D.C. Paramedic Staffing Plan Met with Skepticism

Fire Chief Kenneth Ellerbe plans to have only BLS transport during early morning hours


ANDREA NOBLE, The Washington Times | | Wednesday, November 14, 2012


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D.C. Chief Plans ALS Transport Cut

Fire Chief Kenneth Ellerbe looks to move medics during off-peak hours.
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A plan to redeploy the D.C. fire department's emergency medical workers in a way that would leave ambulances staffed with no paramedics during the overnight hours is being greeted with skepticism from stakeholders in the D.C. Council, the firefighters union and the community.

Fire Chief Kenneth B. Ellerbe on Tuesday outlined his proposal to pull 14 ambulances staffed with paramedics from 1 a.m. to 7 a.m. and instead have them respond to calls during busier hours from 7 a.m. to 11 p.m.

Ambulances staffed by lesser-trained emergency medical technicians would be used overnight.

While emergency medical technicians are required to obtain a certification that requires around 100 hours of course work, paramedic training lasts as long as two years and is frequently offered with associate-degree programs.

The plan would stagger the work shifts of paramedics, increasing the number of ambulances able to provide advanced life support from 14 to 20 between 1 and 7 p.m., when fire officials say the volume of medical calls is about 20 per hour - double the 10 calls per hour the department averages overnight. But the plan would leave the city with no ambulances staffed with personnel to provide advanced care for more-serious medical emergencies in the early morning hours.

Chief Ellerbe said the move is being made to provide better service to the community after the department studied a year's worth of statistics on call volume.

The firefighters union, which represents firefighters who are cross-trained as paramedics, says the issue is manpower. Capt. Ed Smith, president of the D.C. Firefighters Association, said paramedics, who can administer drugs and intubate patients with breathing difficulties, as well as perform more-advanced procedures, have for several years been either leaving the District or turning in their paramedic cards.

He said that the department has been slow to replace them, noting the department, which is configured to maintain 14 ambulances staffed with paramedics throughout the day, has had staffing troubles. As a result, the ambulances often are downgraded and staffed with emergency medical technicians, who are trained to evaluate symptoms and perform less-complicated medical interventions, such as CPR.

"They are not covering the 14 units they have now," Capt. Smith said.

The union president provided data indicating that on a daily basis this year an average of 4.4 units that are supposed to be staffed with paramedics are not because paramedics are not available. Chief Ellerbe disputed the union's statistics but did not provide data on the frequency of downgrades.

"Manpower is not the primary issue," Chief Ellerbe said. "The primary issue is call volume, us looking at the data and statistics and using that to actually make some smarter management decisions."

For the overnight hours, the department would rely for assistance on 21 paramedic engine companies, or fire engines that are staffed with a firefighter trained as a paramedic, and seven paramedic supervisors.

Kenneth Lyons, president of the American Federation of Government Employees Local 3721, which represents the department's civilian paramedics, spoke alongside Chief Ellerbe and said he believes that the department has enough trained paramedics to cover the overnight time slot.

"The one concern we've had is whether or not the system we have is flexible enough to meet the needs of the community, as well as to ensure that adequate care is provided to the community on the 24-hour basis," Mr. Lyons said. "This plan, though not perfect, we believe does meet that need."

No implementation date was provided for the shift. The initial plan was supposed to take effect Nov. 5, but it appears that start date was put on hold after D.C. Council Chairman Phil Mendelson raised concerns that the council had not had a chance to weigh in on the plan.

"While the configuration, which is essentially a shift change for single-role providers, may have its advantages, I am troubled that the department appears to be moving forward with such a major change without even the knowledge of its stakeholders," Mr. Mendelson wrote to Chief Ellerbe in a letter dated Oct. 18, adding that "the public has a right to know about any changes to the delivery of emergency medical care."

The council chairman, a Democrat, cited a provision of D.C. law that says the council must approve any major "changes in the manner the department provides medical services."

Mr. Mendelson did not return calls seeking comment Tuesday.

Chief Ellerbe indicated that the plan is not complete. He briefed representatives of the paramedics' and firefighters' unions Tuesday and said he also would seek input from the council and the public.

Anne Renshaw, president of the D.C. Federation of Citizens Associations, said the idea of redeploying paramedics has been tested in the department at least three times since the late 1980s but was never well-received.

Ms. Renshaw, who frequently testifies on emergency medical services issues before the D.C. Council on behalf of the federation, cautioned that as department officials weigh deployment decisions they keep in mind what is at stake if their plan fails.

"Any plan such as this has to be done very carefully. There is the human element that factors in," she said. "We just want to have the safety of the citizens at the uppermost in their mind."

The redeployment is not the first controversial plan introduced by Chief Ellerbe since he took office in January 2011. He broached the prospect of changing firefighters' 24-hour shifts to 12 hours - a move that the chief acknowledged would result in the loss through attrition of as many as 475 sworn firefighters from a total of about 1,800 in the city.

The department and union are still engaged in negotiations over the schedule change and are barred from discussing it.

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D.C. Chief Plans ALS Transport Cut

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