DC Fire and EMS from a STAR CARE Point of View

Back in September of 2010 when this blog was still in its infant stages and living on Blogspot, I wrote a post about STAR CARE, which I described as the “magnetic north of your moral compass.”  In light of the recent events in Washington, DC (say it with me folks: WHICH ONE?!) I want to take a look at the decision made by Lieutenant Kellene Davis that led to her granted retirement and dodging of department discipline.

For those of you who have spent the last couple of months living under a rock, or just recently have been introduced to the wonderful world of the internet, Lieutenant Davis was the officer in charge of Truck 15.  To summarize, and keep the story short, she failed to act when 77 year old Cecil Mills had collapsed across the street from her fire station.  He eventually died.  While we cannot be sure that a response by Truck 15 would have saved the man, what we can be sure of there was no action taken.
Now, Dave Konig was quick to point out to me that STAR CARE is an EMS tool and not a fire department tool, but DCFEMS is an EMS provider, so STAR CARE can and should apply to them as well.  As the commanding officer on Truck 15 that day, the responsibility ultimately rests on her shoulders, or at least that is what DCFEMS wants us to believe, so looking at her actions seems to me like the appropriate thing to do.  Let’s take a look at this and see how Lieutenant Davis did.
S: SAFETY
This was an unknown medical, so looking at it from the most positive side of things, she did not send her crew into danger or allow them to cross a busy street.
T: TEAM BASED
By preventing her crew from acting, she did not allow them to serve the purpose that the crew was deployed to do which is protect the people and property of Washington, DC.
A: ATTENTATIVE TO HUMAN NEEDS
I doubt that Lieutenant Davis would want a medical emergency experienced by herself or a member of her family with the same disregard that she showed for Mr. Mills and his family.
R: RESPECTFUL
Again, by her actions and lack of leadership, Lieutenant Davis showed a great deal of disrespect for the general public that she swore to protect.
C: CUSTOMER ACCOUNTABLE
The following is taken directly from Mike Taigman’s web page: “If I were face-to-face right now ith the customers I dealt with on this response, could I look them in the eye and say, ‘I did my very best for you.’”  I don’t think I need to go into that one any further.
A: APPROPRIATE
In most cities, Lieutenant Davis would have opened her department up for a huge lawsuit.  From what I have read, however, that is not the case in Washington DC.  A case a few years back in St. Louis comes to mind, however.  Responders were found to be grossly negligent and were sued directly.  Could the same be true for Davis?  Time will tell.  Suffice to say, her actions were definitely inappropriate.
R: REASONABLE
Would a person of equal rank to Lieutenant Davis have taken the same action that day?  I would like to think not, and judging from the overall reaction of the emergency response community, I think it is reasonable to say that most agree that Davis acted poorly.
E: ETHICAL
I don’t think there was anything ethical about this.  A dying man is left lying on the side walk across the street from a fire station waiting approximately 15-20 minutes for someone to come to help him.  To me, that violates everything that emergency responders stand for.
While any one of the firefighters assigned to Truck 15 that day could have disobeyed orders and gone across the street to help, I understand, to some extent, why they did not.  It has been my experience with the fire service that rank is greatly respected and direction is expected to be followed.  While rank exists in many independent EMS departments, medics and EMTs are quite often expected to act autonomously and not rely as heavily on supervision, so it is a different mind set.
To say that Lieutenant Davis got off easy is a gross understatement.  The only thing that DCFEMS can hope for is that all of the other problems that they have as a department eventually overshadow this complete inaction by the retirement board.  A life was lost, which is terrible, but the unethical behavior of Lieutenant Davis and the borderline dismissal of it by DCFEMS is appalling.  I believe without a shadow of the doubt that there are some terrific people who work for DCFEMS but once again, I have to say that restructuring is long overdue.
At this point, all the EMS community can do is sit back and take notes on “how not to run an EMS service” because DCFEMS is putting on a clinic.
  • While I would agree that DCFEMS is an EMS provider, I wouldn’t necessarily agree that they’re focused on EMS. Without a focus on EMS they are much less likely to give STARCARE any cred or true effort as an EMScentric agency would.

    Just sayin’.

    • MedicSBK

      The problem is though that they ARE an EMS system. Whether they focus on it or not it is a large percentage of their call volume.

      Furthermore, although STAR CARE was developed by EMS professionals for EMS services / professionals, its concepts are pretty fundamental.

      • Again, we agree that they are an EMS agency/provider. I’m not willing to say they are an EMS “system” because one agency does not a system make.

        While the acronym STARCARE was introduced by EMS professionals for EMS agencies focused on providing EMS service in a fashion familiar to EMS providers (being that of a “protocol” or “standing order”), the concepts are rudimentary and can be found in many different types of services under different acronyms.

        The disconnect, in my opinion, is that they maintain their focus on what they are traditionally known for (firefighting) as opposed to what they do the most (medical calls). They are not the only department to misalign this focus, nor are they the only industry in which this focus becomes misaligned. I can think of many other examples where a company’s focus was not where the majority of their work/market share/future was. Blackberry, Hewlett Packard, Dell, General Motors, IBM, Caldor, Barnes & Noble, Borders, and Circuit City are a few that come to mind.

        On the bright side, there is always the potential for a culture change but the right leadership needs to be in place with the right amount of support. While I am not as well versed about the politics side of things there as others, that does not on the surface appear to be the case.