Thursday, February 12, 2009
One department. Two articles. Two different pictures. A look at EMS in Washington, DC.
Read John Pekkanen's article from Washingtonian.com
Read Mannie Garza's article from JEMS.com
Is the future for the DC Fire & EMS Department bright or is it just more of the same when it comes to EMS? That's a very good question.
Two magazine reporters recently tackled the issue. Both articles featured quotes from the same people. But the answer to our opening question is likely to be different depending on which piece you have just finished reading.
The most recent article is in February's edition of The Washingtonian. It is by veteran medical writer John Pekkanen and is called What Happens When You Call 911 in Washington, DC. (Note: While I read this article earlier in the month I delayed mentioning it until I found it available online.)
Pekkanen's conclusion is summed up right at the top:
After years of bad blood between District firefighters and emergency medical personnel, DC’s system is still broken. The suburbs do it much better.
In January, JEMS.com published the article From Worst to First? by Mannie Garza. It seems to set a more optimistic tone with the opening paragraph:
Can our nation’s capitol transform its EMS system from what USA Today declared in 2003 to be the nation’s worst EMS system into a model for systems nationwide? Washington, D.C., is now moving forward with an ambitious plan to accomplish just that goal. Can our nation’s capitol transform its EMS system from what USA Today declared in 2003 to be the nation’s worst EMS system into a model for systems nationwide? Washington, D.C., is now moving forward with an ambitious plan to accomplish just that goal.
So, which article really captures what is going on in the DC Fire & EMS Department? I am not sure I have a good answer for that one.
Every time there has been a change in leadership or direction in EMS in Washington, I pretty much tell the new person just what I told the ones who came before them: I've been covering this problem since 1983 and I just want someone to fix it so I can move on with my career. It has just been my way of saying the citizens deserved better than they had been getting.
Despite all of its problems there have been many wonderfully skilled people providing top notch emergency care through all of these years. They have just been practicing their craft in what has been a dysfunctional system, alongside a smaller number of people we have reported on who shouldn't be allowed anywhere near an injured or sick person.
As for what is currently going on in the DC Fire and EMS Department, I know there are still some very dissatisfied people working on both the fire and civilian EMS side who don't think the current plan will work. You probably can say that about many departments.
On the other hand, whether it is everyone's cup of tea or not, there is a plan for the future. There hasn't always been one. Chief Dennis Rubin, like any other fire or EMS leader, can't suddenly wave his wand and fix the ills that were decades in the making.
No matter who is in charge, or whether it is fire department or third service based, it will still take time and a long term commitment by city leaders to take EMS in the District of Columbia from worst to first.
At some point we will be able to look back and see which of these articles did a better job of capturing the moment.
Comments:
Links to this post:
<< Home
Outstanding observation, Dave. As an officer and medic in DC, I, for one, think the care provided has never been better. However, given the current architecture of the system, we need radical change.
We could debate the articles and direction of the organization and have task force after task force study one thing after the other but there are three certainties, again IMO:
1. The current system is being run on compliance and not commitment. This works over a few years but will not work over the long term.
2. While well envisioned, the PEC program has always been problematic. It is my understanding that this ALS delivery system is under review because of the article. Whether quints or PECs, in any department using a piecemeal approach to service delivery has never worked optimally. True 1 + 1 staffing and an efficient operation relies on a medic on every apparatus and all transport units. Balto is heading there and Miami-Dade has been there and it works. The constant on and off the fire engine, as in DC, is creating more problems than can be justified.
3. Both articles did not mention the Office of Unified COmmunication which is anything but. There is no truth in dispatching. The Classon Code Medical Priority Dispatch is a joke. We need experienced dispatchers, who could be civilian, but with the constant interaction of firefighters and paramedics to provide guidance. This does not exist and the responders face challenges every day because of this fact.
We could go on, but the question is whether the current leadership is shown to be lacking given the time since DR took over. This is, of course, a reflection on the mayor and his staff. After the Rosenb TF, he (the Mayor)made his decision and in effect broke a campaign promise. Each of your readers will have to make the decision of his political culpability. In the meantime, the hardworking Members of the DCFD will continue to the best with the hand they are dealt.
