» This Story:Read +| Comments

Firefighter May Have Neglected EMS Rules

Discussion Policy
Comments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions. You are fully responsible for the content that you post.
Washington Post Staff Writer
Wednesday, March 25, 2009; Page B01

Internal D.C. fire department documents show that a paramedic might not have followed procedures in responding to a man complaining of chest pain who did not go to a hospital and died hours later of a heart attack in December.

This Story
View All Items in This Story
View Only Top Items in This Story

Edward L. Givens, 39, of Northeast Washington signed a release form refusing further treatment, but family members said the paramedic in charge convinced them that he had acid reflux and just needed an antacid.

Givens said he played basketball, smoked marijuana and ate a hamburger before he felt chest pain and had trouble breathing, said his brother, Anthony Givens, who was at the home during the 911 call. Anthony Givens said he told the paramedic that both his parents had heart attacks, but routine treatment for chest pain was not administered. Instead, according to the documents, the paramedic judged his brother's problem was stomach-related, despite an abnormal result from a cardiac monitor. But EMS personnel are not trained to provide diagnoses, Medical Director James Augustine said in a report.

The choices made in response to that call again raise questions about the medical training of firefighters and whether the city's plan to integrate firefighting and emergency medical services is producing the best care possible. Mayor Adrian M. Fenty (D) promised the city would improve emergency services as part of a settlement with the family of David E. Rosenbaum, a retired New York Times reporter who was assaulted in 2006 but assessed as drunk by responders. He died two days later.

D.C. fire and EMS officials would not discuss the documents, which include an operational review, a two-page medical quality review and an event chronology, referring questions to D.C. Attorney General Peter Nickles. The operational review and the medical review differ in certain conclusions. The operational review raised concerns about the thoroughness of the evaluation; the medical review said that an "adequate patient history was obtained" and that documentation was "acceptable."

Nickles acknowledged that the two reviews might disagree on some operational points but said that the medical review was more informed because it included information from the autopsy. "Given the tragedy that occurred, it would be easy to conclude there could have been more of an effort," but it might not have made a difference, he said.

Fire Chief Dennis L. Rubin has referred the case to the District's inspector general.

Training remains a concern, according to the documents. The paramedic who attended to Givens was a firefighter with paramedic certification. He was taken off the streets for three months and sent to the training academy for remedial instruction. The documents show a three-lead electrocardiogram for Givens produced "some ST-segment elevation," which a top EMS official said "should have generated a higher index of suspicion" of a heart problem.

Last month, the department began mandatory training for paramedics on responding to cardiac patients, including proficiency testing with the 12-lead ECG, which looks at the heart's electrical activity from 12 angles instead of three. Chest pain treatment in the District calls for paramedics to "consider" a 12-lead ECG, along with giving the patient aspirin, oxygen and nitroglycerin. Many jurisdictions make the 12-lead ECG routine.

"The three-lead is not reliable" to detect a heart attack, said Terry Jodrie, a regional medical director for the agency overseeing Maryland's emergency medical services.

The Givens case is instructive because the District is moving toward a system that relies more on firefighters with advanced life support or paramedic certification, phasing out single-role medics.

About four out of every five fire department 911 calls are medical.

CONTINUED     1        >

» This Story:Read +| Comments

More in the D.C. Section

Fixing D.C. Schools

Fixing D.C. Schools

The Washington Post investigates the state of the schools and the lessons of failed and successful reforms.



Use Neighborhoods to learn about Washington, D.C., Maryland and Virginia communities.

Top High Schools

Top High Schools

Jay Mathews identifies the nation's most challenging high schools and explains why they're best.

Facebook Twitter RSS
© 2009 The Washington Post Company