Band-Aids and Broken Systems in DC

The city council in Washington DC passed an ordinance this past week to contract with private ambulance companies to provide additional ambulance coverage to handle an overflow of lower priority calls.  The response from the paramedic’s union is the usual rhetoric one would expect: “If we don’t show up people are going to die!”  Wrong, folks.  If nobody shows up that might happen.  Does it have to be a DCFEMS ambulance?  Absolutely not.

For the life of me I cannot figure out how a system the of Washington, DC’s can operate without a safety net.  How is there nobody there to pick up the overflow?   In Springfield, Massachusetts for example, a city of 150,000 people we had a relief valve for when the volume outpaced the resources.  Other companies signed agreements and participated in the 911 system when we needed them to and guess what?  Because of the structure of our system, and the allowance that we could select who was part of the system in my seven years in management I never heard a complaint about the level of care that was provided in any instances of backup response.  Sure, you ran into the occasional response time issue however much like the proposed DCFEMS changes those units were commonly handling lower priority calls.  It is much easier to get a truck who is making a turnaround at a hospital to pick up a CPR call or a shooting than it is the toe pain or another suicidal person.

The key to a partnership like this is structure and oversight.  While some might complain that the hastily made plan by the city council might lack just that, but creating and instituting these measures should not be difficult.  For example, a great place to start is to set standards for who you will let in on the action.  Is it smart to let every mom and pop shop descend into the neighborhoods of DC to provide emergency care?  Absolutely not, but there are plenty of services in the heavily saturated DC area who could more than handle the volume.

And let’s not lose sight of the fact that although the patch on one shoulder might not say “DCFEMS” the patch on the other shoulder says EMT or paramedic. The training is the same and believe it or not, there are cases in the private industry where they actually get more medical training than one might think.  The constant vilification of the private industry based on the actions of a few choice providers is as ridiculous as saying that all fire based EMS is ineffective because DC Fire and EMS is ineffective.

Lastly, isn’t that what this all comes down to?  Washington, DC is in the boat that they are because they cannot handle the volume.  Street level folks will complain constantly that if they were not on the toothache or the nursing home run for the bed sores that they could handle the true emergencies.  The “don’t blame the patients” argument is another post for another time but doesn’t a plan like this one alleviate that problem and provide some much needed relief to a system that is broken?

The argument from the paramedic’s is an ironic one and smells of the arguments made by AMR in Las Vegas when the fire department started taking over the 911 system.  I cannot help but feel that they don’t want anybody foot stuck in the door.  They don’t want to allow anyone to have an inside look at their system. If the level of disfunction is as bad as it seems from the outside, that insider view could jeopardize the continued role of DCFEMS in the prehospital care continuum.

AFGE Local 3721 President Aretha Lyle’s suggestion of “increasing city EMS staff” is a noble one.  Just hire more people, right?  What is more important is that you hire the right people who are ready to do the job at hand.  In the meantime, how about we start by reassigning fire line personnel to the medical side in hopes that the right piece of equipment arrives on scene instead of one that is not equipped to ultimately provide what DCFEMS promises to its residents: a ride to the hospital.  Furthermore, this comment leaves such a bad taste in my mouth.  Again, here we have someone linking the street level providers with corporations.

AMR is the big dog on the block, and they are getting bigger by eating all of the other dogs.  Their corporate goals are what they are, however that is no way a reflection of the care that is delivered at the street level.  That argument is as valid as saying that “all too often people working for fire departments apply for the job hoping to fight fires, so they worry about the next alarm coming in instead of putting the patients that they care for first.”

Ms Lyle continues, “All too often private corporations use governments to pad their own pockets instead of putting people first.”  So as a result, sending nobody is a far more effective plan?  The Union would never stand for having one fire truck covering the entire system so what is it okay for an ambulance to do the same, especially when EMS calls are far more common?  And then there is burnout.  How many runs are DCFEMS paramedics doing in an eight, twelve, or twenty four hour shift?  How can you properly care for patients and then document your care when you’re doing two or even three calls an hour?  “More staff” would be great, and might be an eventual answer but it takes time to hire, train, and get those people on the street.  In the meantime, why continue to struggle?  Why continue to walk the tight rope without a safety net?

Yes, madam union president, this is a band-aid on a gaping wound and the city is hemorrhaging because of failed leadership and a system that has degraded to an nearly ineffective level.  It is time to let a little bit of help come in.  Stop riding the minority who handles the majority of the calls in the system.  They need a break too, and this gives them the opportunity to get just that.  The calls will be answered, there will be plenty of work to go around and who knows things might just work a little better.

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