By Elissa Silverman
Washington Post
Copyright 2007 The Washington Post
WASHINGTON — Toby Halliday had many questions, but this was one of the biggest: Why do firetrucks often arrive before ambulances to medical emergencies in the District?
In the case of his father-in-law, retired New York Times reporter David E. Rosenbaum, the firefighters who responded to the January 2006 call about a man down failed to complete a basic exam and seemed eager to hand off the vomiting patient to ambulance workers when they showed up minutes later. So began a downward spiral of failure and seeming indifference throughout the department that ended with Rosenbaum’s death two days later.
“I came to this like a lot of people, thinking that pretty dramatic change was needed,” Halliday said. “The results under the existing structure had not been good for many years.”
But after six months of study by a task force that Rosenbaum’s family opted to create in a legal settlement with the District, Halliday and fellow members decided against drastic structural change. Instead of splitting D.C. Fire and Emergency Medical Services into separate agencies, they opted to unite an internally divided workforce by making firefighting and emergency medical work the same job.
Mayor Adrian M. Fenty (D) accepted the recommendations late last month. The most significant change will make the agency fully integrated: All personnel who respond to 911 calls will be expected to be able to put an intravenous line in a patient as readily as they connect a fire hose to a hydrant.
“Firefighters and ambulance crews need to work together as part of a team and not become further isolated,” Halliday said.
The transition won’t be easy. City firefighters have been required for 20 years to be certified as emergency medical technicians, but almost 200 are not because they were hired before that rule took effect. Among them: the firefighter in charge of the first responding vehicle, a firetruck, in the Rosenbaum case.
Also affected will be about 200 professional EMTs and paramedics, who will be encouraged for the first time to learn how to fight fires. In exchange, they will get higher salaries and increased benefits.
Fire chief Dennis Rubin, a member of the task force, said the measures will make the department stronger by elevating the importance of medical services and eliminating a cultural divide that has been exacerbated by varying schedules and work rules and a disparity in pay.
But hurdles — and detractors — remain.
“It’s really two separate jobs, and both can’t be done well” by one person, said a firefighter who spoke on the condition of anonymity because he feared retaliation from leadership.
A 24-hour shift at Engine 11 in the Columbia Heights area of Northwest Washington highlighted the divergent demands the department faces.
Of 24 calls that the firehouse’s ladder truck and fire engine went out on, 18 were medical in nature. That mirrors the citywide average: Three of every four calls to the D.C. department are medical. But firetrucks often arrive first, largely because they stay closer to their home bases at the city’s 33 fire stations.
Ambulances often cross the city and have to wait an average of 40 minutes outside a hospital’s emergency room for a patient to be admitted. So although firetrucks have been staffed mostly by EMT-certified firefighters, some residents say firefighters wait for the ambulances, which are more likely to be staffed by medical personnel with more training.
Among the calls during that shift: An elderly woman had fallen out of bed. A man complained that his lungs were burning from bad crack cocaine. At least two runs involved men sprawled on sidewalks. A bottle of vodka lay near one.
“That wears on us,” said firefighter Joseph Papariello, who is also a certified paramedic. “We’re not doing what we’re designed to do.”
Five of the 24 calls came from tripped fire alarms. Only one was a box alarm, or possible fire.
The firefighters jumped on each call. On their way to the possible fire, with sirens wailing and traffic parting along 13th Street NW, their emergency radios crackled. The reports of smoke were likely a meal gone awry in an oven. The truck turned around, and the firefighters returned quietly to the station.
The hallways of Engine 11 illustrate the division between firefighters and single-function emergency medical workers. Framed photos show firefighters battling neighborhood blazes. Not one shows a firefighter responding to a medical call. The symbolism is significant to some.
“They’ll tell you they didn’t come to ride an ambulance,” said Hattie Tompkins, an emergency medical supervisor who works out of Engine 11. “They came to fight fires.”
Kenny Lyons, who heads the union representing civilian medical workers, said he is unconvinced that the integration would improve the department’s performance in medical calls. In effect, he said, the agency is slowly phasing out those who had a singular passion for emergency medical work.
But Halliday and other task force members said they think that Rubin’s efforts to make emergency medical services an equal priority with firefighting send a stronger message than dismantling the department. They said they would monitor the reforms.
Almost two years after Rosenbaum was beaten with a lead pipe as he took an after-dinner walk, city officials seem confident that the conditions that allowed emergency responders to conclude that he was drunk, among other failures, are a thing of the past.
“I hope that just my simple presence alone is sending the message . . . that this administration will simply not tolerate indifference,” Rubin said.