STATter911.com has confirmed with DC Fire & EMS Department sources that no pre-hospital care report was filed in the initial response to assist a little girl with trouble breathing. That incident is now under review as the department tries to determine why the child, who died the next day, was not transported to a hospital when her mother first called 911. With no report, that also means there is no signed release from the family of Stephanie Stephens indicating a family member or guardian declined to have the girl taken to a hospital.
According to the department sources, who are not authorized to speak on this incident, the review will also look at the family’s claim that the medic told the mother to use steam from a hot shower to help open up her daughter’s lungs.
As 9NEWS NOW first reported on Wednesday, the toddler’s family is publicly asking why the medic crew did not take the two-year-old girl to the hospital after the initial emergency call was placed.
A second 911 call resulted in the girl being taken to Children’s Hospital about nine-hours after the initial response. The girl died the next day at the hospital.
Stephanie Stephen’s paternal grandmother, Tondalia Richardson, tells 9NEWS NOW, ”I just don’t understand it. I just don’t understand it. If they were called then why didn’t they take her? That’s the part I don’t understand, this is an infant, why wouldn’t you take her?”
Investigators say it was just before 5:00 AM on February 10th, in the middle of the second round of back-to-back blizzards, when the child’s mother called 9-1-1 because Stephanie, whom many called Tu-Tu, had trouble breathing.
DC Fire and EMS released a statement on Wednesday that says in part, “Within minutes a Medic Unit arrived on the scene. Emergency first responders performed a patient evaluation. There was no transport.” The statement does not indicate why there was no transport.
The sources say both Engine 33 and Medic 33 were dispatched on the call. Medic 33 had a veteran paramedic and an EMT aboard. Both are civilian EMS workers, or “single-role-providers”, as the department calls them.
The release indicates at 1:45 PM the second 911 call was received from the child’s home reporting “abnormal breathing”. This time a different crew aboard Medic 33 transported the little girl to the hospital.
Richardson looked after her granddaughter every week and says, “She was the bubbliest thing. She was loving and happy and outgoing.”
Stephanie was laid to rest this past Tuesday. Her grandmother is wondering why this little girl’s life had to be cut short just shy of the girl’s third birthday.
The grandmother claims Stephanie died of pneumonia.
The paramedic and EMT on the initial call are on administrative duty and are not to have contact with patients as the review continues.
Surae Chinn contributed to this report.
Also on STATter911 …
- Mayday audio: House fire on Chicago’s West Side. – May 30, 2011
- UPDATED: One Girl Dies, One Gravely Injured After Prince George’s County house fire. Two other children, parents & firefighter hurt in early morning Brentwood blaze. – January 19, 2011
- UPDATED – New video added: Allentown, Pennsylvania explosion update: 5 dead, including infant. – February 10, 2011
- Investigation after death of elderly woman in Washington, DC. WTOP Radio reports medic on leave after failing to accompany patient to hospital. – November 29, 2011
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Wonder if the family signed a refusal?
not to backseat quarterback the situation, but when will providers learn that it is easier to just transport people to hospital than to have something like this come back and bite you in the A$$. Is it worth losing your job????? I am a firefighter in the metropolitan D.C. area and my motto when on a transport unit is BE NICE ( treat everyone like a family member), and TRANSPORT everyone who calls 911. If they decide to refuse explain the consequences and get on the box with med control to cover you.
Anonymous, you are wrong. We shouldn’t transport EVERYONE who calls 911, it’s that simple.
I don’t know where you work in the Metropolitan DC area, so I don’t know your experience. But I refuse to transport one with a paper cut. (And that is just the tip of the iceberg as most everyone in this area knows) I believe, in fact, that person should be give a citation for abuse of the 911 system.
It is EMERGENCY medical system, not ROUTINE medical system. Somewhere along the way that memo has been overlooked.
My post has nothing to do with this call in DC that Statter911 is reporting.
We are NOT allowed to refuse anyone from transport. I hope our protocals were followed and they got a signed release by her parent or grandparent. Please reread the story it says she died the NEXT day at the hospital which I’m sure was Children’s Hospital a, “state of the art” center.
DCFD-LT…. Why would that be any different. Rosenbaum died 2 days later at Howard and our department is still being “raped” because of the hospital’s fault…
DC Fire & EMS has bent over backwards trying to ensure that it can get an ALS provider (Paramedic or EMT-Intermediate) to the scene within eight minutes of dispatch. This, despite the fact that there is no basis in science for this goal, and this goal isn’t even a national standard. (The national *consensus* standard allows for an eight-minute drive time, which is at least a minute more forgiving that DC’s standard)
This is the wrong approach for saving lives. This focus on *response times* virtually demands that Paramedics work alone, without another equally trained provider to make suggestions and decisions with. Most EMS failures are rooted in poor decision-making, not poor practical application. The NFPA standard for EMS response requires two ALS providers to the scene, unfortunately it doesn’t require that those providers be partners. Team-based decision making does not happen when one member of the team supervises the other, as it is in DC’s Paramedic Engine & EMS Supervisor plan for getting two ALS providers to some calls.
