DC Fire and EMS......again....

[croaker260]

http://www.wjla.com/news/stories/0409/616560.html#commentsform

[dr-exmedic]

croaker, I wasn't sure if this story was on the front page of this site when you posted:

http://www.emsresponder.com/article/article.jsp?id=9420&siteSection=1

More of the same, really. It's exactly what outsiders have come to expect when you read a story with DC EMS in the headline:
Despite repeated requests, the department has not released the results to the public, but has characterized the performance of their paramedics on these tests in very positive terms," Mr. Halliday said.
...
Mr. Givens, whose family has sued the District over the handling of his brother's case, said he was angry that fire officials defended the performances on the videos and the written test scores, the vast majority of which were below 60 percent.
IIRC, they've gone through 3 or 4 medical directors in the last 4-5 years. I don't know if the MDs are throwing up their hands in frustration or being forced out because they're trying too hard to reform things.

[VentMedic]

It is getting hard to tell if the stuff happening in Washington DC stems from ignorance or arrogance. Either way it just demonstrates a total indifference to quality patient care.

I find this disappointing and even absurd since this is our Capitol. This is the example our legislators must read with their morning coffee when they about to determine reimbursement and funding for EMS in this country. This is not just some little retirement county in Florida (Collier). Washington DC is an area everyone knows about from scandals with the Mayor and other politicians. One should expect something better knowing the nation is watching you. And, this should definitely be the case after the agency has made so many headlines with previous blunders.

I seriously must question the integrity of the whole system. It is hard to believe the EMT-B test is soooo hard (12/08) that they must now resort to cheating. It is even more ridiculous to blame the testing center for the FFs lack of integrity for cheating. The testing center did not tell them to cheat. Maybe if the focus was on learning the material rather than memorizing the answers, it would be easier.

More headlines including those from the past which were referred to in the recent articles.

Critical Condition: D.C. Paramedics Up to Par? (with video)
Evaluation of video leads to questions
Apr 24, 2009

http://www.nbcwashington.com/news/local/Are-DC-Paramedics-Up-to-Par.html

City Investigates Alleged Cheating on EMT Test - Washington Post
24 Apr 2009

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/23/AR2009042304902.html

Chief Reacts to EMT Investigation, Alleged Scandal
Fri, Apr 24, 2009

http://www.nbcwashington.com/news/local/Fire-Chief-Reacts-to-EMT-Investigation-Alleged-Scandal.html


FROM 2008

DC medics to be retested
Wednesday, February 27, 2008

http://emergencymedicaltechnician.blogspot.com/2008_02_01_archive.html


Controversial Exam for D.C. EMTs
posted 12/09/08

http://www.wjla.com/news/stories/1208/576376.html

[VentMedic]

The latest from Washington D.C. It is just too sad that this happens to be in our nation's Capitol.


http://washingtontimes.com/news/2009/jun/09/after-failing-tests-dc-paramedics-to-be-retrained/?feat=home_headlines

Some D.C. paramedics to be retrained

Tuesday, June 9, 2009

About a dozen D.C. paramedics were ordered into retraining and others have been required to take course work, but D.C. Fire Chief Dennis L. Rubin told a city council committee that a series of poor performances in medical-knowledge tests did not require punishment or a major shake-up in the department.

D.C. Council member Phil Mendelson, however, called the results "completely disturbing."

The Washington Times reported in April that dozens of the District's paramedics either failed to meet a minimum national standard on written exams that tested their medical knowledge or had mishandled basic lifesaving procedures during videotaped assessments.

During a hearing Monday at City Hall, Mr. Mendelson, chairman of the D.C. Council's Committee on Public Safety and the Judiciary, took note of The Times' report and questioned Chief Rubin closely about the District's emergency medical services and the test results.

"Why shouldn't people be alarmed?" Mr. Mendelson asked.

Chief Rubin stressed that the exams were evaluations that were meant to guide the department's training program and to improve medical protocols.