We could debate the articles and direction of the organization and have task force after task force study one thing after the other but there are three certainties, again IMO:
1. The current system is being run on compliance and not commitment. This works over a few years but will not work over the long term.
2. While well envisioned, the PEC program has always been problematic. It is my understanding that this ALS delivery system is under review because of the article. Whether quints or PECs, in any department using a piecemeal approach to service delivery has never worked optimally. True 1 + 1 staffing and an efficient operation relies on a medic on every apparatus and all transport units. Balto is heading there and Miami-Dade has been there and it works. The constant on and off the fire engine, as in DC, is creating more problems than can be justified.
3. Both articles did not mention the Office of Unified COmmunication which is anything but. There is no truth in dispatching. The Classon Code Medical Priority Dispatch is a joke. We need experienced dispatchers, who could be civilian, but with the constant interaction of firefighters and paramedics to provide guidance. This does not exist and the responders face challenges every day because of this fact.
We could go on, but the question is whether the current leadership is shown to be lacking given the time since DR took over. This is, of course, a reflection on the mayor and his staff. After the Rosenb TF, he (the Mayor)made his decision and in effect broke a campaign promise. Each of your readers will have to make the decision of his political culpability. In the meantime, the hardworking Members of the DCFD will continue to the best with the hand they are dealt.
# posted by 
: February 12, 2009 3:12 PM
: February 12, 2009 3:12 PM
No one is better at smoke and mirrors then our dear old Rube. Things in the city are just as bad as ever and articles in JEMS written by a member of the DCFD are just his jaded misnomers because he's clueless to what is really going on in the streets.
Multi alarm fires are up because firefighting skills are watered down with endless hour upon endless hour of being forced to ride ambulances that Firemen don't and never will want to ride.
You put these guys on the ambulances and they are left with their heads out ready to get chopped off. The department runs them into the ground, and doesn't give 2 craps about it's work force as long as there aren't any more public incidents that they have to explain off.
If people only knew how much lying was going on and knew what was the truth they'd go ballistic.
Multi alarm fires are up because firefighting skills are watered down with endless hour upon endless hour of being forced to ride ambulances that Firemen don't and never will want to ride.
You put these guys on the ambulances and they are left with their heads out ready to get chopped off. The department runs them into the ground, and doesn't give 2 craps about it's work force as long as there aren't any more public incidents that they have to explain off.
If people only knew how much lying was going on and knew what was the truth they'd go ballistic.
# posted by : February 12, 2009 3:59 PM
: February 12, 2009 3:59 PM
Anon,
deal with the 'ambo' issue like you have a pair. It is a trend nationwide to save jobs, benefits, etc. Quite saying it is worthless.... what is, is the time jerking around between the few fires most cities have.
deal with the 'ambo' issue like you have a pair. It is a trend nationwide to save jobs, benefits, etc. Quite saying it is worthless.... what is, is the time jerking around between the few fires most cities have.
# posted by : February 12, 2009 6:14 PM
: February 12, 2009 6:14 PM
Wow, someone from D.C saying that "they" shouldn't be riding the ambulance and that their firefighters are watered down because of it. I bet that this is one of those people that dog the P.G career staff of saying get on the ambulance and do your job, that is what you are here for. Kind of sucks when the shoe is on the other foot. So since that shoe is on the other foot, do your job, you get paid darn well to do it. Deal with it.
# posted by : February 12, 2009 6:36 PM
: February 12, 2009 6:36 PM
Do you actually believe that everyone who works in DC vollies in PG? If so you are the most ignorant person I have ever come across. You should understand that the world is bigger than DC & PG and that people exist and live beyond those borders, and oddly enough have opinions based upon more than the petty differences that exist between you and some guys that tick in your workplace!Just like you said to get over it, that is part of the job ride the ambulance, you need to get over it too, volunteers work where you do.(Yes I said work) So understand that if you are so upset with the fact that you work in a place that allows people to volunteer where you collect a paycheck than maybe it is YOU who should find another job. And no I don't live, work, or tick in PG! I am just tired of both sides getting on here and whining about it, especially when it has nothing to do with this thread!