I feel certain that if this child had received a BLS response, the firefighters would have transported, rather than attempted a home remedy. I also feel certain that had this child received a two-Paramedic Medic Unit response, at least one of those Paramedics would have decided to transport. DC’s single-Paramedic staffing model puts the entire weight of a decision on the only Paramedic on the scene. It effectively absolves the other Fire Department personnel from responsibility for care, as there is someone else’s expertise to defer to. The EMS Supervisor typically does not assist in care or assessment unless absolutely necessary, and if he did, the other on-scene personnel would tend to defer to him, right or wrong.
To save lives, DC Fire and EMS needs to shift from a Paramedic Engine based system to a dedicated system of dual Paramedic ambulances, tiered with BLS ambulances.
DC has struggled to hire enough Paramedics to staff all the Engine Companies. DC is over budget and facing cuts. DC is spending money hand over fist in overtime, trying to staff the ALS Engines that it has. This is largely because most of the Paramedics it has are only being used as part-time Paramedics – they must respond to all of the other calls that Engine Companies receive. Dedicate them to ALS, on ALS transport units, and give them BLS transport units to handle the 75% of 911 calls that don’t require ALS, and DC could get by with fewer ALS personnel, even if it did the right thing and doubled them up on the ALS units.
Steal a page from the ever so successful Seattle Medic One program.
How can a 2 year old die an no body is to blame? dannn didnt her parent call 911 three weeks ago….maybe 911 is to blame then. The truth is some calls really dont fall under emergent call while some do. I am hoping the medic did get a refusal signed though, this should cover his/her ass…..hopefully. its just the system we live in somebodys got to be blame for the abnormal.
A duty to act, a failure to act, that failure caused injury or death, = NEGLIGENCE.
Maybe it would have made a difference, maybe not. Always error on the side of the patient, esp. a child.
Horrible what happened. But remember, when its your time to go, no matter the age, its your time to go. You cant keep death from knocking, just try to prolong it. Just my thoughts…
Jake is right. I would not transport everything either. As a matter of fact I dont. If they have a car or friend that can take them and they DO NOT require paramedic intervention, then I recommend they go that route.
I have been a FF/PM for 20yrs and in that time I treated everyone like I would want to be treated. Now that I am a Co.officer, I am responsible for my crews actions. Therefore, I make sure my medics do a thorough assesment on all patients. I dont care if it is our 40th call of the day and all hell is breaking loose. We are there to do a job. Lets do it right!
I am not gonna assume anything on this incident. But I do hope that all involved did the right thing and did a thorough assesment on this little girl.
What if this was your little girl. You would want the best treatment given to her.
To me, the most relevant sentence in this story is: “A second 911 call resulted in the girl being taken to Children’s Hospital about nine-hours after the initial response.”
Nine hours after the first call the family called 911 again…..
Nine hours of listening to the kid have trouble breathing….
We certainly can not assign any responsibility to a parent to provide for the care of their child in that time…. Nope, blame the medics on the first run.
The comments seem to point out the situations of no Transport for a paper cut. The issue here, is plain and simple; (1) Child
Trouble Breathing, (2) did the parents say anything concerning childs Medical History? (3) Was a Refusal signed? (4) Was there any attempt to establish Medical Consultation with a Physican at Hospital? If not why not? (5) The necessary Official DCFD Forms for whatever reason are either submitted, nor listed as any reason/cause for not Transporting child. (6)
Even if Parents didnot say anything about Child’s Medical History/Condition, that should have been enough reason to check with Physican. It’s also possible the people donot have
Health Insurance. This inand of itself isnot/doesnot constitute
no Transport. It is awidely known factor DCFD EMS Incidents are overwhelming. The Personnel assigned to EMS Duty do a good/Respectable to cope with never ending runs. The one call which Common Sense should have been a deciding factor, in conjunction with DCFD Protocols to Transport a Pediatric/Child
Medical Emergency. Once at the Hospital the First Responders have done their job as they are Trained. The Hospital assumes full responsibility for the Child’s Condition and possible Hospitalization.
Thank You
In the Know: I Have to disagree with you. Response times do play a role in how EMS is provided. Waiting more than 10mins for a Paramedic unit is unacceptable. Especially if the person is experiencing a “true” medical problem.
Also, since when did response times play a role in allowing single medics on units??? That is because of budgets.
