Washington, DC – The Struggle Continues

This past week, Washington DC finally took a step in the right direction by hiring what they call “civilian paramedics.”  While I am not a huge fan of the term they use for their new employees, I cannot help but stand up and applaud their move to hire staff that can be 100% dedicated to addressing the department’s shortages.

I have seen a lot of numbers of the past week: 38 paramedics on a shift with only 14 in ambulances.  80% of the department’s 160,000 calls medical in nature.  Trucks out of service.  Running out of gas.  Catching on fire.  Lately, it has been one horror story after another for DCFEMS.  While hiring paramedics seems like a logical move, one city councilman went as far to call it a “step in the backwards” for the department.  City Councilman Phil Mendelson was part of the Rosenbaum Commission which, in response to the assault and death of New York Times reporter David Rosenbaum.  That commission was a driving force in the cross-training of EMS personnel, and the overall integration of the fire and EMS systems in the nation’s capital.

The circumstances surrounding Rosenbaum’s death seem more to me to be driven by complacency and burnout than the failure of the EMS system.  The EMTs involved failed to recognize a serious medical emergency and wrote the patient off as being drunk.  Because of this, he did not get the care that he needed.  The only place where the system failed was by not having the EMTs that initially responded to the call properly prepared for what they encountered.

Now, almost six years after that committee’s recommendation, it is easy to see that the changes that were aimed at improving the system have failed.  The biggest sign of this is not the response times.  It’s not the number of trucks out of service.  It is the number of overworked and underappreciated paramedics who carried 80% of the department’s volume who have left the department because they have seen the writing on the wall.  The time for change clearly is now.

Many have called for the firing of Chief Kenneth Ellerbe.  Some would even argue that due to his spotty past before his return to DC that he should not have been hired in the first place.  I struggle though to see what replacing one fire chief with another fire chief would solve.  The department itself at this point needs a drastic overhaul, one that should involve not seeking out “civilian paramedics” but instead focusing on “career paramedics” and career EMS leadership.

With every day, week, and month that passes in Washington DC, things get worse.  The hole that they have to dig themselves out of gets deeper and deeper.  It is time to rework the department, and maybe even think about once again separating fire and EMS and bringing in a team who can focus on improving the city’s response to medical emergencies.  The current model is one that does nothing but drive up mortality rates, and burns out paramedics.

With each new vacancy on the street, you get one more bleary eyed paramedic working yet another 18, 24, or even 36 hour shift.  While his or her wallet might be stuffed with more overtime than they can think of, that money will do nothing for them when they lose their ticket due to a medication error, or their inevitable back injury.

It is time to do what many think is the unthinkable: it is time to break an EMS department away from a fire department.  Thankfully, DC is not in the financial dire straits that Detroit is.  Find the money, and start the transition.  Get the right people in to do the job, and repair this struggling system.