Rosenbaum's Undiagnosed (Critical) Condition

"0143-Per Dr. Wadhwa. A-18 placed oos due to very poor judgment & TX in Code # 1 Pt which was transported to Hosp # 5 as a code # 3. Per Medical Director unit placed oos members are ordered to type spec. report to Dr. Wadhwa & explanation EMS #5 Capt. Carter notified."

-- D.C. Fire and Emergency Medical Services log for Jan. 6, 2006

At 10:18 p.m. on Jan. 6, Ambulance 18, driven by Emergency Medical Technician Selena Walker, who was accompanied by Firefighter-EMT Michael Deems, arrived at Howard University Hospital with a robbed, beaten and soon-to-die "John Doe," later identified as New York Times reporter David E. Rosenbaum.

Amit Wadhwa, medical director of the D.C. Fire and Emergency Medical Services Department (FEMS), was working at Howard University Hospital on that Friday evening. At 1:43 a.m., more than three hours after Walker and Deems arrived with Rosenbaum, Wadhwa called the EMS senior duty officer, ordered Ambulance 18 taken out of service, and left word for Walker and Deems to send him individual written special reports on their handling of the patient.

The significance of the quoted entry above?

Within days of the Rosenbaum killing, FEMS Chief Adrian Thompson stated publicly that the department's "providers" -- the firefighters on Engine 20, which arrived first on the scene, and the two Ambulance 18 EMTs who transported Rosenbaum to the hospital -- had met all of the department's pre-hospital standards of medical care. As the entry indicates, on the night of the incident, Wadhwa had reached a contrary and decidedly less favorable conclusion.

He ordered Ambulance 18 taken out of service ("oos"), citing "very poor judgment & TX [treatment]" on the part of the ambulance's EMTs, Walker and Deems. They had, according to Wadhwa, transported Rosenbaum as a Code 3 (stable) patient when in fact he was a Code 1 (unstable) patient. Code 1 warranted a transfer of Rosenbaum from Ambulance 18 -- a basic life support unit -- to an advanced life support unit staffed with skilled paramedics. That didn't happen. Sadly, an advanced life support unit was only a few blocks away.

What went wrong?

I have copies of written statements that Walker and Deems submitted to Wadhwa and Thompson as well as written statements that Engine 20 firefighters -- Anthony Fields, Frelimo D. Simba, Reginald Chandler and Michael A. Roy -- provided to their superiors.

In summary: Engine 20 personnel found a patient lying face-up on the sidewalk, in an altered mental status. He was not able to speak. They claim to have examined and assessed the patient and found no signs of trauma. (Note to the D.C. inspector general: Sworn testimony on this point is most desirable.)

The ambulance with Deems and Walker arrived on the scene. In separate reports, the EMTs described Rosenbaum as "incoherent." Both Engine 20 and Ambulance 18 workers said that Rosenbaum vomited numerous times while on the ground. Deems said the vomiting episodes continued during transport to the hospital.

Despite Rosenbaum's altered mental status and the unknown reason for it, other than suspicion that he was drunk, the workers did not "collar and board" him -- that is, stabilize his neck with a cervical collar and immobilize him on a backboard. Instead they sat him up and placed him on an ambulance cot.