I have had to work as a single medic in the past and it wasnt all that difficult. I am trained after all.
But I will agree with you. It is a very good practice to have two trained medics on a unit at all times. It does ensure that patients get the best care.
I work in a system that has a paramedic on an engine and responds with a two person paramedic unit. It works very well.
Every EMS system has the ability to have two medics, it comes down to the cost in most cases
Just something else to fuel the fire: Didn’t this incident occur @ 800 Southern Ave, SE???? If so it is 1.4 miles from E-33′s quarters to that address and 0.8 miles from the incident address to Greater Southeast Community Hospital, FYI.
Was E-33 operating as a PEC on this run? If so then there was 2 Paramedics on the scene.
Fyrecapt:
1. Hsu, A. , Getto, L. , McGinnis-Hainsworth, D. , Megargel, R. and O’Connor, R.
“The Impact of Paramedic Response and Scene Times on Outcome following Blunt Trauma.”
“Conclusions: Paramedic response time had little bearing on the composite endpoint of ED death, immediate transfer to operating room, or admission to the intensive care unit in patients with blunt trauma. ”
2. Pons PT, Haukoos JS, Bludworth W, Cribley T, Pons KA, Markovchick VJ.
Paramedic response time: does it affect patient survival?
“A paramedic response time within 8 minutes was not associated with improved survival to hospital discharge after controlling for several important confounders, including level of illness severity. ”
3. Thomas H. Blackwell MD, Jay S. Kaufman PhD
Response Time Effectiveness:Comparison of Response Time and Survival in an Urban Emergency Medical Services System
“there is little evidence in these data to suggest that changing this system’s response time specifications to times less than current, but greater than 5 minutes, would have any beneficial effect on survival.” (From a place with a 10:59 response time standard)
4. Price L
Treating the clock and not the patient: ambulance response times and risk
“The results of this study suggest that the 8 minute response time is not evidence based and is putting patients and ambulance crews at risk. ”
5. O’Keefe T, Dixon S, et al
The costs and benefits of changing ambulance response time performance standards.
“For all patients together there was no reliable evidence of an improvement in
outcome with faster response, and we estimate that the odds of dying were only 1.4%
less with responses ≤ 8 minutes compared to responses over 8 minutes.”
Is 5 enough? I could find more.
The plural of anecdote isn’t evidence. Paramedic response times below 8 minutes DO NOT SAVE LIVES.
If they don’t save lives, they are a waste of money, and if you’re wasting money in a fire department, you are indirectly causing the death of others.
If DC wants to save lives, it needs to give up on their extra-stringent ALS response time of 8:00 dispatch to scene (and accept, perhaps a 8:59, or even a 10:50 ENROUTE to scene, or at the very least a 480 second ENROUTE to scene, as specified in NFPA 1710).
More important than the ALS response time is the BLS (Fire Engine or Ambulance) response time. DC should expend 10x the effort and expense on this than it spends on maintaining ALS response times.
DC would then have a manageable number of paramedics – paramedics that it could work in pairs, and paramedics that could have a very close relationship with the OMD and the quality control system.
In the know said:
“Steal a page from the ever so successful Seattle Medic One program.”
They didn’t even have to steal one, they were practically handed a blueprint. The post-Rosenbaum condition had the Chief of Boston EMS, another highly successful tiered EMS system as a member. Given the committee’s report, and the fact that Chief Serino refused to sign his name to it, it seems clear that his input was ignored.
Let’s also not forget that DC’s mayor was elected, at least partially, on a platform of separating DC Fire from EMS in the name of improving EMS service to the community.
We can see how well that’s going. He broke both parts of the promise.
Too bad most of the response from DCFD is about CYA, fantastic, a little girls dies and it’s about everybody’s else is fault.
Anon – it’s not enough to get two Paramedics on the scene – that’s just checking boxes. They need to be *partners* if they’re going to be able to make decisions as a team. No doubt a single paramedic will make the right decision 99% of the time. But, in a department that makes 140,000 EMS runs a year, that’s still 1400 bad decisions a year. Having a second, full-time filter with each Paramedic might drop that to 14 bad decisions a year.
I’ll bet that this run involved the Medic unit taking one look at the 2 yo, and told the engine, “we got it”, thinking they could milk the run, on the scene, perhaps until they got relieved.
Well, here we are again.
I’d thought you folks in DC would like to know that firefighters and EMTs from other departments across the country watch and read what goes on in the nation’s capital and sometimes just shake our heads in amazement.
I’ve been reading your blogs since 2007. I’ve seen what you post on the “watch desk.” I’ve watched videos of DC Council meetings. I’ve even read the OIG report from the Rosenbaum case. I save all this stuff because I like to show it to new firefighters being trained in my department. Yeah, yeah, I know. We ain’t as good as you. We don’t have the runs, the fires, the shootings, the stabbings, the acrimony, blah, blah, blah. We have easy jobs with no pressures. We’re all vollys or wannabes. Sure, right.
