KANSAS CITY, Mo. — An internal review found Kansas City Fire Department paramedics and EMTs often failed to follow established procedures for patients with chest pain, according to The Kansas City Star.
The audit, conducted earlier in 2025, showed that KCFD emergency medical crews complied with chest pain protocols in just 13.2% of cases reviewed. Overall, the audit found that department personnel followed recommended treatment steps for all medical calls less than one-fifth of the time.
The audit noted, failing to follow established protocols — such as obtaining vital signs, applying a cardiac monitor, or administering aspirin — may increase the risk of poor outcomes for patients experiencing heart attack symptoms. The report specifically noted that missing steps like providing low-dose aspirin can have serious consequences, referencing a 2009 study in the medical journal Prehospital Emergency Care that links these interventions to improved survival rates.
Calls for training, transparency
Deputy Chief Laura Ragusa, who oversees medical operations for KCFD, initiated the audit after field supervisors expressed concerns about lapses in patient care. The review covered a sample of EMS calls during a 2-month period, as well as all calls involving chest pain or acute respiratory distress.
Ragusa’s lawsuit called the findings “alarming,” according to The Kansas City Star.
Ragusa’s report called for increased hands-on training for EMS personnel and the implementation of ongoing skills assessments. According to the document, most EMS calls in Kansas City are medical, not fire-related, highlighting the need for a stronger emphasis on clinical care.
The report also recommended regular audits to track compliance improvements and set a benchmark of 50% adherence by the end of next year.
The audit also noted that neighborhoods with higher call volumes, often lower-income areas, may face the greatest risks, as residents are less likely to have access to bystander CPR while awaiting EMS arrival.
Next steps
Ragusa has recommended quarterly reviews and targeted remediation efforts for EMS staff, with the goal of significantly improving compliance rates.
City officials have not publicly commented on the audit or the lawsuit, and the KCFD medical director declined to be interviewed.
