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C'mon DC: Can't you do better for your community?
Redeploying ambulances is but a small token gesture
By Art Hsieh
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Editor's note: Art Hsieh takes a look at DC's plan to alter paramedic staffing levels. |
The issues plaguing DC Fire-Rescue are not new. I remember back in the early 2000s the difficulty they faced in recruiting and retaining qualified EMS providers to its ranks.
The department has had many grand plans since then to revise and transform the EMS system of the Nation's capital.
Instead it continues to be plagued by system failures, some which have been spectacular (recall David Rosenbaum anyone?). Band-aid fixes are not going to serve the DC citizenry very well.
Let's not point fingers here. Agreed, it's the simplest thing to do — shift blame to another party. But it won't fix anything.
What will is a major, dispassionate, top to bottom look at the system, from its funding source, to its administration, to the line workers, and ultimately the mission of the department.
I do agree with the Chief — it's time for change. Certainly the previous history of the department's inability to provide consistent quality service validates that.
Redeploying ambulances is but a small token gesture — it won't move enough ALS personnel to adequately staff the other shifts. And clearly, without a major change in hiring practices, this too is doomed to fail.
Old cities, old government infrastructure, old mindsets — c'mon DC and Detroit. Can't you do better for your community?
Skip Kirkwood Tuesday, November 13, 2012 4:08:14 PM One of the things I don't think is right is a system that treats a sick person differently at 3 am than it does at 3 pm. 
Dan Greenhaus Tuesday, November 13, 2012 4:40:58 PM Numbers don't lie, the call volumes are greater during the day during the night. Many places staff more ambulances during the day than during the night. The thing that DC is missing that people DO get sick during the night, and it's not a smart move to have to rely on the engine paramedics to perform ALS when the overworked BLS crews (who are working 24s and now have no ALS crews on the end of their shifts) are hoping there isn't a fire alarm that is tying up the engine crew and tying up their closest paramedic.
Jeff Burrell Tuesday, November 13, 2012 4:50:33 PM Apply the theory to the EDs. There are hospitals that you recommend during the day tour, and aside avoiding at night - and vice versa. Kinda sad the inconsistency that prevails ...
David Shrader Tuesday, November 13, 2012 5:33:42 PM It absolutely makes sense to have more ambulances on the road when there are more calls. If you ran a restaurant, you would have more wait-persons on duty during peak meal times than at 3AM.
But what is the right number? That takes some fairly sophisticated, ongoing analysis. It is not a zero sum game that only looks at the people and equipment that currently don't meet the need and simply rearranges them to achieve some arbitrary financial goal or to staff down to the number of people that happen to be available right now, or to save a political career...in the short term. Always in the short term in DC.
It is entirely likely that they need to add shifts during the day and not necessarily take any off during the night. You can't know without the analysis. And if you've never done it before, its unlikely that you will be successful the first time. Kinda like landing a 747 on your first flying lesson, at night, in instrument conditions on a short runway, with a tailwind.
Static staffing usually results in too many units at some hours and not enough at others. In essence it treats the patients during the day worse than it does at night by not having enough units for the demand and making them wait longer for a response.
Staffing at the number of units required for peak demand 24/7 is egregiously wasteful unless those crews serve other essential, but low frequency, jobs that would be staffed anyway (i.e.: fire suppression). In those cases the marginal utility of the crew to the other function (i.e.: firefighting) is significantly reduced during the peak load ambulance periods. Its worse in urban environments that have higher Fire response loads, like DC. The economics of it are complex and new EMS roles are developing that may fundamentally change the calculation.
A host of other issues affect the equation, including: maintaining an adequate and dependable fleet, actually staffing according to plan, deployment practices that cover the demand, efficient shift change procedures, materiel management, being able to meet crew expectations of shift start and finish times better than 95% of the time while meeting deployment goals, overload "surge" procedures to staff up quickly, planning of special assignments, procedures to deal with drop time problems and diversions...it goes on for what could be a series of articles.
If DC were serious about solving its issues, the city's problems could be solved using methods that are used in hundreds of cities and counties across North America. Rearranging the deck chairs on the Titanic isn't going to do anything to slow its sinking even if it keeps the Captain from becoming the latest casualty of the process....for a while. Historically, DC took a very broken EMS system and shoved it into a fairly broken Fire Department, ending up with a very broken Fire Department EMS System. Its main value to the industry is to serve as an example of what not to do.
These comments are not meant, in any way, to denigrate the men and women that work within the DCFEMS EMS operation. I respect them for the job they do but pity them for the situation into which they are forced. I suspect that both the field and management personnel are doing the best they can in a tragic set of circumstances and with the tools they are allowed to have. I can't imagine running an EMS system that has to have its budget approved by Congress! I also can't blame those who decide to leave to improve their own lives and jobs.
Some really good people have broken their picks on the DC system. More's the shame as it would not be too difficult to fix if the political will existed to do it right. 
Skeeter Sawyer Tuesday, November 13, 2012 5:48:27 PM Good points, Dave! Very thought provoking and informative.
Brendan Kearney Tuesday, November 13, 2012 7:22:55 PM Did I miss something? In the interview I saw, the Chief reported the plan was still in development and not yet finalized-- has anyone actually seen the details of the plan that apparantly won't work? 
Bob Sullivan Wednesday, November 14, 2012 2:15:25 PM I don't understand why DC and other cities think the solution to a paramedic shortage involves fire trucks. Why not put paramedics in QRV's instead? 
