A controversial redeployment plan that would leave D.C. ambulances staffed with no paramedics during the overnight hours will not take effect until next year at the soonest, as stakeholders consider the benefits of a proposal that national authorities are calling everything from “innovative” to “unconscionable.”
The plan, introduced last month by D.C. Fire Chief Kenneth Ellerbe, would pull paramedics from 14 ambulances between 1 and 7 a.m. and instead have them available for calls during busier hours from 7 a.m. to 11 p.m. Paramedics’ shifts would be staggered, increasing the number of ambulances able to provide advanced life support during the afternoon hours, when fire officials say call volume is highest.
Ambulances staffed by lesser-trained emergency medical technicians would be used overnight to provide basic life support, and cross trained firefighter-paramedics and paramedic supervisors could administer more advanced aid as needed.
The plan, which Chief Ellerbe initially hoped to implement Nov. 5, requires approval from the D.C. Council. And council Chairman Phil Mendelson, a Democrat, said that a vote would not come until next year’s council session after a hearing later this month.
In the meantime, the proposal is drawing attention nationally among emergency medical directors and specialists always looking to maximize resources.
“In the [emergency medical services] world, it is not uncommon that deployment patterns shift depending on the time of day and call volume,” said Arthur Romano, deputy director of EMS for Greenwich, Conn., explaining that shifts and downgrades are most often done to save money. “But they are shifting levels of care at the nighttime hours, which is somewhat unusual.”
The proposed plan essentially offers two different levels of service to the city, said Paul Werfel, paramedic program director for the University Medical Center at State University of New York, Stony Brook. The increased staffing during the day lopsidedly benefits commuters who come to the District to work and leaves residents lacking sufficient care at night, he said.
“If I live in Crystal City, my level of EMS resources is higher than for a person who lives in the District,” he said. “I think that stuff is unconscionable.”
The District has long struggled with EMS delivery, most notably reflected in the 2006 death of New York Times journalist David E. Rosenbaum, who was fatally beaten during a robbery as he walked near his Northwest home. An inspector general’s investigation resulted in findings of an “unacceptable chain of failure” in the response to the medical call and “alarming levels of complacency and indifference” on the part of the first responders. The incident prompted the creation of a task force to reform the city’s EMS service.
The District’s current model calls for EMS delivery throughout the day with 25 ambulances staffed by EMTs and 14 ambulances staffed with one paramedic and one EMT.
Delivery models vary across the country. Among the premier EMS providers, Miami staffs its paramedic ambulances with a firefighter EMT and two paramedics. Miami, like the District, provides medical services through its fire department. Boston, also highly regarded, administers prehospital care through a department separate from the fire department. The city staffs just five paramedic ambulances, which are selectively dispatched to only the most serious emergency calls. San Diego, which provides medical services through a fire-based public-private partnership, staffs its fire engines with a paramedic and puts one paramedic on ambulances. Department policy calls for two paramedics to respond to life-threatening emergency calls.
The three cities all provide 24-hour coverage with paramedic-staffed ambulances.
Chief Ellerbe has touted the change in the District as a way to provide better service to the community after the department studied a year’s worth of statistics on call volume. While paramedic shortages are fairly common in smaller departments across the country and dollars are tight among most local governments, the chief repeatedly has denied he is pushing his proposal for staffing or budgetary reasons.
But even among new and cutting-edge ideas, the District’s plan comes off as an anomaly, said medical professionals who were unable to point out any other departments in the country that use the model. Likewise, D.C. officials did not identify any similar plans in use.
“We are certain that there are probably comparable plans around the nation, but we designed a plan to meet the specific needs of the District of Columbia, which is growing at a record pace, unlike few other cities in the nation,” fire department spokesman Lon Walls said.