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The fire within EMS
Concern grows over slow response times
(Published July 12, 2004)

Click here to read Part 2 in the Series

First in a Series
By ROBERT ARKELL
Staff Writer

An elderly man collapsed from an apparent heart attack while shopping inside a grocery store on Connecticut Avenue near Chevy Chase Circle, and those who witnessed his recent fall dialed 911 at 11:27 a.m.

A police officer sped to the scene almost immediately along with Fire Engine 20, which carried uniformed firefighters cross-trained as emergency medical technicians. Firefighter EMTs are trained to stabilize a patient, but paramedics were responsible for transporting that victim to a hospital. Medic 11, an ambulance staffed by civilian paramedics, received the call at about 11:31 and arrived on the scene at 11:42 -- 15 minutes after the initial call to 911.

Witnesses told Anne Renshaw, an advisory neighborhood commissioner in Upper Northwest Washington, that the heart attack victim either died before the ambulance arrived or was barely alive when paramedics placed him in the ambulance.

Renshaw is among city residents whose concern is growing over continual anecdotal evidence of serious breakdowns in the District's ability to respond in a timely manner to medical emergencies. For years, Upper Northwest Washington residents have been partially dependent for rescue service on the Bethesda-Chevy Chase Rescue Squad in suburban Maryland.

As the heart attack victim lay dying at Magruder's, Renshaw said, the closest D.C. fire company -- Engine 31, based at Connecticut Avenue and Fessenden Street NW -- was busy taking another call. Medic 31 and Ambulance 20 both serve as the only two medical transports for Upper Northwest Washington and both were out taking other calls. It is unclear where Medic 11, based with Engine 11 at 3420 14th St. NW in Columbia Heights, was coming from when it answered the call.

That's because official bases for D.C. ambulances don't mean much in practice. A medical unit might be based with a certain engine company, but if other ambulances throughout the District are out on call, then that ambulance might find itself running to a call on the other side of town.

The incident at Magruder's belongs to a long, troubled history of the District of Columbia's Fire and Emergency Medical Services Department. Funding issues, abuse of the 911 response system by citizens, inadequate medical supplies and animosity between civilian paramedics and sworn firefighters have plagued the Fire/EMS Department for more than 20 years.

Renshaw recalls a 45-minute response to a heart attack victim on June 7 and a 40-minute response to a pipe bomb blast on Wisconsin Avenue two years ago.

"EMS has always been regarded as a stepchild [to the Fire Department] and has never received the recognition it deserves," Renshaw asserts.

The latest controversy revolves around Fire Chief Adrian H. Thompson's new plan for a dual-role, cross-trained department and efforts by the emergency medical workers' union to make EMS a third uniformed service. Kenneth Lyons, president of EMS Local 3721, says his union supports legislation currently before D.C. City Council that would break away EMS from the Fire Department.

"The relationship between these two unions (fire and EMS) is directly affecting EMS," Lyons argued during a recent interview. "This is one of the major factors as to why EMS can't go forward. We just want to go out and do our duties without the interference of the IAFF (International Association of Fire Fighters)," he said.

Lyons insists that the firefighters' union, Local 36, has shortchanged civilian paramedics with pay and use of facilities for the past 20 years.

According to Lyons, there are only 100 active EMS paramedics and 22 ambulances left to respond to an area with a population of about two million during the day and nearly 600,000 at night. If EMS becomes a third service, Lyons believes that EMS will have the appropriate funding and organization to hire more paramedics and purchase more ambulances.

Lyons doesn't think this change will happen because the Fire Department depends on EMS funding to balance its budget.

"It all comes down to $28 million," Lyons claims. "EMS was allocated $28 million. EMS will only receive 10 percent of that money. This has been consistent since 1990. I think it has come down to dollars and cents. …[Firefighters] are overextended. You have more firefighters than EMS, while there are 4,000 fires and 200,000 medical responses that occur during the year."

Lyons said EMS paramedics do not have the necessary resources to respond to medical calls, while firefighters have access to better facilities and transportation units.

Fire/EMS spokesman Alan Etter said that the Fire Department's fiscal 2004 budget totals $150 million. He said $89 million goes to the Fire Department, $27 million goes to EMS, and the rest is distributed to communications and administrative branches within the department.

According to records provided by Etter, there are 37 EMS transport units. Fire units include 33 engine companies, 16 truck companies and three heavy-duty rescue squads. Local 36 President Ray Sneed and Chief Thompson, who served for more than 30 years as a D.C. firefighter before being promoted to lead the department, say there are 1,300 firefighters working in the District and 300 civilian EMS paramedics.

