This summer, half of the cardiac care technicians in Fairfax County -- the specialists who T operate the county's mobile intensive care units -- flunked a test given by the county fire department to measure the technicians' on-the-job skills. And nearly 40 percent failed an accompanying written exam designed to measure basic knowledge of emergency practices.
The results stunned and frustrated fire department officials.
But while officials say the low test scores don't necessarily mean the cardiac care technicians (CCTs) are unqualified, they concede the results point to serious shortcomings in the county's training and testing programs.
The problem reflected by the test results, department officials and CCTs agree, is just one of several problems facing the county's four-year-old medical emergency program -- problems that department officials say can hamper their efforts to provide efficient emergency care.
Among those problems, as described by fire officials and CCTs:
* Because of growing public demand for improved emergency services, officials of the fire department, which is responsible for the mobile units, say they have been under intense political pressure from the county Board of Supervisors to put units into service faster than the department can train the technicians to operate them. The result, fire officials say, is that the countywide emergency program is understaffed, forcing the department periodically to keep medic units off the road because of manpower shortages.
* Radio communications with hospitals, a crucial factor in use of the sophisticated medic units, are sometimes inadequate and can hamper patient care in some sections of the county, where fire officials report problems on as many as 60 percent of their calls.
* Friction between volunteer and county fire fighters over the use of medic units sometimes limits service in areas where a vehicle is out of service and rescue personnel are unable to use neighboring units as backups.
Medic units differ from traditional ambulances in having sophisticated monitoring equipment and communication capabilities. The unit attempts to bring the emergency room to the patient rather than waste valuable time just transporting patients to hospitals.
Although fire officials say they have been fighting continuing manpower shortages and equipment breakdowns, the dismal showing of CCTs on the skills tests this summer was one problem they had not expected.
The tests were part of a long-range training and development program for CCTs, and were administered for the first time this year after a series of CCT refresher courses set up by the fire department.
But the unexpectedly low scores by CCTs has forced the fire department to reevaluate both its training program and the test.
The practical skills exam, which 50 percent of the CCTs failed, tested emergency skills such as patient assessment, oxygen therapy and intravenous therapy. The CCTs fared only slightly better on the written exam, designed to test basic knowledge of emergency practices, with 38 percent of the medics failing that section.
Fire officials say they haven't yet determined if the medics -- who are trained by the fire department -- are deficient in emergency skills or improperly schooled, or whether the test itself was too difficult.
"Such a large number flunked that our training schedule has come to a halt," said Craig DeAtley, who monitors the CCT programs for the fire department.
"The results," added Lt. Geoffrey McNamara, emergency medical services training coordinator, "have set our advanced training plans back at least a year."
Under original department guidelines, any medic who failed either part of the test was to have been placed on probation and given 30 days to pass the exam. But fire officials admit the department is under political pressure to keep those men on the job, and until officials complete their evaluation of both the test and the training program, no medic will be placed on probation.
At the same time the department wrestles with developing a new training program, it also faces the continuing problem of staff shortages. The 69 medics now working, fire officials say, represent only three-fourths of the CCTs needed to operate the county's nine medic units and a 10th purchased earlier this month by the county Board of Supervisors. The county requires two CCTs and a firefighter with basic emergency training to staff each advanced medic unit.
A mobile intensive care unit and the equipment needed to operate it costs about $68,000, compared to the $47,000 price tag on a traditional ambulance. Staffing and operation of units is even more expensive: about $250,000 a year for each vehicle, according to fire department officials.
But money, fire officials say, is not a major factor in the staff shortages. Instead, they contend, the real problem is that the Board of Supervisors and volunteer fire departments have been buying units faster than the department has been able to train medical technicians.
"In the minds of some people, they are trying to force the system to grow much too fast," said DeAtley. "They don't have the pieces of the puzzle together and they are stretching the manpower thin."
However, Supervisor Marie B. Travesky (R-Springfield) charges that the fire department and the volunteer stations have brought on their own problems.
