An open letter to the leaders of DC Fire and EMS

The co-founder of EMS1 shares his concern for a system addicted to the status quo and outlines a path to great medicine


Dear Washington D.C. leaders, elected officials and EMS stakeholders,

I love your city and its 200 years of history as our nation's capital. And, because our relationship began when I was a child in grade school, this letter is particularly difficult to write. I'm not sure how to sugarcoat it, so let me be frank:

You have an EMS problem and it's time to seek treatment.

As the co-founder of EMS1 (started in 2007), the Rosenbaum incident was one of the first major stories we reported. That incident uncovered a broken system that needed a major overhaul.

Well, it has been 10 years.

And the effects of mismanagement, lack of support, direction and vision remain clearly evident. I can see the sadness in your eyes and I hear it in the messages I receive from your field personnel. The overwhelming weight you carry each day seems unbearable. The addiction to politics and the good ol' boy system is piling stress and worry higher and higher. The pressure has to be unbearable.

I am here to help. But it's your decision whether or not you accept it.

EMS1 has talked about you — the D.C. Fire and EMS department — and how to help in more than a thousand articles since 2007 and now I'm hoping that you will see how this addiction to your status quo is hurting the lives of many people.

Addiction is terrible. It's a disease that alters the way you think and perceive reality. You don't have to keep running a department like this. This is serious and there are EMS experts who can help.

You have a long journey ahead. Let me walk alongside of you — one step at a time. For nine years I've had a front row seat to EMS and witnessed both amazing and awful EMS systems across the United States. Consistently, your system has represented what not to do. You haven't listened to some of the brightest experts in our industry. And, while the debate will continue regarding fire-based vs. third party vs. private, there are clear benchmarks of what makes a great EMS system.

First, care about people.
Care about your employees and your community. The work environment needs to be a culture of safety and commitment to greatness. I'm mostly worried about the perceived lack of support for the medical director and EMS supervisory leadership. Chief Gregory Dean, you came from an EMS-centric department (Seattle, Wash.) whose focus on initiatives like cardiac arrest survival have been replicated across the country.

I get it, Chief. D.C. Fire and EMS successfully dug this disastrous hole over years and years of poor decisions. It'll take more than your short tenure to turn it around.

But, equally so, we aren't seeing the camaraderie and commitment to your team that it takes to turn it around. The best and brightest need to be empowered to make a difference. If Dr. Jullette Saussy felt like she had the resources and support to do her job, we wouldn't be having this conversation. Empower your educators, medical directors and EMS leadership. Support one another.

Second, care about medicine.
Like, really care about medicine. Go to bed thinking about medicine. Dream about medicine. Wake up wanting to practice great medicine. You have 700 EMS personnel that need to recertify. Who's going to verify their skills? What mandatory standards are in place to assess their critical thinking skills?

After more than 20 years in the EMS profession, I am still challenged by my peers, medical directors and education leadership to provide better medicine to my patients. We do this through QA of every EMS chart, ride-alongs, preceptor observation, case studies and hands-on scenario trainings.

I challenge you to reach out to the top 50 EMS providers, textbook authors, national speakers and educators in the nation. Envision those experts over the course of six months going on ride-alongs, reviewing the current status, building an education system for remedial training and providing a sustainable system plan ready for implementation.

Be advised, education is expensive. Doing the right thing is expensive. This process will be painful, but you'll be pleased with the end result. How great would it be if the nation's capital was the center of EMS excellence?

Third, be proud of what you do.
The fire career is amazing. The law enforcement career is amazing. Guess what? The EMS career is amazing. Focus on excellence. Lock arms with those that have the same beliefs.

The EMS division isn't a step ladder to the fire division. There are great firefighter-paramedics out there. I know many. But it's absolutely OK to like being a paramedic. In fact, it's more than OK. Being a skilled, knowledgeable, caring paramedic is a difficult task and takes dedication, time and commitment.

Finally, let your best people shine.
You have awesome people. This wake-up call is not about them. In fact, it's for them. There are many dedicated individuals at D.C. Fire and EMS who wake up each day looking forward to their shift. They wear their patch with pride and are excited to serve in our nation's capital.

Support them. Ask their input on how things can be better. Listen to the boots on the ground. They're running long shifts and are exhausted. They need your words of affirmation, your support in education and your operational expertise to reduce their burden.

What are the biggest priorities? Great question. Ask your troops. They are living in the EMS trenches every day. They have a voice. Let them be heard.

D.C. Fire and EMS, sadly, you've devoured some of our brightest people who've tried to help you succeed. Even I'm weary of offering my colleagues' help to you. Their livelihoods are based solely on their reputations and your track record for treating them nicely is, well, subpar.

The choice is up to you. Today is your intervention day. Are you in?

Sincerely,

Kris Kaull, Paramedic
EMS1 Co-Founder, Editorial Advisory Board member

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