REALLY Solving the District’s EMS Problems

Friday the Washington Post published an opinion article by Toby Halliday.  Mr. Halliday is apparently the son in law of David Rosenbaum, the New York Times reporter who many feel died because of the inactions of the Washington DC Department of Fire and EMS.  Rosenbaum’s death in 2006 prompted the formation of a committee in 2007 that shaped DC’s EMS system today.    Mr. Halliday was part of that committee.

The restructuring that took place in 2007 has been a far cry from an effective solution of the problems that plague DCFEMS.  Some of them were not even addressed, for example, mismanaged ambulances that caught on fire, ran out of gas, or were out of service when they were needed.  While the 2007 study addressed some operational issues it completely ignored many cultural issues the likes of which resulted not only in the death of David Rosenbaum, but also Medric Cecil Mills Jr who died on a DC street while firefighters from Engine Company 26 refused to go across the street and see what was going on.

It seems like the article posted by Mr. Halliday is one that is attempting to address and defend the findings and still unfollowed recommendations of the committee that was convened seven years ago in the face of criticism that DC should adopt an EMS system similar to that of Boston, which, arguably is the most effective metropolitan EMS service in the country.  While different systems might be more effective at different levels, I think Washington, DC is a strong testament to the needs of large municipalities when it comes to prehospital medicine.  In Friday’s article, Mr. Halliday shares the “key task force recommendations” from the 2007 committee.

1.  Elevate and strengthen the EMS Mission – While Halliday cite leadership failures and a lack of patient-care experts in leadership positions, if they are searching for an effective mission statement they should look no further than the EMS based EMS system in Boston.  Boston EMS’ mission statement reads as follows, “Boston EMS, the provider of emergency medical service for the City of Boston, is committed to compassionately delivering excellent pre-hospital care and to protecting the safety and health of the public.”

Personally, I feel that the strength of an organization starts with their mission statement.  Once that mission statement is drafted it is up to leadership to make sure that it is followed and adhered to by the members of that organization.  If it is just for show, it will mean nothing, but when focused on in every project that an organization is involved in, it becomes the core of everything that department does.

Furthermore, if looking for a structure that puts patient-care experts in leadership positions, Mr. Halliday and the District should look no further than Boston’s vision statement which contains the following, “Boston EMS’ vision is to expand upon our role as a critical public safety industry that delivers exceptional pre-hospital emergency medicine in an urban environment.  The department will remain at the forefront of EMS advancements, driving progress in clinical care, operations, research, and training.”  That last sentence says it all.  WILL remain at the forefront of EMS advancements.  That is not only a commitment to the people of Boston, but it is also a commitment to the industry.

Pair their vision statement with their core development values of Patient Advocacy, Clinical Excellence, Leadership and Innovation, People, Collaboration, Pride and Unity, and Preparedness and what you have is a blue print for success in EMS.

2.  Ensure compassionate, professional, competent patient care – The second point Halliday cites seems like a no brainer to me.  While he cites shortcomings in performance evaluations and accountability, I cannot think of a department design that better fosters compassion, competent care and professionalism than one with a single solitary mission, in this case, to provide patient care in line with the values set forth by a department like Boston EMS.

The one point that I agree with in Mr. Halliday’s piece that I find myself agreeing with 100% is when he discusses the fact that, “. . . FEMS provides public information only on the speed of its responses, not the quality of the response when it arrives.”  Quality of the response does not address the number of responders or apparatus parked in front of a residence or even the number of paramedics that are present.  It actually involves what those paramedics can do, whether there is one, two, or ten of them there.

