Chief Gregory Dean needed a bold move to solve his department’s problems of too many EMS calls and not enough ambulances. My gut tells me he’s making the right move — bringing in private ambulances to transport low priority patients. The chief’s goal is to keep firefighters from spending hours out of their shift stuck in hospitals waiting for emergency departments to take a patient who probably didn’t need an ambulance in the first place.
If the pilot program approved by the City Council yesterday (Tuesday) works in the short term, Chief Dean hopes to be able to deal with fleet, staffing and training issues that the last administration neglected for most of its four years.
This turn to private ambulances has moved faster than almost any other District of Columbia plan to improve EMS I’ve seen. The emergency legislation was passed unanimously by the City Council just one week after it was presented by Mayor Muriel Bowser. But the mayor and fire chief take on a lot of risk by asking for a quick fix for something that’s been broken since at least the early 1980s.
The biggest risk is leaving the impression that this is the magic pill that will finally make ambulance delays and poor service go away. It won’t. It’s just one step that hopefully allows Chief Dean to solve crucial infrastructure problems involving apparatus and personnel. Though, with the call volume in the District of Columbia, I’m skeptical that still sending at least a fire truck and BLS ambulance on all EMS responses will really provide the needed relief. Under the plan, the DC Fire & EMS Department crews on the scene will be the ones who decide if the patient can be sent by private ambulance.
Even if this works perfectly, providing the results Chief Dean hopes for, many on the City Council have made it clear they don’t like this plan as a permanent fix. They believe EMS is a service that should be completely provided by the DC government and not outsourced. I’m sure Chief Dean is hoping the success of his plan will solve this dilemma and convince the skeptics. Council members also rightfully tried to make sure this rapid move didn’t ignore transparency and effective reporting requirements for any private ambulance service that gets the contract.
To avoid everyone thinking this rush to private ambulances alone will cure some of the larger problems plaguing EMS in DC, Mayor Bowser needs to quickly provide a more comprehensive view. It has to be one that acknowledges EMS isn’t just a DC Fire & EMS Department problem.
This includes finally addressing the long-standing systemic problems where the real first responders reside, the 911 center (in DC, that’s the Office of Unified Communications or OUC). As I’ve been warning for a long time, until OUC can properly classify EMS calls and promptly dispatch them, EMS will continue to fail. Fixing 911 will also help the DC Fire and EMS Department’s image since they get blamed even when it is OUC’s fault.
Then there is the public health issue. That’s the elephant in the room that will poop on any plan that doesn’t address providing something other than the DC Fire and EMS Department as the primary means of accessing routine health care for the poor (the first soundbite in Mark Segraves report in the video above also addresses this issue).
While it’s subtle, Chief Dean’s move to private ambulances for low priority transports may actually be the initial baby step toward solving the health care issue. That I recall, it’s the first time the DC government will let citizens know their emergency may really not be an emergency. It tells the public they can no longer tie up valuable resources for what should be routine doctor or clinic visits. Hopefully Mayor Bowser will build on that with real alternatives that eventually cuts the abuse of both 911 and the DC Fire and EMS Department.