# posted by : February 12, 2009 7:05 PM
: February 12, 2009 7:05 PM
I don't live in the District, but I listen on my scanner. Last weekend there was a river rescue, a boat overturned. A DC fireboat rescued the victims quickly and took them to the Washington Sailing Marina. The victims refused medical attention. The Incident Commander wanted a signed released. So he sent and ambulance and an EMS supervisor to the Washington Sailing Marina. They got lost. "It's not in my map book." Well sure, it's in Virginia, near the humped-back bridge. They missed the turnoff, went down to the airport, turned around, came back north, missed it again. Could an Arlington ambulance have been sent for the signed release? I dunno. Was the Fire Department IC punishing the EMS crew by sending them to Virginia? I dunno.
From what I'm hearing on the scanner, the DC ambulance service seems to be better coordinated than it used to be, but the Washingtonian article claims that patients aren't being sent to the most capable hospital to treat their specific complaint, and I can't tell about that.
From what I'm hearing on the scanner, the DC ambulance service seems to be better coordinated than it used to be, but the Washingtonian article claims that patients aren't being sent to the most capable hospital to treat their specific complaint, and I can't tell about that.
# posted by : February 12, 2009 7:31 PM
: February 12, 2009 7:31 PM
Here's a novel concept... Why couldn't the fire boat crew have gotten the "signed release" on the patient? Aren't they all EMTs??
# posted by : February 12, 2009 8:06 PM
: February 12, 2009 8:06 PM
Well understand this, the Washingtonian Magazine article is defintely biased. That being said, it is a true representation of what exists in the DC Fire & EMS Department today. As a member of this department do I like it, No. Do I enjoy the fact that articles only portray what we do wrong and not what we do right on a daily basis, no I don't. However, that is the bed that our leadership (DR, LS, RS, AJ)has made for us and we must all collectively lie in it. The article in JEMS is a total fabrication, and is more of a wish list of things that our management would like to be doing rather than things they have already accomplished. Make no mistake though, the DCFEMS is an example of dysfunction at its most acurate definition. Before you use your broad brush to paint our entire department, I suggest that you gather more info than 'I listened to a water rescue' to construct your conclusions upon.
# posted by : February 12, 2009 8:12 PM
: February 12, 2009 8:12 PM
Washingtonian - incredibly biased, but unfortunately almost completely true.
JEMS - incredibly biased, and almost completely false.
For those who suggest that "dealing with the ambulance" is appropriate to "save jobs & benefits": How do you expect to save a $50k/y job by averaging it with a $30k/y job?
The DCFEMS has two fatal flaws: 1) it will hire and retain anyone - it does not seek out and hire the "best" applicants, those with aptitude and a proven work history; and it can't seem to fire anyone for nonperformance. It only occasionally fires people for gross misconduct, but never for nonperformance. 2) DCFEMS Management fails to recognize BLS EMS Transport as a White Elephant. The non-compensational benefits of being employed to ride a BLS Ambulance are far smaller than those associated with being a Firefighter or a Paramedic; the first arriving firefighters, and the better trained paramedics do almost all of the life-saving, and thus receive most of the job satisfaction. The financial benefit, as shown by salary surveys across the country, significantly lags as well. The only people who seem to enjoy BLS transport, particularly, busy urban BLS transport, are either very young, part-time, or both; neither of which is prevalent in a unionized, government employee group.
From the department's and city's perspective, we spend $40M+ per year in ambulance transport salaries, and are only reimbursed $10-12M. Providing such a service is a money loser - except for the tax subsidy. This may change if Universal Healthcare becomes a reality - but even then, the total reimbursement will only double.
The citizen's may have been willing to pay $30M a year for ambulance transport when times were great - but when times are tough, who knows?