Having a single role department allows all training and focus to be placed on pre-hospital care.  Members of that organization are there for one solitary reason, and not to someday potentially make the jump to a fire engine or because doing EMS is a “necessary evil” to be part of a fire department which is an attitude I have encountered more than I would like to admit in my career.  There is no problem with wanting to be a firefighter.  I admire most firefighters because they do a job that I not only have no desire to do but would be absolutely terrified to take part in.  Leadership like Chief Ellerbe or Chief McDonald of Las Vegas who try and fool the public by telling them that everyone within their organization is operating with the public’s best interest in mind, however, is not fair to the public.  The argument of “We are better positioned to get there quickly” needs to be taken completely out of the mix.  It is time to demand quality and not quantity.

Personally, I have a lot of respect for people like the Canadian firefighter who posted this comment on my article on Toronto EMS from last year: “Speaking as a front line firefighter I have absolutely zero interest in becoming a paramedic through sone(sic) type of merger scenario. So try to remember sometimes when your bkood(sic) is boiling over the latest rumour of the Red Devil take over the guysbin(sic) the halls want nothing to do with it.”  Much like my feelings on being a firefighter, he wants nothing to do with EMS and that is perfectly okay.

3. Enhance responsiveness by revising deployment and staffing- At this point in the game, there is no better way to revamp deployment and staffing than to pull apparatus out of the DCFEMS fleet, hire single role providers, and establish a leadership team that is focused on a single mission: providing pre-hospital care to the residents and visitors of the District.  I still fail to understand why this concept is so foreign to so many people.  If a third service or private service were having the problems that DC is experiencing, the city would move on from them faster than you could blink an eye.

The department still puts ambulances out of service when staffing is short, and the fire union has shown that they will not budge on staffing and shift hours.  No one is willing to work towards solving the real issues with the department.  EMS response is a dynamic business.  Call volumes fluctuate by time of day.  It take the same number of firefighters to battle a blaze at 3am that is does at 2pm.  The staffing models are different.

The fact that Washington, DC’s ambulance is run by the fire department is not the root of the problem, the bigger issue is the deep seeded cultural issues that plague the department as well as many operational issues and distribution of the work force that do not make sense or do not seem to be in the best interest of the public.  The only way to alleviate most of these issues is to take the response of emergency medical response out of the hands of Chief Ellerbe and his staff.

Turning DC’s EMS response over to a third party municipal service could be ground breaking for EMS.  It could set the tone for the future and finally address some of the issues that plague so many large municipal EMS systems in the country.  Boston EMS has written the blue prints.  It is time for Washington DC to follow their example.

  • Ambulance_Driver

    I agree. I think Boston’s tiered response system is a model other large municipalities would do well to emulate.

  • EMS Artifact

    I don’t think it would work. The problems with EMS in the nation’s capitol go much deeper than just the name on the vehicles and uniforms. The problems are cultural and structural.

    There appears to be a culture of incompetence and unaccountability from top to bottom on both the fire and EMS parts of the operation.

    They go through medical directors like shit through a goose and chiefs at a slightly slower pace. I have no doubt that both the chief and the medical director see people that need to be fired, but are powerless to terminate anyone because of a number of factors beyond their control.

    Change has to start at the top, with the Mayor himself. He has to send a clear message, both with personnel and funding, that incompetence will not be tolerated.

    Keep in mind also that one of the recommendations rejected by the Rosenbaum Committee was to restructure EMS as a third service, patterned after Boston. The felt it was too difficult politically to achieve.

    • MedicSBK

      As I stated in my post, you’re exactly right, it IS a cultural issue as well.. and a deep seeded one. SOMETHING needs to be done, and a constant restructuring of the fire department and its leadership has failed over the past seven years.

      Emergency Medical Services in the Nations Capital do not need better Fire Department leadership. They need EMS Leadership.

      Also, with the barriers that exist for those who WANT to be single role providers not only getting hired over the years (which has improved recently) the pressure they must feel from the fire union in the city who has openly stated that they don’t want them there is a factor that I have no doubt probably keeps good EMTs and paramedics from even wanting to jump into the fray.

      Who would want to go work for a system that has so many problems? The system NEEDS to be rebuilt.