volunteer rescue/ambulance squad training programs given to the DOH.

The Role of the DOH in Regulating Volunteer Squads

The legislature did give the DOH broad authority over hospital and health care related services.

***the State Department of Health shall have the central responsibility for the development and administration of the State's policy with respect to health planning, hospital and related health care services and health care facility cost containment programs, and all public and private institutions***."15

Nevertheless, the DOH's power to regulate certain Health Care Services is limited by the following section of law found at N.J.S.A. 26:2H-2b.:

"Health care service" means ****, ambulance service, ****, but excluding services provided **** by [volunteer] first aid, rescue and ambulance squads as defined in the "New Jersey Highway Safety Act of 1971," P.L.1971, c.351 (C.27:5F-1 et seq.).16

The DOH's power to regulate certain Health Care Services is again limited by the following section of law found at N.J.S.A. 30:4D-6.5:

The provisions of this act shall not apply to services provided by volunteer first aid, rescue and ambulance squads as defined in the "New Jersey Highway Safety Act of 1971," P.L.1971, c. 351 (C. 27:5F-1 et seq.).17

Based upon the foregoing sections, the DOH has published regulations dealing with ambulance service and mobility assistance vehicle services (generally wheelchair vans). In those regulations, the DOH acknowledges that it has no authority to regulate or set standards for volunteer rescue/ambulance squads. NJAC 8:40-2.5 provides in part:

In accordance with the provisions of N.J.S.A. 30:4D-6.2 et seq. and 26:2H-1 et seq. this chapter shall not apply to Mobility Assistance Vehicle Services or Ambulance Services provided by volunteer first aid, rescue and ambulance squads as defined in the "New Jersey Highway Traffic Safety Act of 1987" (N.J.S.A. 27:5F-18 et seq.).18

The DOH is in possession of an Attorney General's Memo19 that discusses the 1987 HTSA20 and the DOH's proposed invalid coach - ambulance regulations. This memo places great weight on the issue of whether or not a squad charges patients for their services in determining volunteer status and thus whether the DOH can regulate such a squad or its activities. The Attorney General explains:

Thus, a working definition of volunteer squad for purposes of determining the regulatory authority of the Department of Health is a first aid, rescue and ambulance squad which is organized and operated under private auspices and receives no reimbursement for its services from charges to the individual served. Using this definition, the Department's regulatory authority would extend to ambulance and emergency medical services which charge for services, such as those provided by a hospital-operated unit and by a proprietary organization charging for service***. So long as the first aid, rescue and ambulance squad is predominately comprised of members of a private group and charges no fee for its services, the organization qualifies as a "volunteer" squad which is excluded from the scope of Departmental regulation under N.J.S.A. 26:2H-2(b). [emphasis added]

The DOH's published position is if an ambulance service is nonvolunteer (meaning it charges for its services) then the DOH sets the standards for this service and regulates it. DOH regulation N.J.A.C. 8:40-3.7 requires a nonvolunteer ambulance to be staffed with at least two certified emergency medical technicians that are also certified in CPR.

Another issue that causes some confusion in New Jersey is the role of the DOH as the certifying agency for the EMT course. Presumably, under the DOH's broad power to deal with health care related issues found in N.J.S.A. 26:2H-1 et seq., the DOH has applied to and been accepted by the United States Department of Transportation as the certifying agency for the New Jersey EMT course. There is no specific statutory grant of authority to the DOH for this activity. In fact, arguably, this certification activity has been granted to another state agency to perform; specifically, the Office of Highway Traffic Safety.21

The DOH's current position is that the EMT Training Fund Act22 gives the DOH the ability to establish minimum training course requirements for EMT courses and EMT continuing education units (CEU) for which they provide funding. The EMT Training Fund Act does not give the DOH any power to regulate the activities of or set training requirements for volunteer squad personnel.

Based upon the clear language of the statutes and their own regulations, the DOH has no role in regulating or setting training standards for volunteer rescue/ambulance

Conclusion

The NJSFAC adopts a uniform basic first aid training program for voluntary rescue/ambulance squads.23 The NJSFAC. annually publishes its basic training and minimum ambulance crew configuration. The decision as to who is qualified to serve on a local squad (including the determination that the required basic course requirements are satisfied) is to be made by the volunteer squad's officers and their local municipal government.24 The DOH has no statutory authority to regulate or set standards for volunteer rescue/ambulance squads.25

References

  1. Rick Heller is an attorney licensed in New Jersey and Pennsylvania and a New Jersey EMT. He is also a life member of Rutherford First Aid-Ambulance Corps, Inc and an active member of Livingston First Aid Squad,Inc. This article reprinted with permission of the editor of the Gold Cross Magazine.
  2. N.J.S.A. 26:2K-21b. & 26:2K-49
  3. Letter dated October 6, 1989, to Ken Koenitzer, NJSFAC from Peter N. Perretti N.J. Attorney General
  4. N.J.S.A. 26:2K-7a & 26:2K-49
  5. N.J.S.A. 26:2K-7h
  6. N.J.S.A. 27:5F-22
  7. N.J.S.A. 27:5F-27
  8. N.J.S.A. 27:5F-30
  9. N.J.S.A. 27:5F-22
  10. N.J.S.A. 27:5F-29c.(9)
  11. N.J.S.A. 27:5F-22
  12. N.J.S.A. 26:2K-39 et seq. L. 1989, c.314 amended L. 1996, c. 13
  13. N.J.S.A. 27:5F-22
  14. N.J.S.A. 27:5F-22
  15. N.J.S.A. 26:2H-1
  16. N.J.S.A. 26:2H-2b.
  17. N.J.S.A. 30:4D-6.5. Inapplicability of act to services by volunteer first aid, rescue and ambulance squads
  18. NJAC 8:40-2.5a.
  19. January 11, 1985 Memo to Roy W. Nichels, Director Office of Emergency Health Services [DOH] from Charlotte Kitler, Deputy Attorney General
  20. N.J.S.A. 27:5F-18 et seq.
  21. N.J.S.A. 27:5F-29(9)
  22. N.J.S.A. 26:2K-54 et seq. (L. 1992, c. 143)
  23. N.J.S.A. 27:5F-22
  24. N.J.S.A. 27:5F-27
  25. N.J.S.A. 27:5F-30 & 26:2H-2b.