He added that the department's medical director, Dr. James J. Augustine, recognized that the tests showed a "generalized deficiency" in two areas, including one related to paramedics' reading of the electrical activity of the heart. But he said the workers were not in need of discipline.

"We feel like we have turned the corner, but we'll continue to provide education to bring them up to national standards, and we'll do it in a way that's not punitive," Chief Rubin said.

Instead, he said, the paramedics were required to take a two-day, 16-hour course related to the heart activity issue, while 12 to 15 workers who still performed poorly were forced to undergo remedial training.

"I don't see a need to provide any kind of discipline," Chief Rubin said. "But we've made some significant improvements, and with a little bit of time I think you're going to see a lot more."

After the hearing, Mr. Mendelson called the test results "completely disturbing" in an interview with The Times, but he likened the exercise to rounds in a hospital where there can be "a discussion of shortcomings to improve skills."

"You've got to be able to have a discussion of shortcomings to improve skills," said Mr. Mendelson, an at-large Democrat. "So it can't be a punitive process."

The written tests - equivalent to the National Registry of Emergency Medical Technicians test for paramedics - were performed last year at the Maryland Fire and Rescue Institute (MFRI) and taken by about 175 of the city's 250 advanced life-support providers. 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.

The Times obtained about 90 of the videotaped assessments and 95 of the written test scores. On the 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.

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.

Chief Rubin said 75 employees still must be tested. MFRI then will provide officials with a comprehensive analysis of the results.

[dr-exmedic]

I agree that remediation is generally better than punishment, but at this point, are these folks too far gone for remediation?

[croaker260]

I agree that remediation is generally better than punishment, but at this point, are these folks too far gone for remediation?

Yes and no.

Remediation may help individuals, but wont change the culture of DC fire. Without changing that, old habits will resurface.

[ktflame24]

EMS in DC is not as bad as many of you think. I have traveled the country and rode with many agencies and think that a majority of our providers are better than most. The big problem stems from the poor management aspect of the agency. The lack of training, funds for equipment, Medical Directors that get frustrated with Fire Chiefs that can barely spell EMS (:-), poor past hiring practices that hired you as long you were a resident and had a card. They didn't care if you had a clue or not. The big kicker, the place is a political nightmare. Public Safety in DC has a big target on its back. Very news worthy to the country. Things are improving slowly but surely and yes they can't be done overnight. I think a few of our major issues right now is system configuration and dispatching. We utilize MPDS and it sucks bad. It recommends too many ALS responses that should not be dispatched as such. Also, we provide ALS first response with 20 ALS Engines, 14 ALS transport Units and 25 BLS Ambulances. For the most part the ALS providers on the Engines hop on the BLS unit and continue care and transport with BLS Ambulances for ALS patients. The ALS transport units are usually left for the BLS responses (Who knows why?). Medical Box Alarms are usually the plan of the day for our communications division (1 BLS First Responder (4 Engine or 5 Truck Co. FF's ), 1 BLS Ambulance (2 FF EMT's) and 1 ALS Engine (3 FF and 1 FF/PM). So you get 10 or 11 members for a single patient on ALS medical or trauma emergencies (1 certified to provide ALS). Can you say WTF?

[ktflame24]

I agree that remediation is generally better than punishment, but at this point, are these folks too far gone for remediation?

Yes, there are a few that have gone too far for remediation and should not be practicing ALS providers. This is just a handful of folks. The funny thing about this whole testing thing especially the written portion is that study time was not provided and the exam was taken cold. I bet if the entire country took an old NREMT-P exam and did not prepare for it, many would not pass either. Now as far as the practical skills portion of the test there is no excuse there. We do this everyday and should be proficient at running codes and treating the critically sick or injured.

