Children’s Hospital doctor blasts DC Fire & EMS Department over death of child. Calls lack of transport ‘inexcusable’. Refers to case as a ‘pediatric Rosenbaum’.

I wonder if the paramedic passed the competency test administered at MFRI? These civilians are terrible.

First, it’s tragic what happened with this little girl. Clearly, someone at the Fire Department needs to answer for this and I’m very angry that it happened.

But, I think that anyone who has been following Fire Chief Rubin and the EMS system can’t honestly say that “little progress” has been made at improving EMS in our community.

Instead, I find it interesting that Dr. Wright is drawing a parallel to the Rosenbaum case. There are a number of similarities, but let me point out one that hasn’t been mentioned. In both the Rosenbaum case and this one, the hospitals – where both patients eventually died days or hours after they arrived – were awful quick to jump out and blame the Fire Department for the problem. Could it be they are doing this to limit their own liability in these cases? I’d be interested to see if Children’s will do the same public investigation of it’s own actions in the death of this little girl that Fire Chief Rubin seems to be doing in response to this tragedy.

But I also find Kenneth Lyons, the President of Local 3721 who represents EMTs in the District, very unbelievable. In the Rosenbaum case, just like this one, an EMT represented by his union was responsible for taking care of each patient. I followed the link to the OIG Rosenbaum report posted above and am quoting from page 45:

“On Ambulance 18, EMT 1, who was an EMT-Advanced, had the highest level of pre-hospital training… It is unclear to the OIG team why an EMT-Advanced working with an EMT-Basic would not consider herself responsible for anything other than driving the ambulance. In fact, EMT 1 made a point of distancing herself from the care of the Gramercy Street patient. She told OIG interviewers explicitly that, “It wasn’t my patient.” She neither assessed the patient herself, nor helped her partner assess him… EMT 1 told the OIG team that she assumed the patient was a drunk because he was covered in vomit.”

Then a few paragraphs later, this disturbing similarity to the case of the little girl we are now reading about:

“A thorough patient assessment was not conducted. General Patient Care Protocols direct a comprehensive initial assessment of every patient “to form a general impression of needs and priorities.” EMT 1, who had the highest level of pre-hospital training and was the senior crew member, did not take charge of patient care as required by FEMS protocols. Although EMT 2 stated that he conducted some of the required assessments, he did not document all of them on the 151 Run Sheet.”

“EMT-1″ is apparently the same individual that just got her job back after Fire Chief Rubin fired her. Kenneth Lyons and Local 3721 are the union that sued the District to reverse the firing. Since that time, Lyons and 3721 have done just about everything to focus attention away from their members – like “EMT-1″ in the Rosenbaum case and now the EMT in the case of the little girl – and instead blame Fire Chief Rubin for their problems. I’ve attended council hearings and heard Lyons testify time after time about how the EMS system isn’t working. It’s not working alright, but not because of Fire Chief Rubin. Instead, it’s Lyons and the 3721 EMTs that seem to be having the same problems again and again in doing their jobs correctly. Lyons might call his department “schizophrenic,” but I didn’t really get mad until I went to the Local 3721 webpage and saw a copy of an employee grievance they posted about not wanting to participate in random drug testing. Here’s the link to the document:

http://www.local3721.org/EMS_News/drug_testing_grievance.pdf

In this grievance dated December 10th, 2009 and signed by someone identified as a “Chief Shop Steward,” Local 3721 apparently quotes from a District regulations manual by pointing out that the “DPM §3903.2(d) states that (emphasis added): Strictly tangential, casual, or occasional contact with children or youth does not automatically make the position safety-sensitive or its incumbent subject to testing under the Program.” They then go on to say that “Clearly, the positions of Emergency Medical Technician, Paramedic, and the positions at Fleet Maintenance do not meet the regulatory standards for being designated as “safety-sensitive” and as such, the incumbents of those positions are not subject to random drug testing.”

So let me see if I’m reading this right: 1) the EMTs are saying their jobs are not “safety sensitive” and 2) they are refusing to participate in random drug testing as part of their job? Don’t they use drugs to treat sick people? And why did they say their contact with children or youth is “strictly tangential, casual, or occasional?”