So today, I asked a few wannabe recruits in my department about what they thought of your latest problem. Some had your typical 20ish responses, but one really struck me. He said only one word:
R-E-S-P-O-N-S-I-B-I-L-I-T-Y.
He’s a newly certified Paramedic too. He said nothing else except individual responsibility really mattered. Why? Because it all comes down to one DC paramedic treating one little child. See, that’s what medicine is really about. A caring relationship between a healthcare provider and the patient that makes a difference. Nothing less, nothing more. And all this from a 19 year old kid with hardly any experience.
So now, people on Statter 911 are posting journal articles about why single medic units don’t work the best. Close relationships with OMDs, quality care, so on and so on. Seattle Medic One. Boston EMS. And (imagine this) why a fire based system doesn’t have what EMS needs. Surprisingly enough, a fire based EMS system works fine in my department and a bunch of others around the country too. Why? Because we hire caring EMTs and paramedics who understand the meaning of that one word:
R-E-S-P-O-N-S-I-B-I-L-I-T-Y, just like that kid I talked to today.
So here’s a few predictions. I’ll bet that when all of this is done, it will come down to the bad decision of one person. I’ll bet it will be shown that this one person turned down additional help on the call. I’ll bet that the other crew member riding with them told them not to do what they did but they did it anyhow. I’ll bet that this one person busted two or three general orders and medical protocols about how to treat and what to do for the patient. I’ll bet they didn’t do a report or get a signed refusal. And, I’ll bet that a bunch of people from DC will soon be posting all kinds of the usual
E-X-C-U-S-E-S on this blog.
Instead, please do the rest of us a favor, DC. Stop blaming your department. Stop blaming your chief. Stop blaming the EMS system. Stop blaming the public. Stop blaming the mayor. Stop blaming the council. Stop blaming the medical director. Stop blaming training. Stop blaming the calls. Stop blaming your union. Stop blaming response times. Stop blaming firefighters. Stop blaming EMTs. Stop blaming racism. Stop blaming the media. Stop blaming everyone and everything else. No excuses. No roadblocks. No investigations. No reports. No commission or task force. It’s all getting very old.
Instead, take a long, hard, cold look at what each and every one of you are doing wrong individually and start taking responsibility for fixing it yourself. We know you have it hard. We all know the history. We know that 95% of the people working in DC are some of the best around. But, in case you didn’t know it, DC needs to fix that other 5% like right now.
Remember through all of this that a little 2 year old kid by the name of Stephanie Stephen DIED. She’s not coming back. Regardless of what you say, do, write, yell, pontificate or whatever else, regardless of who you, the unions, the hospitals, the lawyers or the courts blame, the men and women of the DC Fire and EMS Department own this. Fire and EMS. You had a DUTY to your patient. You failed that duty. Not the hospital. Not the medical director. Not the chief. You on the fire truck or ambulance. Start taking responsibility today. No one else.
DC Fire and EMS is better than this. Stephanie Stephen deserved better than this. A whole bunch more kids in DC deserve better than this.
So, fix it. Do it NOW. Please. Stop making excuses and start taking responsibility.
God bless all of you and have faith.
Has anyone of you took a step back and thought…Maybe, just Maybe, the parents refused transport? If so, then the EMS crew on the scene is guilty of failing to obtain a signed release (RESPONSIBILITY).
“…confirmed with DC Fire & EMS Department sources that no pre-hospital care report was filed in the initial response to assist a little girl with trouble breathing….that also means there is no signed release…”
If it wasn’t written down, it wasn’t done. RESPONSIBILITY
There was no patient assessment. RESPONSIBILITY
I would love to be an attorney on this one.
Well said Beach Firefighter you are absolutely right in your statement.
Unless I missed it, was the cause of death ever listed in the articles? Is it possible that even if the child was transported on the original call, that the child would have died? There are other factors involved in this and information that must be ascertained before judgement can be made.
And I’m not trying to overlook any procedural elements that may have been violated. If there is no paperwork/refusal from the original call, then that should be dealt with. But the child’s death may have been unavoidable. We don’t have all the information yet.
“Remember through all of this that a little 2 year old kid by the name of Stephanie Stephen DIED. She’s not coming back. Regardless of what you say, do, write, yell, pontificate or whatever else, regardless of who you, the unions, the hospitals, the lawyers or the courts blame, the men and women of the DC Fire and EMS Department own this. Fire and EMS. You had a DUTY to your patient. You failed that duty. Not the hospital. Not the medical director. Not the chief. You on the fire truck or ambulance. Start taking responsibility today. No one else.”
