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Home > Topics > Ambulances / Emergency Vehicles
November 06, 2012

DC faces 'critical' paramedic shortage

Due to overwork and stress, paramedics are leaving departments at a high rate

By Dan Goldstein
Fox 5

WASHINGTON — Paramedics, the most elite medical responders in the city's fire department, are leaving the District's Fire and EMS agency at such high rate due to overwork and stress that the department is now facing a critical shortage, multiple department sources told FOX 5 News.

Call volume in the city has been rising over the past three years as a result of increased population, but the department's emergency medical system, especially its staffing of paramedic units, has fallen short, FOX 5 has learned.

For example, FOX 5 has learned that on many days, the department is unable to fill all its 14 paramedic-staffed ambulances that are supposed to be in service around the clock every day to respond to the most critical life-threatening calls, because it is short as many as 100 paramedics to fill the slots.

Paramedics have more than 1,600 hours of training in life-saving emergency procedures, compared to about 300 hours of training for emergency medical technicians or EMTs, who make up the bulk of the department's EMS first responders. Unlike EMTs, paramedics can use the most sophisticated defibrillators for patients in cardiac arrest, start IVs, push life-saving drugs like insulin and insert breathing tubes to help patients in respiratory distress.

But in D.C., there aren't enough of them. Several years ago, the city shelled out $7,000 in bonuses to recruit paramedics, but many of them have already left for other jurisdictions like Montgomery County, Md. and Annapolis, according to the firefighters union. Moreover, there hasn't been a paramedic class or hiring effort since to replace those that have left, the union says.

"There aren't enough paramedics in the system," D.C. firefighter union chief Ed Smith told FOX 5 News. "We need an increase in units."

To offset the shortage, the department has been forced to pull firefighters who are cross-trained as paramedics off engine companies to backfill the ambulance slots. Currently about two dozen fire engines, which cost more than $500,000 each, are also now serving as expensive EMS shuttles, delivering paramedics to emergency calls to get a top-level medical provider on-scene quickly on the most urgent runs when paramedic-staffed ambulances aren't available.

But taking engine companies out of service to run medical calls is risky, says Ed Smith, the union chief.

"Hopefully there are no fires during the same time," he said.

Even more serious, FOX 5 has learned the department has been forced to hold over some paramedics who have already worked a 24-hour shift for as many as 12 more hours, just to keep some units on the street, leading to fatigue and low morale.

"Somebody's going to die or get hurt from this and I don't want a part of it anymore," one veteran D.C. firefighter/paramedic told FOX 5.

The D.C. first responder only agreed to talk if we hid their identity, for fear of retaliation.

The city's emergency medical system, the paramedic said "is going to crash. Everybody knows it. We all talk about it. It's going to crash and there's no predicting who's going be in its way."

The D.C. firefighter/paramedic also told FOX 5 that because of the shortage, they are often bounced around the city from station to station every shift, depending on need. That makes it hard to learn a particular area of the city, they said, which can lead to longer response times as paramedics struggle to find an out-of-the-way address or apartment.

In addition, paramedics aren't allowed to refuse department orders to continue work, even if they're exhausted from working 24 hours straight.

"You cannot go home, you will be put on charges, which are disciplinary action, even if you don't feel up to it," the D.C. paramedic told FOX 5.

D.C. Fire and EMS Chief Kenneth Ellerbe told FOX 5 News that the city doesn't have a paramedic shortage, saying there are more than 240 paramedic-certified employees in the department, even though not all on are on the street or available to care for patients.

"I know that we are able to respond to the community every time we have a call," Ellerbe said in an interview.

He said that holdovers of paramedics do occur, however.

"We do have the capacity to hold folks over to reduce our overtime," he said. "But, also to make sure that we are fully staffed to make sure that we can respond to the needs of the community."

Still, in a follow-up interview at the chief's request the day our story was to air, Chief Ellerbe declined to answer questions on the safety of the system, referring questions about whether a 36-hour shift for a paramedic puts patients at risk to his medical director, David Miramontes.

"I can tell you we provide really good patient care," Miramontes told FOX 5.

To reduce the fatigue on paramedics and EMTs, the city has come up with a new deployment plan for its ambulances called "power shifts" where more units will be on duty during the daytime, when the call volume is highest, and be reduced at night when there are far fewer calls.

"That will allow us to put from 25 to 45 units on the street, particularly during our heaviest call volume hours," Ellerbe said.

Still, union chief Ed Smith has his concerns, saying the plan actually leaves the District without a dedicated paramedic-staffed ambulance from 1 a.m. to 7 a.m. The power shift was to go into effect this month, but FOX 5 has learned it has been delayed, at least until next year.

Marie Bates, who lives in Southeast Washington, is one District resident who has witnessed the struggles of the DC EMS system up close and personal. In August, she called 911 from her home on Good Hope Road, SE for chest pains, a top priority call for the D.C. emergency medical system. But since there were no close-by units available, a paramedic-staffed fire engine from Station 29 on MacArthur Boulevard in Upper Northwest had to answer the call, more than seven miles away. The response time was nearly 20 minutes, more than twice what it should have been by department protocol.

"They told me that first they were coming," she told FOX 5 News. "Then they said they were uptown, they couldn't get through."

She worries though about other District residents who may not be so lucky when they call 911 and have to wait for a paramedic to arrive.

"People could be on their deathbed," she said.