If the Rosenbaum TF hadn't railroaded Chief Serrino out, we might have been left with a better "solution": FF/EMTs on fire trucks providing necessary first response; Dedicated career Paramedics on Medic Units providing ALS to the <25% of patients who need it; and low cost (rookie/private sector/??) commodity BLS transport to transport the <75% of patients who don't depend on a 10 minute response time.
JEMS - incredibly biased, and almost completely false.
For those who suggest that "dealing with the ambulance" is appropriate to "save jobs & benefits": How do you expect to save a $50k/y job by averaging it with a $30k/y job?
The DCFEMS has two fatal flaws: 1) it will hire and retain anyone - it does not seek out and hire the "best" applicants, those with aptitude and a proven work history; and it can't seem to fire anyone for nonperformance. It only occasionally fires people for gross misconduct, but never for nonperformance. 2) DCFEMS Management fails to recognize BLS EMS Transport as a White Elephant. The non-compensational benefits of being employed to ride a BLS Ambulance are far smaller than those associated with being a Firefighter or a Paramedic; the first arriving firefighters, and the better trained paramedics do almost all of the life-saving, and thus receive most of the job satisfaction. The financial benefit, as shown by salary surveys across the country, significantly lags as well. The only people who seem to enjoy BLS transport, particularly, busy urban BLS transport, are either very young, part-time, or both; neither of which is prevalent in a unionized, government employee group.
From the department's and city's perspective, we spend $40M+ per year in ambulance transport salaries, and are only reimbursed $10-12M. Providing such a service is a money loser - except for the tax subsidy. This may change if Universal Healthcare becomes a reality - but even then, the total reimbursement will only double.
The citizen's may have been willing to pay $30M a year for ambulance transport when times were great - but when times are tough, who knows?
If the Rosenbaum TF hadn't railroaded Chief Serrino out, we might have been left with a better "solution": FF/EMTs on fire trucks providing necessary first response; Dedicated career Paramedics on Medic Units providing ALS to the <25% of patients who need it; and low cost (rookie/private sector/??) commodity BLS transport to transport the <75% of patients who don't depend on a 10 minute response time.
# posted by : February 13, 2009 7:02 AM
: February 13, 2009 7:02 AM
My spouse couldn't get proper care from his co-workers. A civilian EMS supervisor took it upon himself to have my spouse sent to the PFC instead of Medstar, he was transported in a medic unit as a trauma after being hurt on the fireground. At the clinic he didn't get the care he needed. In fact it is a shame it took me to clean up his bloody arm 6 hours after being hurt. Now forcefully retired and living in poverty. He is in constant pain everyday,and our children wonder why there dad was treated the way he was. My point is if you all can't give care to each other properly ,how are you all going to give it to the public.
# posted by : February 14, 2009 9:44 AM
: February 14, 2009 9:44 AM
DC has a great FD, mostly because of highly skilled Battalion Chiefs who run by-the-book FD operations, despite the lack of qualified FFs. In this case a great commander and mediocre foot solders makes a great army.
But in EMS, you don't have a whole team, just a few units. And you have too much volume for an EMS Chief to be supervising every call. While I am generally a fan of integration, I think two separate departments is the best thing for DC.
But in EMS, you don't have a whole team, just a few units. And you have too much volume for an EMS Chief to be supervising every call. While I am generally a fan of integration, I think two separate departments is the best thing for DC.
# posted by : February 14, 2009 3:11 PM
: February 14, 2009 3:11 PM
I moved from the District about two years. Even though I enjoyed living in the city, I must say there is a big diference between the firemen in DC and other Washington area firemen. Recently my neighbor had a heart attack and we called 911, the Arlington Firemen were very clean looking and professional and really felt concern about my neighbor. On the other hand, a co-worker had fell down some steps and require us to call 911 in DC. When the fire engine showd up they appeared to be up-set and not that concern about my co-worker. I hate to say this but they look like they were over weight and dirty looking. I just remeber them just standing there. One of the firemen told my boss that the ambulance will be here soon. They just stood there not very friendly. I hope for the sake of the community in DC, they do someting about the ambulance problem.
