- The Washington Times - Friday, April 24, 2009

Scores of the District’s paramedics failed to meet the minimum national standard on written exams testing or mishandled basic life-saving procedures during videotaped assessments, according to interviews, videos and documents obtained by The Washington Times.

One of the nation’s premier emergency medical professionals, who reviewed the materials at The Times’ request, said the deficiencies identified during a sweeping assessment of the city’s paramedics posed a safety crisis for the nation’s capital.

“Based on what I saw on those videos, there is no question in my mind,” said Paul Werfel, director of New York’s Stony Brook University’s paramedic program and a clinical assistant professor of health sciences. “To be perfectly honest, I think there’s a real threat here. The safety of the people of the District of Columbia is at risk. It’s a clear and present danger to them.”

He said many of the paramedics displayed a lack of familiarity with the equipment they were using and had difficulty performing basic paramedic tasks, such as intubating a patient. He said that one paramedic put a bag valve mask that assists patients with breathing difficulties on the mannequin upside down, others mismanaged the patients’ airways, and others administered medications to cardiac arrest victims when the situation called for electric shocks. Many of the paramedics used obsolete techniques to determine the condition of the patient.

The city has about 250 paramedics, and about 175 have been put through the assessment program at a training center in Maryland. The Times obtained test scores for at least 95 of the paramedics. Only three scored in a range to get a passing grade under the national standards for entry-level paramedics.

City officials originally threatened an investigation or legal action to stop The Times from publishing the materials, saying exposing the scores would hurt the city’s efforts at improving its oft-criticized paramedic service. But after a further review, D.C. Attorney General Peter J. Nickles said too many people had access to the information to pursue any leak probe or legal action.

Fire and EMS Chief Dennis L. Rubin and Mayor Adrian M. Fenty issued a two-page statement this week addressing the city’s efforts to assess its paramedic force and make improvements.

The statement hailed the department’s “historic effort to improve the level of clinically competent, professional and compassionate patient care through enhanced training, education, performance evaluation and quality assurance.” It said the testing, performed from March to June 2008 by the Maryland Fire Rescue Institute (MFRI), led to the creation of improved clinical protocols. It also said that “several areas for systemic training have been identified,” although it did not name them.

The statement issued Wednesday warned that examining the tests “without a thorough understanding of the testing environment and process could lead to misinterpretation of the results” and suggested that the “attacks” by unnamed people were an attempt to thwart the agency’s reforms.

“Transformational change of this nature is very threatening to special interest groups and individuals that want to maintain the status quo,” the release said. “These persons will continue their attempts to destroy public trust in an effort to undermine the District’s EMS improvements.”

The written test, taken by about 175 of the city’s 250 advanced life-support providers, is equivalent to the National Registry of Emergency Medical Technicians test for paramedics — an entry-level examination required for national certification in 38 states and the District.

The same 175 paramedics were videotaped during a practical skills assessment in which they were required to deal with a cardiac arrest on a high-tech mannequin. Both tests were administered at MFRI, a nationally known training facility affiliated with the University of Maryland in College Park.

The Times obtained about 90 of the videotaped assessments and 95 of the written test scores. On the 95 written tests, only three paramedics scored 70 percent or above; a passing grade for an entry-level paramedic on the national registry exam is 75. Twenty-three paramedics scored between 60 percent and 70 percent, and more than two-thirds scored below 60 percent.

The lowest score The Times reviewed, below 40 percent, belonged to a field training officer, the documents stated.

More than 75 of the 10-minute videos were submitted by The Times to multiple local and nationally recognized paramedic instructors and quality-assurance specialists, who said they observed egregious health care violations.

Story Continues →