EMS in the state of New Jersey is set up in a different manner than most readers will be able to relate to. Most of the EMS systems that I've read about, and viewed as an outsider are some combination of EMT-B's, EMT-I's, EMT-Advanced's, and Paramedics. Everyone rides around in an ambulance, and sometimes different counties provide different levels of care. That is, one county will staff its ambulances with 1 EMT-B and 1 Paramedic, while the next county over will have and EMT-B and an EMT-I.
New Jersey runs on a tiered system for EMS. There are only two levels of pre-hospital care, EMT-B and Paramedic, or EMT-P. In the NJ system, ambulances are staffed by two EMTs, and paramedic services are provided by an MICU unit, staffed by 2 paramedics, who ride in a separate vehicle. Many ALS systems (which must be hospital based in NJ) have elected to use SUV's or chase cars of some kind, because they do not have transport responsibility. This system changes the dynamics of the system a little bit.
For example, on a BLS call, only the local ambulance will be dispatched, the MICU units will not be sent to the run at all, unless the BLS upgrades the call after making patient contact. For an ALS call, one that meets ALS criteria from dispatch, both the ALS and the BLS units are sent. What that means is that for a seriously sick patient, there are actually two providers dealing with the patient on the way to the ER, either 2 paramedics, or an EMT and a paramedic (depending on nature of call, and the specific situation.) If an ALS call is dispatched, and there is no paramedic unit available to respond, the BLS unit is sent without an ALS unit, and an ALS unit is sent as soon as one is free.
This type of system also does not lend itself to much non-call related interaction between the BLS providers and the ALS providers. While this is not always the case, in most of New Jersey, the BLS crews are stationed at different buildings then the ALS crew. Where each town might have a BLS ambulance assigned on duty at any given time, there may only be two ALS units on duty for the entire county. There are exceptions, but this is a general rule. In the rural parts of the state (yes, there are still a few of them) there are often times when the ER is 45 minutes from the scene of the call, and the paramedics are not going to be able to rendezvous with the BLS unit because of geography and time constraints. In this type of situation, EMT-B's are often stuck taking care of patients that need a higher level of care, which has a tendency to mature an EMT in a quicker manner. Additionally, an emphasis is placed on the EMT's riding in the rural area to learn when an ALS unit is NEEDED, and when it isn't. It doesn't do the system any good to tie up a paramedic unit if it isn't needed, and there may be a job going on across the county were the medics are really needed.
I figured I'd post this quick intro to EMS in NJ because most of my stories will be based there, and so I wanted people to understand why when the ambulance pulls up on scene, there are not paramedics arriving. Furthermore, in most of my stories, involving my volunteer squad, it bears remembering.
1.) I lived in a rural area.
2.) My squad operated 4 ambulances and a light rescue truck (2 duty crews at night). We covered 4 towns.
3.) One 24 hour paramedic truck covered the county, and a 12 hour truck ran during the day, so 2 units during the day, 1 at night.4.) Nearest Trauma / Cardiac Center - 45+ minutes from my closest EMS station.
Hope you enjoy the stories!