# posted by : February 15, 2009 5:08 PM
: February 15, 2009 5:08 PM
I have an answer for the ambo problem. Give the civilians the money they want the retirement, the benefits. There is no reason that they shouldn't get paid alot more money to take the beat down on the ambo.Same with the medics. Why do you think we can't hire any medics, becasue the department only adds 10% of starting firefighter salary, which ends up being about 4500 dollars added on to your total salary. All the guys who bitch and moan about riding the ambo stop complaining about the civilians. They like riding the ambo!! So why would you guys complain about people liking to do something that you don't want to do??? The guys wouldn't be assigned to the ambo for 24 hours and 4 months at a time if the guys stopped complaining about it. They would still be riding it for 12 hours and then ride a fire truck for another 12. That worked fine but nooooo guys still complained about that. Now the time between ambo details is getting shorter cause guys are leaving these firehouse before it is time for their detail to the ambo. So it is screwing the guys who just got off of the ambo. It is going to get worse before it gets better. Just wait till they assign you guys to it for a year!
# posted by : February 15, 2009 7:50 PM
: February 15, 2009 7:50 PM
I THINK THAT THE DCFD DIV OF EMS IS WERE ITS NEED TO BE,AND WERE ITS NEEDS TO STAY, AND STOP ALL THIS CRYING AND THINKING THAT A 3 TH SERVICE WILL MAKE IT ALL BETTER.WORK WITH WHAT YOU HAVE LIKE MOST OF THE OTHER CITYS IN THE U.S.A.THAT HAVE EMS WITHIN THE F.D.GIVE THE FIRE CHIEF SOME TIME AND TRYING WORKING AS A TEAM. THATS WHAT WILL MAKE IT WORK NOT SOME 3 TH SUPER SERVICE.THE EMS ADMIN AND PARAMEDIC/ EMT IS WHAT NEED TO MAKE IT WORK, NO MATTER WHAT DEPT YOU ARE WITH GIVE THAT 3 TH SERVICE A REST.
# posted by : April 24, 2009 5:44 PM
: April 24, 2009 5:44 PM
a novel idea for all to listen to. As a Paramedic by choice you know you are not in it for the money but for the helping of sick or injured people. That being said keep up on your CE's and your ACLS and other carded classes. It's not about a system it is about people. As for the FF's Hey you want to be a hero than help the sick and injured that is why EMT is required in most states. Why we can't seem to get it is beyond me. Take Pride in your chosen career. We EMS people don't particularly like being the step children of the fire service but that is our lot in life
# posted by : April 24, 2009 10:53 PM
: April 24, 2009 10:53 PM
If you ask me DCFEMS has way to many out of town employees. On medical calls you can tell the difference between those FF's, who live in the city opposed to those individuals who live elsewhere. Being born in DC, I have a greater respect and bed side manner towards patients that call for help. Individuals that live 2, and 3 hours away, seem to have preconcieved attitudes about the residents of the District. Thus, their level of care is sub-par. I find it hard to believe that an individual would be able to provide the same level of care, and bed side manner to a citizen, when they are only at work for 24 hours before they return to their own community hours away. This is not the case with every 1st responder but, attitudes are infectious. Although the ambo is a beating, to call yourself a true first responder you must be able to deal with every changing situation as a professional. Otherwise, you need to find another profession. Don't get me wrong. I hate riding the ambo, but it's mainly because the FD, Mayor and City leave all the blame if something goes wrong on the individual. Nothing about our job operates in an ideal environment. You run 100k plus calls a year, and have 1 or 2 incidents and its headline news. I suggest that the Mayor, all Chiefs, Council Members and Rosenbaum's TF ride along on some of these units before they make anymore inpromptu decisions. If you ask me the hiring process needs to be re-calibrated, and the abundance of political scape-goating must end. Do like FDNY, Live here, Work here, Train here or get out.
Post a Comment
# posted by : April 25, 2009 2:07 PM
: April 25, 2009 2:07 PM Links to this post:
<< Home
Subscribe to Posts [Atom]