Sneed disputes claims that paramedics are leaving the department. Lyons, on the other hand, asserts that there are only 100 active EMS paramedics to operate 22 functional ambulances. Lyons claims that 12 paramedics are planning to leave after being treated badly by the Fire Department.

Chief Thompson and Local 36 President Sneed both acknowledge that 70 percent of the calls the Fire Department responds to are medical-related. Many firefighters complain that a majority of these medical calls aren't "emergencies" at all, but responses to chronic drug addicts, fights between drunks, and homeless people who want to sleep in a warm cot in an emergency room rather than out on the street.

Thompson wants to solve the department's problems through developing a dual/role-cross-training program, which consists of training firefighters to handle serious medical emergencies. According to the chief's Initiative for Improved EMS Service Delivery: "The Emergency Medical Service operational units will be integrated with the FFD to form one unified, dual-role, cross-trained, uniformed workforce." One "basic life support unit" in each Fire Department battalion will be converted into a unit run by uniformed firefighters/EMTs.

Thompson's program proposes to make firefighters just as qualified as paramedics in handling situations that require advanced life support (ALS) and basic life support (BLS).

"Our grand goal is to move towards an all ALS system," spokesman Etter said. "This system would teach every firefighter how to train in dealing with the most serious emergency responses."

Firefighter/EMTs will go through a six-month training program, but EMS civilian paramedics must go through a two-year program. Dr. Fernando Daniels, the department's EMS director, said full paramedic status requires more than 2,000 hours of training. The responsibility of transporting patients to hospitals would still rest with paramedics.

Thompson and Daniels both said they are confident that firefighter/EMTs will be just as qualified as paramedics to handle the most serious emergency situations, even though firefighter/EMTs will have only six months of training. Daniels declined to comment on the proposal to make EMS a third service.

"The intent of [EMS Local] 3721 is to try and get better benefits for their group as a whole," Chief Thompson said in response to the EMS union's complaints of maltreatment. "Everyone who comes to work for this job works for the Fire Department. We're all here to do a job and go home. Definitive care, not personal differences, is the most important issue for both EMS and the Fire Department."

Firefighters' union President Sneed also disputes the EMS union's claims.

"Having more ambulances is not the answer," he told The Common Denominator. "It is not how you can provide quick transport, it's how quickly you can get a critical care provider on the scene.

"You don't go out and hire anyone else -- you're using the people that you already have. It's better economically. You get more bang for your buck," Sneed said.

Thompson and Sneed place more emphasis on stabilizing a patient than transporting the patient to a hospital. Thompson said that it takes an ambulance the same amount of time to reach a patient along with the firefighter/EMTs, who act as first responders.

According to records supplied by the department, the average dispatch-to-scene response time for EMTs in October 2003 was 4:34 minutes. For EMS paramedics and transport units, the average response time in October 2003 was 6:59 and 7:17 minutes, respectively.

Fire/EMS officials could provide no records showing ambulance transfer times between emergency scenes and hospitals. But records provided by the department show "drop time" -- defined by Etter as the amount of time it takes emergency medical workers to transfer a patient from an ambulance stretcher to a hospital bed -- averaged more than 40 minutes at some D.C. hospitals during fiscal 2003.

The department's records showed the average drop time for George Washington University Hospital was 43:14 minutes in July 2003. At Howard University Hospital, the average drop time in October 2003 was 48:08 minutes. The average drop time at Washington Hospital Center in October 2003 was 44:23 minutes.

Etter and Thompson attributed the department's long drop times to overcrowded hospitals.

Etter said ambulance drop times at Providence Hospital, Sibley Memorial Hospital, Children's National Medical Center and Georgetown Medical Center were unavailable.

A public meeting is scheduled for 7 p.m. July 20 at St. Columbia's Episcopal Church, 4201 Albemarle St. NW, to discuss some of the Fire Department's current problems.

"We look forward to the community meeting," Renshaw said. "Chief Thompson and Dr. Daniels will meet with us in a public forum to discuss the needs of Upper Northwest as far as medical transport service and other crucial matters involving public safety."

Invited participants include City Administrator Robert Bobb, Chief Thompson, EMS union President Kenneth Lyons, EMS Director Daniels and Chief Edward N. Sherburne of the Bethesda-Chevy Chase Rescue Squad.