How Many More Monica Yins?

What if the patient care report or the Form 151 "run sheet" that the D.C. Fire and Emergency Medical Services Department (FEMS) uses to document a patient's treatment turns out to be at variance with the facts? That appears to be the case with Monica Yin, the Northwest Washington woman who had two disturbing encounters with D.C. FEMS ["Monica Yin's First Responders," op-ed, March 25].

To recall: Four years ago, on the morning of Nov. 23, 2002, Yin experienced bouts of nausea, dizziness and disorientation. A call to 911 brought a response from fire and emergency medical technicians who, according to Yin (and eyewitnesses), failed to take her blood pressure or check her vital signs; forced her to undergo physical "tests" (standing, raising and holding her arms above her head); and decided she didn't need to go to the hospital, suggesting instead that she might be "faking."

Hearing that assessment and bothered by the tests, Yin asked that the EMTs leave her home. Her friends took her immediately to George Washington University Hospital, where a "leaking aneurysm" was detected. Yin had emergency surgery the next morning, followed by a medically induced coma, three days in intensive care and eight days in the stroke unit.

Yin's second EMS encounter occurred on Feb. 12 when she slipped on ice, injuring her head. Her friends called 911. Yin went through what she called a "bullying" experience with one EMT who demanded that she respond to his commands, transported her to the ambulance in a rough manner and attempted to cut off her clothing during the ride to the hospital, although she had a head injury.

After my March 25 column was published, Yin was contacted by Assistant Fire Chief Douglas Smith. Yin agreed to meet with Smith but said she first wanted copies of the EMT logs or medical reports filed in the 2002 and 2006 incidents. Smith gave Yin copies of the patient care reports -- though one page of the 2002 incident was missing. Smith offered two meeting dates that didn't work for Yin. They are now trying to arrange a mutually convenient time to meet.

This week Yin and I reviewed her patient care reports.

She was surprised to see that the November 2002 report stated she was "oriented," that her eyes opened spontaneously, that she could obey orders and that her pupils were normal. How could that be, Yin wanted to know, because she recalled that she couldn't stand as ordered by the EMT and that she was unable to respond to his other commands.

She said she was far from being oriented, having had several vomiting episodes and spasms. She also failed to understand how the EMT could assess her eye movement because her eyes were shielded by her arms most of the time. Yin also maintained that the EMT did not monitor her blood pressure, pulse and respiration -- a point eyewitnesses confirmed. The report was also silent on the test of her vital signs. The report, however, correctly noted that Yin released the EMT from providing further treatment. But that, she said, was after the EMT had tried to put her through physical tests of standing and holding her arms erect. She just wanted the EMTs out of her house.

Yin was also surprised to see that the February FEMS report stated that her past medical history was unknown. In fact, she said, her roommate as well as her best friend told the EMTs at the scene that she had a history of aneurysms. They also asked that the stretcher on which she was placed not be rolled to the ambulance over a cobbled alley; they even offered to lift and carry Yin, but the EMT ignored them.

So much for discrepancies in the reports. Yin and Chief Smith can examine the others in their meeting. There is, however, a much larger point -- one that extends beyond Yin and the case of the "drunk John Doe" (actually a 63-year-old retired journalist who had been beaten and robbed), previously reported, and other unreported D.C. FEMS incidents that have been called to my attention in recent weeks.

For some time the D.C. Federation of Civic Associations, representing more than 45 citizen organizations, has been concerned about the delivery of emergency services in the District. Anne Renshaw, the federation's first vice president, asks whether the D.C. Fire and Emergency Medical Services Department, in a city with a daytime population of 1.5 million, is up to the task of responding, ministering and transporting victims to hospital emergency rooms with speed and quality care. The federation believes the answer is no, and there's no reason to dispute that conclusion.

The federation points out that the city's emergency medical service handles 75 percent or more of the 911 calls to the fire department. Yet it is the emergency medical service side of the fire department that gets short shrift -- in staffing, pay and top-level support. "Why are ambulances frequently not available in certain times and parts of the city?" Renshaw asks. "Why must we rely on large expensive fire apparatus, staffed with four or five firefighters, to do what ambulances do in other large cities? Why must firefighters be persuaded and sometimes forced to 'ride the ambos'?" Renshaw wants to know.

She wrote in a federation newsletter that "D.C. firefighters are now required to become EMTs as a condition of employment. Here, too, not all firefighters want to staff EMS ambulance units (referred to disparagingly as 'ambos' or 'gut boxes') and many do so grudgingly. ('Suck it up and ride the ambo,' one D.C. firefighter said to a disgruntled colleague.)"

Forcing people to minister to the city's emergency patients is not what we should want, Renshaw said. That fact alone may help explain the bad attitudes that residents encounter and complain about. There is also concern that the turf battles between career firefighters and trained civilian EMS personnel may compromise response times to medical emergencies. Over the years, the federation observed, citizens have died waiting for D.C. ambulances.

The nation's capital, these civic leaders fear, is losing veteran EMS professionals, especially well-trained, full-time paramedics. Their complaints, they contend, are falling on deaf ears in the D.C. Council and the mayor's office. The result: Monica Yins, cavalierly treated "drunk John Does" and many other horror stories that get swept under the rug.

kingc@washpost.com