"The big flaw is that no one (in the fire department) has really addressed the problem of setting up a system to determine where to locate equipment and manpower," Travesky said.
The fire department has established a master plan for distributing the units. Department officials say that six units purchased by volunteer stations in the past several years weren't included in department projections, however, even though the county is expected to provide staff for those units.
Because of the unexpected volunteer units that have been put into service, the department is short 22 emergency technicians, according to Capt. Douglas Casey, one of two fire department officers who is responsible for evaluating CCTs and medic units.
Those shortages, other rescue officials say, often show up at fire stations around the county.
For example, the Franconia Volunteer Fire Station purchased two medic units in 1978. Because the station had no medics to operate the units, they have been used as traditional ambulances for the past four years. This fall, according to station Capt. Orval Gent, the station will finally get the staff it needs to run the units.
"If we go all over the county and staff all their (volunteer) units, we wouldn't have the necessary coverage everywhere else," argued Supervisor Travesky.
In an effort to ease the staff shortages, the fire department is beginning a five-month training program for new CCTs in October. According to Casey, the department will be operating with a full staff when the class graduates next spring. At least 40 firefighters have signed up for the course.
Meanwhile, one official at the recently opened Fairview Station on Burke Center Parkway said the eight stations that now have medic units "play a game of checkers" to keep their areas of the county covered by the advanced medical care units.
The medic unit at the Fairview station is on loan to other stations or out of service because of manpower shortages an average of seven full days each month, and parts of 10 more days monthly, according to station log books.
If a station doesn't have enough CCTs on hand to staff the units, they may be downgraded to traditional ambulance units.
In addition to the manpower shortages, equipment on the medic units frequently breaks down, according to several fire officials.
"On almost any day of the week you'll find one of the units in the county out of service because of equipment failure," says Casey. At the Annandale Fire Station, one of the busiest in the county, the advanced medic unit is out of service about 15 percent of the time, or about 4 1/2 days a month, Casey said.
The Fairview Station, one of the least active in the county, has reported equipment breakdowns on its unit an average of seven days a month during the past few months.
But fire officials say the frequent breakdowns are not unique to Fairfax County, blaming the rough conditions under which the vehicles must operate and the sensitive equipment which must absorb the rigorous use.
"Look at how we have to use these vehicles," said Casey. "You're not in a quiet emergency room setting -- you're answering calls in muddy ravines, in the rain, on riverbanks . . . ."
When units are out of service, Casey said, their territory is usually covered by units from other stations or the county's 27 traditional ambulance backups.
In other cases, the stations attempt to borrow units from neighboring firehouses. That practice has led to some feuds between volunteer and county fire departments.
Under an informal agreement between county and volunteer units, both groups theoretically are supposed to provide backup units for each other. However, county firefighters contend that volunteer frequently balk at lending their units.
"They (the volunteers) feel their units are abused and not taken care of by some of the people who borrow them," charged Gent, head of the Franconia volunteers.
"They're just being unreasonable," retorted a CCT at a county station who has been turned down for assistance from surrounding volunteer stations on several occasions. "We're always willing to share our units when they need help. They obviously don't have the best interest of the community at heart."
One of the most critical problems for county medical units has been radio communication breakdowns. Radio contact with local hospitals is the feature that most distinguishes an advanced life support unit from an ambulance.
Radio connections with local hospitals allow physicians to view a patient's heart signs on a screen in the hospital emergency room. The doctor then can relay patient-care instructions to the CCTs on the scene. Few physicians will deliver instructions by radio or telephone without that visual contact, according to Capt. Edwin Kibler, chief communications officer for the fire and rescue service.
Medic units operating in the Rte. 1-Mount Vernon area report radio failures on about 60 percent of their calls, according to Kibler.
The department is investigating the frequent communication failures but has been unable to pinpoint the cause, Kibler said.
Fire officials admit they have encountered many problems with their mobile intensive care units. They are quick to blame most of the problems, however, on a young system that is not yet fully operational.
"The department's biggest problem is that it's bending to political pressure to expand faster than it can provide proper training and facilities," said one department official.