In case those of you with short attention spans stopped reading….heres the summary.
Well said Beach FF. Well said. Matter of fact, I dont think anyone can post a valid argument to that post. It’s cut and dried.
BEACH Firefighter, that is one of the BEST posts I have seen ANYWHERE. Personal responsibility. What a concept…
I donot believe Response times played any significant role in this particular incident. It appears from what was reported and commented here, there was some mistakes in the evaluation of the child. Turn the shower on and let the steam assist with Breathing. I cannot think in good conscious that would have served any good relief this precious Little Girl.Think about the potential that the child could have possibly fallen in the shower and either drowned, or injured herself. The Basic Body of Knowledge in understanding Emergency Medical Evaluation is such; (1) You donot have to Diagnose any Medical Condition. (2)
this was a Pediatric/Child Trouble Breathing. Obviously her little Lungs were not functioning properly. ie; Asthma, Pneumonia or any other Respiratory Distress. (3) I think I read where the 800 block of Southern Avenue is close to Station 33. Also the location is very close to the Hospital on Southern Ave. Why wasnot the Decision made to just Transport the Child and get her the closes Hospital/Physican Medical Attention she deserved? This precious little Girl an Angel of Love to her family is now gone through whatever combination of on scene events by First Responders made, or didnot make. Good Lord Rest her Little Soul. This one isolated incident must not/should not be the result of DC Fire/EMS Professional Operations. Did I read someone wrote 140,000 EMS Runs Annually.
Come on people, back off the criticism. If for no other reason out of Respect for this little girl,her family, and most important to each one who is a Primary EMS Professional within DC Fire/EMS. It should be everyone’s mindset that this sacrifice of a precious little child will not occur again with the circumstances. I am quite sure the DC Fire/EMS Authorities
The Medical Director, and the entire Medical Society serving the citizens of DC will bring out the Truth as was/is known.
“RESPONSIBILITY// ACCOUNTABILITY” is what it is all about.
I guess the department will put out a Special Order that instructs personnel to “Be R-E-S-P-O-N-S-I-B-L-E for your actions” and all will be well.
I’m sorry for the family, and I’m saddened by this story.
I’ve done EMS in an urban area for 15 years. I don’t like stupid runs anymore than anybody else, i’ve been on thousands. However, put the patient in the ambulance and take them to the hospital. If you don’t like the work then get out. Its that simple.
That is not to say there are no systemic issues. They clearly exist, but when you are an EMS provider at the scene of a call all those issues don’t matter. Put the patient in the damn ambulance and drive them to the hospital. If they have called, the education system has already failed and it will not be improved on scene during an incident.
Nice post beach guy. You make it sound so easy. Everyone be responsible and it will all be ok. That might work with your ocean front FD and your new class of recruits but in all reality you know nothing about the DC Fire Dept. A civilian medic may have made a bad decision and you’re on here telling all of us to take a long, hard, cold look at ourselves. We run about 140,000 calls a year. Sometimes things go wrong, and now someone will have to answer for it. I don’t think it’s possible for every call to turn out great. I get what your saying but come on, you’re on here preaching to us all like all 2,000 employees made a unanimous decision not to transport the girl. Thanks for the pep talk but we’ve delt with issues like this before, as do most depts that have a large call volume.
Dust replied: “Nine hours after the first call the family called 911 again…..
Nine hours of listening to the kid have trouble breathing….
We certainly can not assign any responsibility to a parent to provide for the care of their child in that time…. Nope, blame the medics on the first run.”
Why should the parents be blamed? If you called 911, (the people who were SUPPOSED to help) and they told you to put your child in the shower and run the hot water, would YOU call them back? I wouldn’t. I’d be afraid they would accuse me of “abusing the system” as Jake says in his post.
And let’s not forget Anonymous who replied: “Why would that be any different. Rosenbaum died 2 days later at Howard and our department is still being “raped” because of the hospital’s fault…”
Your department is being “raped” (as you so eloquently put it) because of a simple failure – the failure to properly assess Mr. Rosenbaum which is the first basic premise of emergency medicine. (And by “raped” I’m assuming you mean media attention since the Rosenbaum family signed away their right to sue the pants off DC FEMS in 2008.)
BEACH got it right! But you guys will continue to point fingers at everyone else, because YOU are the great DC Fire and EMS department with the busiest firehouse in the country and shouldn’t we worship you and blah blah blah blah!
Sorry BEACH, R-E-S-P-O-N-S-I-B-I-L-I-T-Y is not taught in the DC Fire and EMS curriculum.