So maybe in the case of this little girl dying it was “casual” contact. Bad form, EMS, bad form. It’s pretty clear to me who’s “”schizophrenic” here and I don’t think it’s Fire Chief Rubin. You guys need to start doing the job the public pays you to do and own up to your responsibilities.

This incident was not a failure of a system, but rather the failure of a couple of individuals. It is certainly tragic, but it does not reflect on the way the overwhelming majority of us perform our jobs on a daily basis.

It’s interesting to note that Dr. Wright said this was an inevitability. If he was so concerned, why has he never had any type of education or outreach program directed to emergency responders in the city. If he knew it was inevitable and did nothing about it, he should bear the emotional burden every bit as much the medics who failed to do their jobs.

DC TAXPAYER “WELL SAID” I know this current focus is on DC but from my perspective I believe it might be an area wide problem.

Many words from DC TAXPAYER could clearly be echoed in Prince George’s County where very similar conditions exist. Paramedics who don’t even carry the monitor in to a chest pain call, refuse to splint broken bones, even obvious fractures. Patient assesments are rarely completed, if even done by the EMT’s/Paramedics. When done, these assesments usually concentrate on “Why did you call us to go to the hospital”, “You’ll have to wait to be seen they are very backed up.”, “If you want to go can you walk?”

Absolutely disgusting but not surprising. Sloppy and unprofessional looks lead to unprofessional actions. When you show up at a call with your shirt tail hanging out, buttoned crooked, evidence of food or spills on your shirt and such, you will automatically function unprofessionally.

DC and PG are very similar in EMS care. Montgomery provides better care albeit 90% of the time from sweat pants and sweat shirt. Just think, most of these folks get paid $60,000.00 and up a year, many over 1 million with their overtime scams. It is all about the money, not about the care.

The comment referring to the Hospitals in both the Rosenbaum and now this precious child’s incident. First of all the Ambulance that Transported Mr. Rosenbaum to Howard University Hospital was a decision that only the Ambulance crew can speak truthfully about.I think Howard University Hospital is a Registered Trauma Center. Yes Sibley Hospital was the closes Hospital. Sibley isnot a Trauma Center. Based on Media Reports that the initial patient assessment was that Mr. Rosenbaum was under the influence of Alcohol. As far as the Medic 33 incident, onlt the Senior Paramedic can speak about why,whynot, who, where this precious angel child should have been Transported or not. Obviously it appears the decision not to Transport the child was not a good Patient care type decision. The second Medic 33 response obviously thought it was necessary to Transport. The comments about where the child passed away is somewhat out of line. Children’s National Medical Center is a Nationally and Internationaaly recognized
Pediatric Hospital. The child as has been reported had Pneumonia. Obviously the Difficulty Breathing this child exhibited from both Medic 33 responses should have warranted Transport. One can only believe that when this child arrived at Children’s Hospital, she received the very best Pediatric care. This incident as with the Rosenbaum Incident should not
be thought about in total negative responses about DC Fire and EMS Service. There is need obviously for intensified continued EMS Training in Protocols as they reflect in Patient care. I believe I read where DC Fire and EMS Reponds to some 140,000 Calls a year. That Ladies and Gentlemen constitues a lot of day to day operational responses. There needs to be more emphasis on Priorities and Patient Condition. It doesnot seem logical and even fair to single out why,whynot, who, when, where, Chief Rubin has put together a never ending Program of EMS Delivery Service. He apparently is trying have the best Professional Minds and everyday operational folks to achieve what is a mandate given to him. How about let’s take a step back and say a Prayer for Mr. Rosenbaum and this Precious Little Angel Child, Good Lord Rest Their Souls. Also it be a good thing to Pray for the Familes who have Lost their Loved Ones.

Thank You

DC Taxpayer you make very valid points, but if you spent 24 hours on a DC Ambulance and saw the percentage of non emergency responses these men and women are faced with you might have a different opinion. I wont comment on the incident with the little girl, but will attest its very easy to get caught up in the system which can very well affect the decision making of a first responder.
After numerous months, years etc…of responding to the shelters for the lice patient when theres people there to deal with it, to people who call because the ambulance is there ride across town (when you get to the hospital they jump out and run),the homeless man who needs a warm bed and a hot meal, to the man down in the alley, liquor store, dumpster, park because there drunk, not only takes a toll on the first responders, but the hospital staff as well. These are a large majority of the nuisance calls to 911 that overcrowd the emergency rooms day in and day out.

