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“The performances I saw on these particular tapes I would not accept from people graduating a paramedic course, much less people with years of experience,” said Mr. Werfel, a founding member of the board of directors of the National EMS Educators’ Association. “Almost all of them exhibited extremely poor technique,” Mr. Werfel said. “Based on the videos I saw, I wouldn’t be able to sleep at night if I was responsible for putting these people on the streets.”

‘Outstanding’ performances?

Mr. Werfel cited one test in which a paramedic failed to notice for more than 30 seconds that his patient had gone into cardiac arrest. The test, unbeknownst to Mr. Werfel, was taken by one of the District’s senior emergency medical services administrators.

The department’s medical director, Dr. James J. Augustine, who has served in the position since August, reviewed the same test with a Times reporter last month and termed it “perfect,” later describing it as a “textbook” response.

But Geoffrey T. Miller, associate director for the research and curriculum development division of prehospital and emergency health care at the University of Miami, said he would also have ordered remediation for the senior EMS administrator — whose identity he was unaware of when he viewed the test. He viewed the video last month in Baltimore while attending a national conference of the Journal of Emergency Medical Services.

“It may be textbook for them,” Mr. Miller said after he was told of Dr. Augustine’s conclusion. “I think you would find some medical directors around here who would have a different opinion.”

The problems revealed in the tests cut across the divisions normally associated with the fire department, which provides EMS through uniformed firefighters trained as paramedics and by single-role paramedics who have a different union, a different pay scale and different retirement fund from the uniformed fire service.

Four videotapes were selected for evaluation by The Times as a broad-based look at paramedics functioning at different levels within the agency. They included the senior EMS administrator’s test, an EMS field training officer’s test and a longtime single-role EMS provider’s test.

The fourth test was that of a firefighter-paramedic whose skills were called into question in December after he responded to an incident in Northeast involving Edward L. Givens. Family members say that hours before Mr. Givens died, a paramedic responding to a medical call at his house told Mr. Givens he was likely suffering from acid reflux.

“Based upon viewing the videotape, I would have serious concerns about him performing any medical practice,” said Graydon Lord, a licensed paramedic and former fire and EMS chief in Cherokee County, Ga. “I would recommend that the medical director make his determination as to whether this provider can safely practice medicine in the pre-hospital care environment,” added Mr. Lord, who serves as director of EMS policy for the National EMS Preparedness Initiative.

Three regional paramedic quality-assurance instructors with knowledge of the District’s protocols viewed all the videos obtained by The Times and discussed the results but asked not to be identified because their work brings them into contact with the D.C. fire department. The three agreed that while there are some competent paramedics on the job, the vast majority seemed deficient in their skills, with one terming more than half of the advanced life support providers “unsafe.”

First asked in December about the results of the tests, Dr. Augustine — who previously served as Chief Rubin’s medical director when the two worked in Atlanta — told The Times that he had reviewed 91 of the test videos and the paramedics had performed well.

“Less than a handful had an issue at all. A handful had small issues,” Dr. Augustine said. “I found their performances to be outstanding.”

During an interview last month, Dr. Augustine said only eight of the 175 paramedics who took the tests were found to have had any problems. He said some of the problems could be attributed to the fact that the paramedics were working alone in the simulation instead of in teams. But in most cases, the District deploys its paramedics on fire engines or on ambulances paired with lesser-trained emergency medical technicians.

Dr. Augustine also said the lab environment and the use of patient simulators were new to D.C. paramedics.

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