|Several large-scale changes
over the last 40 years have resulted in the way emergency medical
service is delivered in the City of Vineland, New Jersey.
Into the early 1960's, the
ill an injured that had no other means, were delivered to the
local hospital by ambulance. Typically someone would call
Newcomb Hospital and request the ambulance. A taxi dispatcher
would alert one of the local cab company drivers to go to the
hospital and get the ambulance for the emergency. Witnesses to
this process often speak in their stories, about the use of
jumper cables and other mechanical hurdles the driver had before
him. A police officer often helped the driver complete his
mission of grabbing the sick and wounded and moving them toward
In 1963 a way of helping
those in emergency need was put to work. The Vineland Police
Department assigned two of its on duty police officers to the
police emergency unit. The emergency unit was a Chevrolet
Suburban that carried a stretcher and first aid supplies. This
unit did double duty. The officers aboard were able to enforce
the law, respond to police emergencies and now respond to
medical emergencies. This plan shortened the time from the
patient's illness or injury to the time the patient reached the
hospital emergency department.
Also to join the existing EMS
system was a volunteer rescue squad and a transport ambulance.
The rescue squad mostly performed vehicle extrication and a
support function to the Fire Department but was capable of more.
An ambulance driver staffed the transport ambulance via the
Police Department. The out-of-town, Cadillac ambulance was most
often used to take patients from the local hospital to tertiary
care centers. The hospital provided all additional staffing that
was required. Usually this was a single nurse with equipment and
The level of training up to
this point, which moved into the 1980's, varied in all
components. Most of the police officers that regularly staffed
the police emergency units were certified as Emergency Medical
Technicians and in CPR. With the increasing number of EMS and
police calls it was difficult to staff the emergency unit with
currently certified EMTs. This was particularly true when
circumstances required more than one police emergency unit be
deployed. This was becoming more frequent. The volunteer rescue
squad was mostly Emergency Medical Technician trained. Other
training and competencies were tested and improved within the
group. The transport ambulance driver was a paramedic who often
took temporary assignment in the police emergency unit.
Equipment and supplies
gradually improved in the Police emergency units and the Rescue
Squad. Most of the EMS supplies aboard the Police emergency
units were from the hospital. For instance, a fractured wrist
would be splinted with a metal cock up splint and ace bandage
rather than the typical board splint and cravats used by most
rescue squads at this time. Portable resuscitation equipment and
suction was added in the 1980's. The rescue squad obtained the
"Jaws of Life," Hurst tool prior to this.
In 1985 NJAC 8:40 et seq.
became law. It was a portion of the New Jersey Administrative
Code that required a standard of non-volunteer ambulance
agencies. The City of Vineland was notified it should comply.
Vineland responded in a
limited fashion. The police emergency units became Chevrolet
vans. More equipment could be carried and patients could be
positioned at 90 degrees on the stretcher. This improved patient
care. The added room of the van also facilitated additional
equipment and even room for a second supine patient. Vineland
was still far short of the new standard but carried on a system
that exceeded the performance of many unregulated areas of the
state. The wait for help in Vineland was clearly less than in
other areas. The equipment that responded to the emergency was
also less than that which could be found in other areas.
In 1988 the new Mayor, Harry
Curley saw the need to change. He appointed a study committee.
This committee consisted of the following people.
Bernardini - a local orthopedic surgeon and physician leader.
Mr. Tom Rayner - the Chief Operating Officer of Newcomb
Mr. Leon Mazzochi - a long time local business man with a role
in the volunteer fire service.
Mayor Curley - a former Sergeant in the Vineland Police
Department and former Board of Education President.
Director Louis Cresci, Jr. - the City's Director of Health and
Health Officer who was part of the volunteer fire service.
Mr. Si Solazzo - along time City Council representative and
Council President. Mr. Solazzo was also an advocate of the 1963
upgrade to police emergency units.
Director Biaggio Ciulla - Director of Fire and Fire Chief
Director Jack Carr - Director of Emergency Management which
oversaw the Rescue Squad and a full time Fire Captain with the
Vineland Fire Department.
Chief Joseph Cassisi - Chief of the Vineland Police Department
and a police veteran that saw the implementation of the police
was charged with finding the best way to improve the City's EMS
system. Their foremost goals were the provision of quality
patient care and compliance with the state regulations. They
viewed other systems including private, paid, volunteer, large
community, and small community systems.
The result was a
separate and distinct Emergency Medical Service Division to be
within the structure of the Fire Department but located
separately. Jack Carr a paid Fire Captain that rotated shifts
with a platoon was removed from the platoon and assigned to a
day shift to work with this program. Alfred Lincks, the City
Police Department ambulance driver provided research and
information as an internal resource during the committee's
process. He was appointed to supervise the new unit. The Police
Department was not downsized. This freed more police officers to
handle the ever-increasing volume in police calls. The 24 hour
on / 48 hour off schedule of the Fire Department looked like a
fit for the Emergency Medical Service Division. The Fair Labor
Standards Act rulings at the time made this appear as an
economical way to staff. The new Division answered its first
call, June 4, 1990.
The new Division
was compliant with the state regulations. As more personnel were
brought on the City of Vineland Emergency Medical Service
Division assumed its 24 per day / 7 day per week role of
providing state of the art pre-hospital care and transportation.
Under aggressive management the Division moved quickly to
implement a defibrillation program as the regulations began to
make it possible. Mayor Curley was recognized by the NJ
Department of Health for his efforts in the implementation of
The City's Health Department and in particular Louis Cresci,
Jr., Director of Health remained strong advocates for the
system. The local Health Department had experience with third
party billing as a revenue source through its Nursing, Home
Health Care Division. The new Emergency Medical Service Division
was implemented as cost effectively as possible. Ambulances were
mostly parked outside with heaters to help melt frost and snow.
Personnel were hired at lower salaries than police officers. The
primary station was a house the hospital loaned to the City
(still in use today). Another unit was stationed at a volunteer
fire House in South Vineland (also still in use today). In spite
of these efforts there was a fiscal impact. The Police
Department had more officers for patrol and the Fire Department
had a new captain promoted. The Emergency Medical Service
Division began cost recovery efforts through third party billing
and became a Division of the Health Department.
When needed, the
growth of this Division has been supported. Several new vehicles
were purchased under the administration of Mayor Romano. When
internal quality improvement research showed a lagging response
time in north Vineland was worsening, Mayor Campanella's
administration provided for the expansion of the service and the
construction of its first new building. Currently under Mayor
Barse, an examination of the service was commissioned. Carroll
Buracker and Associates, Inc. have submitted recommendations for
improvement of the service that are now under review.
Emergency Medical Service Division operates three ambulances
around the clock. A field supervision component is strong in
ongoing quality improvement. It exceeds minimum state standards
and aptly answers calls at the national standard for response
times. The community views Vineland EMS as an asset. VEMS has
the support of the governing body when needed to carry out its
mission of providing pre-hospital emergency medical care.