This also has all the makings of another Rosenbaum case. After that was all said and done you’d think the FD went to his house, beat him in the street with a metal pipe and then left. What about the guys that assaulted him? What about the crappy hospital that he stayed in for days before he died? Of course the FD takes the hit. This poor little girls family could have taken her to the hospital themselves at any time. Which was right down the road. The girl was in an exceptional hospital for another day and she still died. Like the guy posted earlier said: when it’s your time, nothing can be done.
If we had this kind of outpouring every time you county clowns burned a house down, Statter’s blog would be overloaded and have to shut down.
@ Beach Firefighter
I am a DC Firefighter with 3 years on the job. I agree 100% with your observation. When I came on the job it was because I wanted to serve the citizens of this community. On one of my first calls for trouble breathing I went to grab a stair chair and was told, “This is Lincoln Heights, we dont do stair chairs around here.” I was disgusted by the indifference and apathy of SOME of my co-workers. It is a daily struggle to maintain an attitude of servitude because of people around me that have settled into a routine of bad habits and lack of excepting personal responsibility.
It is true that in some areas of the District, especially in the pre-dawn hours, there are a considerable amount of calls. It is true a large amount of those calls, by definition, do not represent an emergency situation. True the public can be educated on how the 911 emergency response system could be utilized better. But, since when do any of these situations justify being scolded by, manipulated into believing you dont need to go to the hospital by, or even being denied service by the one you are calling on for help? As public servants we have a DUTY to act. We have a responsibility to treat every citizen in the most excellent manner possibe, regardless of time of day or number of calls. This is what we are employed to and took an oath to do. Whatever problems we have with the department, management systems, protocols, staffing, apparatus, etc… should not be taken out on the citizens.
If we are so unhappy with our jobs, we can seek employment elsewhere.
I often hear people blame everyone and everything and complain that it is getting worse and has been for years. Why are you sticking around if you are not taking your part to remedy the problems? If all you are empowered to do in your position is to provide the most excellent service that you can with what you have to provide it with, then that is what MUST be done.
Our commodity is people. We need to be more purposeful in protecting that commodity.
I dont know all the facts in this paticular case but based on previous observations I bet some of the contributing factors are:
1. The call came out about 5am
2. There was a major snow storm outside
3. Relief is in about 1 or 2 hours
4. This is a 2year old and the ELO is going to send me to Children’s (unless there were severe respiratory distress, which there wasn’t at the time because they left her. By the way children compensate very well and dont display distress as soon as adults. When they crash, they crash hard.)
5. Ive been stuck in the snow several times today already, Im tired, Children’s is far away, and I run the risk of getting a call on the way back.
6. I will tell this citizen whatever sounds good enough that I wont be pressed for a transport, get out of dodge, and let the next shift worry about it.
7. Ive done this before without consequence, what should be different this time.
The fact is that if anybody that is posting comments on this incident WASN’T ACTUALLY THERE, then you have no business Monday morning quarterbacking.
This is DCFEMS’s plan for EMS backfiring and biting them in the ass. Two medics on each medic unit and if you have the staffing should be the bare minimum. It’s not rocket science.
And by the way, like somebody else posted, she didn’t die in the care of DC Medics, she died at Children’s National Medical Center.
@ Anonymous 3:51pm
Yes it is true that when it is your time to go that nothing can be done. In these situations the fact that 2 people died brought to light what wasn’t done by protocols but could have and should have been done. If in Rosenbaum’s case a proper assesment were done and he still died, then there would be no problem. Dont get me wrong on this case though, I dont think the department should have taken the hit the way we did. After all he was IMMEDIATELY transported to a hospital where a proper transfer of care took place. The hospital then has the responsibility to reevaluate and reassess that patient. It is unfortunate that a proper initial assessment wasnt done but there was still TIME for more to be done at the hospital. We dont always catch things the first go round. There was a shared responsibility there but the burden should have been with the hospital. They were given the patient in enough TIME to administer a higher level of care, but instead they stuck him in the corner like they do all the suspected drunks.
BUT the 2year old is a different story. She was robbed of the TIME for a higher level of care because she wasnt transported. Like I said before by protocol she could have and should have been transported. We do not diagnose, all we can do is treat symptoms. If at that time a patient refuses there needs to be proper documentation. In this case there was absolutely no documentation of vitals, care administered, or refusal for transport. Who is to say any of these things took place if there was no documentation? The citizen has nothing to prove, we do because there is a standard in place for situations like this. It wasnt followed and a little girl died without recieving proper medical care in ENOUGH TIME.
You place blame by saying the family could have taken her to the hospital any time. Are you aware that there were almost 2 feet of snow on the ground during this storm in which even 4WD vehicles were getting stuck? Are you aware that in this area of the city alot of people dont own personal vehicles and rely on public transportation, which wasnt running because of the snow? The family should’nt have had to take her to the hospital if they called for HELP.