[ktflame24]

Also, we are lacking EMS minds here in DC. We have a few good ones especially our latest Medical Director (Dr. Augustine), but he can't do it alone. We are hiring experienced EMS instructors which are needed like yesterday and can't get any takers. 66,000 dollars a year isnt a bad chunk of change to teach EMS core content to a bunch of EMT's and Paramedics.

[dr-exmedic]

66,000 dollars a year isnt a bad chunk of change to teach EMS core content to a bunch of EMT's and Paramedics.
Do they make you live in DC? God knows I wouldn't move for that price; I doubt I'm the only one.

[ktflame24]

NO, not at all you have the option to live where you want, MD, DC, VA, PA or wherever.

[VentMedic]

I don't buy the taking the test cold part. There were stipulations in the Rosenbaum case that should have clued some in that changes were coming with the expectation of competency accountability. As well, testing was started a year prior to the recent test.

Why do so many in EMS choose to wait until their bosses tell them they have to know what they are doing? Is there not some personal and professional responsibility for maintaining skills and knowledge? Why must those in EMS wait to be spoon fed? I also find the attitude that they must have a special instructor come in to teach them most of which they should already have been taught to be more excuses. If anything, it should only be a review and much of that is obtained through CEUs and recert processes. There should also already be an educator on staff for a department that size doing competency checks. Was there not anything that resembled a QA/QI process in place?

Of course we could also put some blame that most Paramedic programs have instructors and not educators. Many of the instructors do not have any education beyond the cert level they are teaching and the few hours required to call oneself an EMS Instructor is almost laughable.

The response of vehicles and provider levels with this department unfortunately describes several FDs that have wanted to do EMS and have failed miserably because they didn't have a clue what it involved. It really gives those FDs that do EMS right a black eye.

In summary, this appears to be a problem throughout with those at the top guilty of not knowing what EMS is and the providers not caring enough about the patch they wear to take some responsibility to maintain basic knowledge without waiting for the spoon to feed them.

[croaker260]

Do they make you live in DC? God knows I wouldn't move for that price; I doubt I'm the only one.

I make pretty close to that now, and I work for an agency that wants to be educated and challanged. And cost of living is much less.

Why would I move there for more head ache and less pay after adjustment?

Well I am crazy....

[RyanEMVFD]

I keep getting brochures about once a year inviting me to move to D.C. and work there. I'll stay where I'm at, I'm happy here.

Only 6 more years till retirement.

[PhillyRube]

I keep getting brochures about once a year inviting me to move to D.C. and work there. I'll stay where I'm at, I'm happy here.

Only 6 more years till retirement.


Heck, I'm gonna be looking for a medic job when I retire from the PD in the next 2 years! Texas is looking good, I like the way they think there!!

[RyanEMVFD]

I'll be trading you then. I'm looking at going to a police academy and be a reserve until I retire from EMS then go full time.

[dr-exmedic]

Just in case it wasn't obvious enough, it's pretty much everything in DC (http://www.reason.com/blog/show/136345.html)that doesn't work well:
Back in 2007, D.C. Metro General Manager John B. Catoe, Jr. promised new scrutiny for Metro bus drivers after Metro had five pedestrian fatalities from 2003 to 2006, and three more early in 2007 (New York City, by contrast, had just one bus v. pedestrian fatality over that period).

[VentMedic]

Back in 2007, D.C. Metro General Manager John B. Catoe, Jr. promised new scrutiny for Metro bus drivers after Metro had five pedestrian fatalities from 2003 to 2006, and three more early in 2007 (New York City, by contrast, had just one bus v. pedestrian fatality over that period).

That's all? San Francisco's Muni got 8 pedestrians in 2007. I think they still make it to the top 10 of best cities to walk in according to the travel magazines.

[DrBob]

I was in DC the week Reagan was shot. We had a fire at my hotel and I chatted with some DC firefighters who invited me to tour their station, which I did. He showed me their SOP manual, which was about 20 yrs behind the times. He smiled and shrugged his shoulders. So, who writes the SOP for all DC employees and departments?

C'mon, take a guess. :D