D.C. paramedics take longer than eight minutes to arrive on the scene of a critical emergency in nearly half of all such calls, The Washington Times has learned.
That performance rate for a key aspect of emergency medical response reflects a 28 percent drop in the number of units meeting the industry standard since December, when the District removed paramedics from fire engines as part of cost-cutting moves.
Paramedics respond to critical medical emergencies within eight minutes in 55 percent of such calls, according to internal monthly performance reports obtained by The Times through the city's Freedom of Information Act.
In November, paramedics arrived on the scene of such emergencies within eight minutes in 76 percent of the calls, according to the internal records kept by the D.C. Department of Fire and Emergency Medical Services.
On Dec. 15, the city scrapped a pilot program in which paramedics rode on firetrucks, citing the high cost of keeping medics on these trucks while having to pay other medics overtime to ride ambulances that were chronically understaffed. Mayor Anthony A. Williams signed off on the change at the time.
The change in policy was welcomed, for the most part, by the medics union, which has long opposed attempts to put paramedics on fire engines.
But firefighters contend they can get medics to the scene faster and say the recent statistics prove their point.
"The statistics show we were headed in the right direction before the program was phased out," said Lt. Ray Sneed, president of the D.C. Firefighters Association and a longtime advocate of the paramedic engine companies. "The only thing you're concerned about is how long it takes to get a critical care provider on the scene."
D.C. Fire and EMS Chief Adrian H. Thompson blamed the longer response times on staff shortages and overcrowded emergency rooms that tie up crews.
The national standard, and Mr. Williams' goal, for response times to critical calls is for paramedics to arrive within eight minutes from when a call is dispatched 90 percent of the time. The best monthly performance on record for the city was in October, when 77.1 percent of calls received responses within eight minutes.
The eight-minute benchmark is crucial because cardiac arrest victims have a 33 percent higher survival rate when paramedics arrive within eight minutes, according to the American Heart Association. After eight minutes, the prospects of recovery decrease rapidly.
The District's performance measure does not include the time it takes to dispatch a call. Fewer than 50 percent of calls were dispatched in less than two minutes through September, when fire officials stopped tracking the time in their monthly reports.
Improving response times for the Fire and EMS Department has long been a challenge for the District.
The Paramedic Engine Company took advantage of the faster response times of fire engines, which often could begin administering advanced life support five to seven minutes before an ambulance arrived.
On his scorecard goals for the city, Mr. Williams aimed for 12 paramedic engine companies by September 2002 and 20 by September 2003, with an ultimate goal of placing paramedics in all 33 of the department's fire companies. The program began in December 1999 with paramedics in two engine companies, increasing to six by 2000.
Because of a shortage of paramedics, the department did not increase the number of paramedic engine companies after that year, and let staffing levels languish in those that existed. Even while the program was running, none of the paramedic engine companies had enough medics to staff all four shifts. Only 15 medics out of a full complement of 24 were in the program at the time it was suspended.
A citywide budget shortfall of $323 million forced the 1,990-member fire department to trim more than $7 million from its projected $130 million fiscal 2003 budget. A constant source of overspending has been EMS, which has been plagued by staffing issues and has relied heavily on overtime personnel to keep units on the streets.
The 15 paramedics assigned to fire engines were reassigned to ambulances to cut overtime costs and keep the paramedic units on the streets.
"If units aren't available, I can't put them out there," said Chief Thompson. "Those [paramedic engine company] workers were EMS workers. To pull them out of the EMS division like they did and put them on PEC units, that hurts [ambulance response times]. You can't win."
But Chief Thompson said there also were factors beyond his control that contribute to escalating response times.
"This is a very big picture," he said, citing also overcrowding at local hospital emergency rooms that increase the amount of time that medics have to spend there, taking them out of service for subsequent calls.
Chief Thompson said he believes in the paramedic engine company program, but insisted that it can only work when firefighters are trained as paramedics. Instead of four firefighters and a civilian paramedic, fire crews would then have a four-man complement, with one firefighter trained as a medic