This is the stuff you dont get to see nor is it ever reported on. If there was a system in place to deter a large percentage of these calls, the first responders could focus and utilize there skills on the people that do need their help and transport to the hospital. Over time these calls take a toll on first responders and it is the Fire Chiefs responsibility to assure this doesnt happen.

Im not condoning or saying this is an excuse to make poor decisions, but Chief Rubin is responsible for the above mentioned because he has done nothing to assure these nonsense calls stop flooding the Office of Unified Communications.
This man spends more time out of town promoting himself and takes others around him to promote himself. Take a look at the video below as there are several more examples of an absent Fire Chief and ask yourself as a DC Taxpayer, if your Fire Chief and the Director of Public Information Office are dedicated to serving the citizens of the District of Columbia.

Remember these are your tax dollars hard at work. These videos are done during the week, where there absent from their 6 figure salaried positions which the District of Columbia Government provides them.

http://www.youtube.com/profile?user=ColumbiaSoUniv#g/u

To all who have posted,
As a firefighter with D.C. I do agree with some of your conclusions. First, EMS in D.C. should have been separated from the Fire Department. I believe the current Mayor used that as one of his political platforms and he has to date not come through on that promise for reasons unknown. The citizens of D.C. deserve EMS professionals as well as Fire professionals providing those distinctly different services. I also have family that lives in D.C. so this is a concern of mine as well. In my opinion D.C. has done an excellent job at attracting Fire professionals but a less than poor job on the EMS front. The EMS system has been broken for over 20 years due largely in part to the inability of management to grasp certain concepts. A fire based EMS system in the city does NOT work. Paramedic engines in the city do NOT work. A 75% BLS fleet of transport units does NOT work. Hiring from the bottom of the barrel does NOT work. 95% of us come to work and do our jobs to the best of our ability under less than ideal work conditions. This leaves that 5% out of a roughly 1800 member workforce that muddle their way through. You do the math. I also will agree that all firefighters should be trained to the EMT-B level and respond to medical emergencies as first response before that is thrown in my face but I am personally getting tired of EMS training being shoved down my throat because of the actions of 50 or so that couldn’t do their JOB in the first place and probably never should have been hired. Unfortunately the fire department nationally has been tasked to be a “jack of all trades, masters of none” catch-all workforce. If a service to the community doesn’t fit anywhere else (i.e.: law enforcement, housing, public works) give it to the fire department and we as a fire service are our own worst enemy because we take it in the name of “saving jobs”. Eventually that type of thinking will come back to bite us and right now we are getting bit. So I will agree that it is a systemic problem that if not corrected will lead to more suffering by the citizens but I do not agree that it’s a D.C. Firefighter problem. Leadership, accountability, responsibility, and professionalism are core values that start at the top. These are infectious qualities and I can tell you I haven’t been infected in a long time.

My prayers go out to the family.

Boston has a 75%+ BLS fleet. Seattle has a 75%+ BLS fleet. Houston has a 70% BLS transport fleet.

This child would, more than likely, have been transported to the hospital after the first call, had a BLS FF ambulance been dispatched. Firefighters are generally held accountable for their actions. BLS providers rarely “out-think” the complaint, and try and treat the patient in a non-traditional manner. Sadly, the “you call, we haul, that’s all” mentality would have worked well in this case.

