D.C. officials were told years ago that there were deficiencies in the city ambulance service that endangered the health of District residents but frequently ignored the warnings, doctors associated with two local emergency rooms said yesterday.
Dr. Howard Champion, director of the Washington Hospital Center's MedStar unit, and Dr. Douglas White, clinical director of emergency services for Georgetown University Hospital, said it is imperative that the city act quickly to correct the problems cited in a recent task force study on the District's ambulance service.
The task force found that the service, a division of the D.C. Fire Department, uses substandard equipment, keeps poor medical records, has virtually no quality control mechanisms and is staffed by poorly trained and supervised workers. It found that 42 percent of 50 workers surveyed did not have current certification in cardiopulmonary resuscitation, and recommended more than 140 changes to correct 82 deficiencies in such areas as training, equipment, communications, hiring and medical control.
White, calling the report "temperate," said the problems it cites "probably had the consensus of just about every emergency room doctor who works with" the city's ambulance crews.
"If things continue the way they are, there may be an impact on the city's morbidity and mortality rates," he said. "We're not seeing that right now, but we are concerned that if the service continues to deteriorate, that could be a real problem."
According to Champion, "We can stand up and make noises and get no response and have no ability to do anything about it, and that has occurred frequently . . . . If the powers that be in the fire department, if they don't want to get it done, it doesn't get done. The current leadership has been less than sensitive to the needs of the EMS emergency medical services system."
City officials yesterday declined to discuss the specific findings of the report. D.C. Fire Department spokesman Peter Woolfolk said the department is reviewing their records and will "respond in detail" on Monday.
"A lot of things need to be corrected so they the public don't think we're just snatching people from bus stops" and making them city ambulance workers, he said.
City Administrator Thomas M. Downs said the 38-page report by a seven-member task force of Mayor Marion Barry's advisory committee on Emergency Medical Services "was not a consensus of opinion" of the task force.
He said fire department Deputy Chief Ray Alfred, a member of the task force, "early voiced objection to a number of issues that he said were inaccurate," but that other members of the task force ignored his objections. He said that Alfred did not sign the report.
Alfred declined to comment on the report Thursday and did not return a reporter's phone calls yesterday.
"There is not any reluctance to address any supposed or actual deficiencies" in the city's ambulance service, Downs said. He said that a number of the problems cited in the report were based on information that was not factual, and that other problems were already corrected when the report was written or are in the process of being addressed. He would not elaborate.
Champion and White said they are worried that the city will not act aggressively to correct deficiencies cited in the report, which said that some of the problems "are obvious and too urgent to allow significant time to pass without further deterioration in morale and patient care."
"My greatest concern is that they will not respond positively to the suggestions," Champion said. "To go on the defensive at this point is clearly not in anybody's interests."
Champion said that the fire department has made changes since the report was written and that Acting Deputy Chief Thomas McCaffery, head of the ambulance division, is "dedicated, organized and committed enough to do something constructive." However, he added, "The bottom line is that there is so much wrong with the system that we'll be lucky if it's back in shape six months from now, and that's presupposing tremendous commitment."
According to White, the task force was drawn up "because of extraordinary problems that were chronic and lingering and that were not being addressed expeditiously . . . . There is an increasing lack of confidence that, things being as they are, the problems will be addressed."