Republished with permission from Fox 5

Comments
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Steve Cole Steve Cole Tuesday, November 06, 2012 4:35:11 PM I wonder if its the stress, the workload, or simply the fact that Paramedics are second class employees to DC Fire and EMS, and their pay and treatment reflect that?
Andy Johnson Andy Johnson Tuesday, November 06, 2012 4:49:12 PM DC needs, and has for a long time, needed an overhaul of their EMS system and philosophy towards ambulance service. There needs to be a global approach by government and departmental officials. Until this happens, throwing any amount of bonus money at the problem, isn't going to fix the problem. People have already died because of issues with the DC EMS system. Not sure what its going to take for them to wake up and move forward, not backwards.
Randy Hulse Randy Hulse Tuesday, November 06, 2012 5:02:17 PM Correct yourself on the comments about what EMT's CAN'T do! In many states, and EMT can start an IV, push D50 (hypoglycemic patients), give nitro and aspirin, AND secure airways with combitubes and King airways (which is quicker than intubations). Good EMT's can assist medics with just about any task they need to have done. They can immobilize patients, control bleeding, do CPR (AED) and just about every aspect of patient assessments. An EMT works just as many hours as a medic and does most of the ambulance driving, patient lifting, and cleanup/restock of the rig. I agree with the article in general, but don't make it sound as if medics are doing EVERYTHING out there. Perhaps if EMS had nice stations with kitchens, bedrooms, and entertainment lounges like fire fighters, it wouldn't be so stressful. While FF are relaxing at the station, EMS crews are usually posted at a gas station for 12 hours in the truck, waiting on the next call!
Heather Le Heather Le Tuesday, November 06, 2012 6:27:16 PM I agree with you Randy, and in some places EMT's can drive for CCEMT-P calls, instead of having a double P-med truck. Everywhere things are different depending on protocols and training. I've done Security / EMT a couple times now and that's completely different all in it's self. I also could do a lot of what you mentioned but where I'm at now I can't. Thank you so much for defending us. and sometimes depending on your partner EMT's have to do everything but the MEDICS paperwork. I only had a handfull f those partners but I wasn't wkg EMS just private.
Doug Zalud Doug Zalud Wednesday, November 07, 2012 3:10:27 AM It's been that way since the 80's. Before becoming involved with fire/EMS in NOVA back then, my former boss told me I had a better chance if I could crawl into MD or VA. It's seems to be the same thing for almost every major city. Good luck, gang. You deserve better.
Susan Topping Cartwright Susan Topping Cartwright Wednesday, November 07, 2012 8:39:59 AM They may do better if they separated EMS and Fire, many persons like myself can do EMS but not the fire side. I work on just the ambulance.
Randy Chapman Randy Chapman Wednesday, November 07, 2012 8:43:09 AM they need more pay i think the job of a firefighter/ems provider should be one of the highest paid jobs in the nation
Dawn E Topping-Streets Dawn E Topping-Streets Wednesday, November 07, 2012 8:44:10 AM I'm a paramedic of 25 years. Also instructor for local university and teach for AHA. It they would consider spliting up fire and ems and so that paramedics can be hired and not have to fight fire they may be able to recrut a few more. Many medic like myself would consider moving to work for the agency but I can't fight fire. I gave that side up a long time ago.
Ann Milton Ann Milton Wednesday, November 07, 2012 9:07:54 AM But living here would be a Big change from the Huntington/Wayne County. Otherwise, I completely agree!
Steve Jacobi Steve Jacobi Wednesday, November 07, 2012 9:25:41 AM How can you justify being the highest paid in the nation? Many do both FF and EMS for free and are very happy doing so. Also, with the entry into the profession at being just a mere 110 hours for EMT and as little as 600 for Paramedic in some states or some with no background checks, how can a job with such easy requirements be worth the high salary? What about teachers and most other healthcare professions who require at minimum a Bachelors and some a Masters or Doctorate degree? It is no secret that even Paramedics on private ambulances make more than teachers who need much more education and must deal with the insults and violence in the classrooms everyday. What about road construction crews which have a death/accident rate over 10x higher than EMS providers or firefighters combined? What about law enforcement and correctional officers? How about linemen, sanitation workers, underground pipe crews and coal miners? Think about them as you are sitting in your comfy chair at the station watching TV, surfing the net or sleeping in a nice bed provided by taxpayers who some are making alot less than you.
George Beltz George Beltz Wednesday, November 07, 2012 3:45:25 PM I've been an EMT-B since 2007. We have been trained to perform CPR/AED, Lifepack, immobilization, transport. We have been certified to administer O2, maintain airway (King's Airway), epi-pens, aspirin, nitro, glucose (testing and administration) and we can maintain IV's. EMT-A's start IV'S and have more skills that can be used.
Rhonda Radandt Rhonda Radandt Wednesday, November 07, 2012 7:50:30 PM You describe an advanced EMT... not a EMT-Basic
Rhonda Radandt Rhonda Radandt Wednesday, November 07, 2012 7:52:07 PM Let them be critically short... so what? Let them see what its like to not have anyone respond to THEIR cries for help... maybe that's what they need to get a picture of reality... people need to go where the jobs are and where they can afford to support their families.
Randy Hulse Randy Hulse Wednesday, November 07, 2012 11:16:27 PM Wrong! Take TN. for an example...an EMT-B can do IV's (of course they are trained for it), and all of the other things I listed. I have been an EMT - B and protocols I have worked allow us to do that stuff.
Rhonda Radandt Rhonda Radandt Thursday, November 08, 2012 5:10:53 AM correct YOURSELF... it depends on what State you live and what that State allows.
Steve Jacobi Steve Jacobi Friday, November 09, 2012 8:46:06 AM So you are going to punish the people who need help for the failures in EMS? Yeah that's a real professional attitude! What have you done for EMS lately?

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