First and foremost, my most sincere thoughts and prayers go out to the family(s) of those that have been affected in these mentioned EMS jobs. I agree that is SOME cities these unfortunate outcomes are more than occasional in occurance. But, the other side of the coin is that there are many more cities / areas where these type of outcomes are less frequent to almost completly absent. DCFES has made the move to incorporate the fire and EMS and not to split these services. Facts are facts – 3-4 out of every 5 requests for assistance can be related to the EMS side of services. If an FD decides to take on this public need it should so by viewing the resolution that qualified EMS administration / personnel need to be hired to be trained in fire suppression. Not fire personnel being hired or promoted to train or over see EMS. I agree that there must be a continuity of direction and administration is a must to have this a success. But quite frankly the bargaining units can paint whatever picture they would like – it is their dues paying personnel that are either not doing their job and they are now required to defend them – no matter what. Medicine is practiced and certainly is not a black and white science – mistakes will be made. The bargaining unit should be a leader in promoting a better patient care first system. DCFEMS problems seem to be cyclic. How many medical directors in how many years? How many FD Chiefs in how many years? If the required solution is to better the patient care (EMS) in DC the solution is simple on paper. For some reason there is this huge block that does not allow this information to get from the brain to the hands that directly effect the change in public safety. DCFEMS has well documented accomplishments within its history – its repeated attempts to fix its EMS happens not to be one of them. Hell – its only our nations capital that welcomes many visitors from all over the world and within the US. This is not to mention some of the most important people in the world work and reside there. The anwser is not if the service should be fire based or third service – the answer is doing EMS with patient care as a priority with respect and professionalism. EMS is the focus in this very specific situation.

There are a few discrepancies in the Rosenbaum case that have yet been portrayed to the public. The majority of them stem from the OIG report that stated Mr. Rosenbaum had an open head wound that was bleeding and the ambulance improperly diagnosed him as being drunk. The autopsy report that was made public in several of the ensuing trials was quite different:
1) He had no open head wound, and the wound he did have could only be identfied via CT scan and
2) He was drunk, toxicology reports showed his BAC to be .12 and they also stated that although he was not taken to the closest hospital he was taken to the appropriate facility.
Now in the case of this poor little girl that passed away. I agree she should have gone to the hospital, but what the parents aren’t telling you is that they adamently refused going to any hospital but childrens in the midst of a three foot snow fall (the live less than 1/2 of a mile from Greater southeast hospital!) And two she died from pneumonia, which last time I checked doesn’t kill anyone overnight, what did the parents do prior to calling 911, and what did the doctor do when she was finally admitted to the hospital?

“annonymous”…

Seriously? It continues?

The three police officers, the neighbor, and one of the ER nurses all reported that there was bleeding from the head. The officers stated that they witnessed fire fighters with a bandage to the back of the head. One of the fire fighters reported finding something like blood on his glove during their “assessment” but couldn’t find it again and decided it was vomit. A man got hit with a pipe so hard it killed him…that is going to leave a mark. A hematoma or a lac or both. Was it hard to find an injury? Probably because it was dark and he was covered in vomit. Again, that goes back to a thorough assessment. The neighbors reported he couldn’t move his right side and only lifted his left arm. He couldn’t speak understandable words and vomited over and over again.

Seriously? You don’t have to be a paramedic to see that something is wrong with that man. The neighbors also reported that in their opinion the fire fighters didn’t know what they were doing while waiting for the ambulance.

Again with the “he’s drunk”!!!! It is irritating. People who are drunk CAN and DO have more than one problem. A drunk person on the ground probably didn’t lay down softly. If he can’t speak and won’t stop vomiting and doesn’t move one side of his body….CLUE PHONE- it is more than just a drunk guy. Even if you don’t think he was beaten then you gotta think he fell.

The report states taking him to Sibley would have still been proper care because they would have ACTUALLY looked him and could have transferred him later.

I can not believe that people still try to defend anything that happened that night.

As for the little girl…dude, DC is like 68 sq miles and Southeast is 10 miles from Children’s. So, the little girl gets left at home because the ambulance had to go 10 miles? Yeah, I get it…blizzard. But were talking about city streets for ten miles. Would it be hard? Yeah, but I bet it wouldn’t have been a problem if an engine had to drive 10 miles for a fire. That is a sorry excuse. I would want my kid to go to Children’s, too. She is going to get admitted and she’ll need to be at an appropriate hospital. Especially considering Southeast’s reputation.

And one more thing…pneumonia is the number one killer of kids under 5 years old in the world. It usually grows from another respiratory infection that gets worse and is complicated by additional risk factors such as asthma. I bet you $20 bucks…a 2 yo inner city girl with SOB probably has asthma. AND… acute respiratory distress syndrome can develop quickly and can be a fatal complication once the pneumonia affects both lungs. Children who have been compensating for long periods of time will no longer have the strength to overcome the increasing hypoxia that is killing them….and they die.