If someone that you called on for HELP because you dont know what to do, tells you just let some steam open her up, you will do what they tell you because you have submitted to their expertise as an emergency care provider. Nine hours pass, yes, because in the TIME that is being wasted you are following terrible advice. Eventually you say the “Medical” advice that I am following isnt working and you call for HELP again. Only this time too much TIME has passed without “Proper Medical” advise and your child succomes to pneumonia.
In this case the citizen was failed because they were misinformed and misdirected by the person that they called on for HELP.
Again, if the citizen refuses, fine, there MUST be proper documentation to back that up.
I love the comments saying a 2-medic system would have improved the victim’s chances. So you are saying that not only are the EMTBs completely absolved of any decision making, but there never could be two incompetent paramedics working together?
You can cry “DCFD is to blame” all you want. Show me a fire dept that doesn’t have their share of members who are less the “average”. Some people are here simply because they couldn’t make it anywhere else. You can scream R-E-S-P-O-N-S-A-B-I-L-I-T-Y all you want. Most of our members live up to that theory. Unfortunatley, some don’t. That’s what happens when you work for an agency that will not take the proper action against those who don’t becuase they’re afraid of the “lawyer” word.
My thoughts and prayers to the little girls family!
I can not believe that DC providers keep blaming the patient’s family and the hospitals when calls go badly. It is simply amazing to me how much they don’t get it. The simple fact that someone would say, it isn’t our fault because she died at the hospital just emphasizes how little they know about medical care. It is an embarrassment to the providers that may actually be trying to provide professional medical care.
Further, to blame the family for not taking her to the ED themselves doesn’t take into account their knowledge or lack of knowledge of the situation. They may have no understanding of what truly sick is, especially since kids don’t “fall off the cliff” until they are very critical. By the time they saw that things had turned very bad it was already too late. They had called what they thought were medical professionals who told them to stay at home.
It is tragic that DC is served by a department plagued with poor emergency medical care. It is even more tragic that such care just seems to continue without any hope of improvement. Since Rosenbaum’s death, how many poor patient outcomes due to negiligence have come to light in DC? If there was one it would be too many, and I can think of a few already.
I also wonder about supervision. How are the units being monitored in DC? How does a med unit make a 2yo SOB and then leave without so much as a mention as to why they aren’t transporting? Before you start the “we are so busy”…we are making a 100,000 runs a year and I know it wouldn’t go unnoticed here. We have to verbally state a DNT (did not transport)and acknowledge that we advised a chief on the dispatch channel. Refusals have to be reported to a chief who has to agree or come to the scene. The district chiefs monitor their zones via CAD terminals in their vehicles, and if a unit cleared without transporting on a 2yo SOB… in a blizzard … someone would be asking why.
A few years ago, Memphis was asking why they were dealing with multiple negiligence lawsuits in the fire department. They found poor care, but also that no one was watching hen house. They have created a new EMS command structure that has experienced paramedic leadership to ensure that proper care is being given and that people are doing what they are supposed to be doing. DCFEMS should start looking around to other departments and cities for ideas because it doesn’t get much worse than this.
Yes, some poor patient outcomes have come to light. No argument there. But, think about this…out of roughly 140,000 calls, how many is some? Since the Rosenbaum case, the few that have come to light also says that thaousands are handled properly by members that do care and don’t need their every action scrutinized. Good caring providers don’t need to be watched like a hawk. That becomes micro-management which contributes directly to the poor decision making process. Looking back at the Rosenbaum case, you may recall that Howard Univ. Hosp. was found to have been a direct contributer to his death.
Until the report is released, lets not go off half cocked. When the report is released, deal with the R-E-S-P-O-N-S-I-B-L-E parties accordingly…whomever they may be.
Good QA goes along way. That means from the time the 911 operator receives the call till the patient is discharged from the hospital. Lots of people fall under that umbrella.
Stuart – you have to look to the leadership (or lack thereof). Rubin comes in with all the fanfare Mayor Fenty can provide. The Medical Director, Dr. Williams, was there pre-Rubin and was making changes. The minute Rubin is advised that his medics are failing tests and need to be re-trained en mass, Dr. Williams suspiciously “resigns” and is replaced by Rubin’s buddy from Atlanta, Dr. Augustine in August 2008. Dr. Augustine vows to improve education, but that is mighty hard to do when he was traveling the country working at his other jobs. Then Mr. Givens dies in December 2008 and an investigation is started. He was the 39 year old man with chest pains that was told to take some antacids and was dead from a hart attack six hours later. The press finds out about the testing which shows how incompetent DC medics are and questions are raised that Dr. Augustine and Chief Rubin can’t (or won’t) answer. Now that the Givens family has filed a lawsuit, Dr. Augustine has left town faster than a cheetah going after a gazelle. Of course, he says he left for “health reasons” but it is really the health and safety of the residents of DC that are at risk. This agency has shown time and time again that EMS takes a backseat to fire and it runs through more Medical Directors than you can shake a stick at. No Medical Director in recent memory has lasted much more than 2 years at longest. There is no consistency in EMS care and, according to news reports, both Dr. Augustine and Chief Sa’adah (Asst Chief for EMS) are the subjects of lawsuits for failure to provide competent care. If the Medical Director and EMS Chief can’t provide competent care and leadership, why should anyone expect the rank and file to do any better?