I am not trying to be a jerk but you are embarrassing yourself and the department. Every time someone blames the hospital, the family, or the patient it is just pathetic. It is everyone else’s fault but the people who work for DC Fire. It speaks to the nature of the problem and the complete lack of training.

I know I seem like I am harping on DC but this is important.

They waited 9 hours because they didn’t know any better and someone who they THOUGHT was a medical professional told them it wasn’t an emergency and to get her some warm/moist air. They went with that advise and didn’t call back until she was falling off the cliff. Again, children compensate until the very end. She crashed and it was too late.

I understand that making excuses and trying to disperse the blame isnt the correct thing to do, in any situation, but as i sit here and read these comments, EVERY time something happens in DC, it just gets kind of nauseating and I cant blame these guys/gals from coming on here and defending themselves. Are they in the right? I dont know. But i see some of your comments on here as if things like this never happen in your city, county, town, village. I got a newsflash for you, it does. You just dont have the Hubble-telescope focused in on you as these men and women do being in the Nation’s Capital. You think everything goes right all day, everday on the EMS side in Boston, Philly, LA, and the almighty Seattle? doubt it. The people in the DC metro area have a hardon for DC Fire..good and bad. Its the name of the game.

you know I get sick to my stomach hearing you so called firefighters talking about how you dont wantto do your job.Chief Thompson told the truth about the white firefighters who dont want to ride the ambulance. If you dont like to provide a service to my citizens than get the hell out of the city.There is a culture deep rooted in the these outsiders that is the root of the problem. The young guys come on the job with no time on and are already talking bad about the ambulance. The merger can work we just need to weed out the firemen who dont want to ride the ambulance and hire people who dont mind doing a job with a purpose. These outsiders have no stake or ties to the city thats why they dont care. Im an officer in the DCFD and the attitudes stink in regards to riding the ambulance. I wish you all go back where you are from and play firefighter back home,setting fires and so forth.

exray,

Whether or not you are an Officer has little to no bearing on this argument. You are in charge of the men when we go to work. You no longer ride the ambulance, but you are probably one of the people who don’t offer solutions to the issues that surround the Ambulance, but rather just tells the men to do what you tell them to do. “Look at me I’m in Charge, I’m an Officer”! The fact that you are an Officer in this Department and your posts have the undertones of racial bias is both sad and upsetting. I am a firefighter, and I am African American, and I hope that someone like you is never in charge of me. Thompson was not right in what he said in the newspaper article, he was fanning the flames of an already unstable situation and contributing nothing to it. He mentions that “white firefighters” do not want to provide EMS to the citizens of this city. Not only is this statement inaccurate, it does not support his case in the wake of the recent cases of botched EMS care that are in the news headlines. The lead providers on all of those cases were not white, but of other races. So what does that say about your argument and Thompson’s? Why does race even factor into this discussion. I will tell you why, because people like you and Thompson bring it into the situation. After the EMS cases were brought to light did you hear anyone say “they provided poor care because they were black, or latino, or a female”? No you did not, and you didn’t hear that because race has no bearing on this argument, and is only interjected into it by people like yourself who are trying to accomplish some sort of misguided personal objective.

I do not believe that anyone who is worth something as a person or an individual in our department believes that race is something we consider when we come to work. I personally do not care what race the men I work with are as long as they are dedicated, professional, and competent Firefighter/EMT’s and Paramedics and I can rely on them to do the right thing. The race agenda is used by many to forward their own personal cause which only undermines the true mission of the Department. You speak of those who don’t want to do everything that the job encompasses should leave and go back to where they came from. Well you may be right, we have sworn a duty to provide a service to the citizens of this city and they depend on us to get it right the first time they call us. But if they should leave then so should you, anyone who comes to work and sees the men they work with as anything but brothers is also in the wrong profession.

I am sorry for the death of this little girl, but I can’t watch the real issues that need to be corrected in this department get swallowed up in lost in an argument over race when that is not the issue here.