Okay let’s see here……Over the last 4 years there have been 3 cases of mistreatment by DCFD. There was the Rosenbaum case, the Givens case, and most recently and unfortunately the Stephen case.
That makes a rough ratio of 3:560,000 (Based on a 140,000 estimated call volume) that related in patient death (even though one is still skeptical as DCFD fault, but for the sake of a good point I will give you the Rosenbaum case).
So that means that roughly 559,997 cases went how they were supposed to.
3 deaths are very sad and NEED to be addressed, but everyone getting on here and bashing an entire department because of the actions of a few is down right wrong. Yes we have our problems but damn be for real, most of us and I say MOST of us again, come to work with the right attitude and the right training, and the right mentality to take Responsibility to the highest level.
Don’t bash me for the actions of a few, as I wont bash your department for your one sided ignorant, selfish, uneducated (in DCFD workings) posts.
The rank and file can be expected tp perform competently but knows they will not be backed by the incompetent leadership. Patient dies and leadership says “wasn’t what I did. Must have been them”. What kind of match is that? The focus hasn’t been on firefighting either. How much of the training budget has been blown on ” the Rock Garden” vs fire crew proficiency training?
We just don’t have the right number of qualified instructors and evaluators. For that i blame the incompetent leadership, not the providers. The Training Acadamy is the first stop in any DCFD career. If that’s substandard, what’s left?
First off, God Bless Stephanie Stephen’s
Second, i wish some of the naysayers would request a ride along with a unit in DC. Maybe some of them have, but i can obviously point out the ones who havnt. Maybe then some would understand. DC employs some of the best first responders in the world. Hands down. I volunteer in a department of 50 active members and have s**t bags in it, how can you expect that they won’t have a few either? Excuse? No. Its reality. Responsibility is paramount, definitely. But to come on here and tear down a world-class department the way some of you are talking is utter ignorance.
And as for all name “high-horse” talk in between that well put statement beach fireman..Do members of DC flaunt? Sure, but no more than many of you from other departments that wear your t-shirts in public, stickers on your truck, and tell the stories of that fire you fought two years ago in the bar like it happened yesterday. The men and women of this department are proud, carry a long and storied tradition, and yes, they put out fires very very well. They have a lot to be proud of. And when people come on here and egg them on, on a daily basis, egos are going to fly
I was going to write a long statement but this should suffice.
Terrible, terrible tragedy.
Pneumonia is Not an overnight illness.
The fact that the baby died 1 day later made clear that this was not a new illness.
Was baby seen at PCP for pneumonia prior?
Would you let EMS leave if you thought your baby was ill, even with a signed release?
Would you wait 9 hours later to call back, if your baby was still ill?
Name a hospital east of the river that serves residents? None.
GR SE operates as a limited facility? ie Can we blame Fenty?
Children compensate at extremely high levels.
Never met a medic that would not transport a child with signs of Resp Distress. ie It doesn’t happen even in DC.
Medic should have done the paper work!
If we don’t know the facts, we can’t rush to judgement.
Last you can’t compare were you are from to DC.
We have politics, with residents, with transients, and tourist and terrorist in a 66 sq mile radius, a population at high noon of a million plus, with 33 FHouses.
And the entire nation looking at us. We are not Boston, Seattle, the Beach or some county.
Sorry for your loss.
Beach FF got it done. And for all the people whining about “abuse of the 911 system”, if it WASN’T abused, then MOST of us wouldn’t be getting paid. We don’t have to LIKE scrambling out of bed at 4am for tooth aches and back pain the pt has been having for 3 years, but we have a responsibility to get it done.
Most of this nonsense is a clashing of egos with a whole bunch of excuses, and even more prattle about stuff that has nothing to do with the original story. A little girl died, and her death includes an EMS unit showing up at her house and leaving, without transporting the girl. End of story. Lots of people are to blame and there are lots of reasons on why it happened. The point to be made is that a 911 call was made for help, and the little girl was not transported. The reasons are irrelevant.
And lastly, pt refusals were designed for people who didn’t call 911 and don’t want to go the hospital. Using them on first party callers for medical situations is a luxury and a measure of lazziness.