DESPITE THE efforts of many skilled and dedicated crew members, this city's emergency response system hasn't functioned as it should for more years than anyone dares remember. Time and again, reports have come in of slow responses, lost ambulances and lives that maybe -- just maybe -- could have been saved with faster medical attention. Various bureaucratic maneuvers have been carried out with mostly indiscernible success: shifting the rescue service out of, and then back into, the fire department; changing certification requirements; periodically revising the instructions to dispatchers on how to treat various calls on 911; shifting more ambulances to peak hours; and retooling the phone equipment. Still other policies have been misunderstood by the public, including a fairly recent decision to send firetrucks instead of ambulances on calls that dispatchers deem low-priority -- even when there's an ambulance available. For a new mayor already addressing other emergencies of all kinds, here's one that screams for her attention.

A not uncommon scene these days: someone's lying in the street, someone else calls 911 and along comes a hook-and-ladder team, which is now supposed to include at least one firefighter trained as an emergency medical technician. If the medical problem turns out to be more serious than believed -- which the city says happens 11 percent of the time -- there's a delay until an ambulance can get there to treat and transport the victim. Why the firetrucks? Fire Chief Ray Alfred says this policy has accomplished the department's goal of reducing the time it takes to get help to people. There aren't enough ambulances to do the job and not enough money to buy and staff more.

But as firefighters and others have pointed out, this procedure can delay transportation to hospitals and increase the risks to those who are more seriously ill or injured than originally believed. Howard Champion, director of the MedStar shock-trauma unit of Washington Hospital Center, describes it another way: "stupid." He says it's "an expensive waste of resources, and it takes away from the purpose of an ambulance, which is to provide emergency medical treatment and transport to patients who need emergency care."

Chief Alfred does note that he has neither the number of ambulances nor the trained technicians needed to answer all the calls -- which include a large proportion of low-priority requests for rides to hospitals. Reducing these non-emergency calls -- as well as outright abuses of the system -- is difficult in any city. Here, the system is unusually busy, responding to about 150,000 calls a year. In too many cases, the city never collects the $55 fee for ambulance services, and collection efforts are expensive and more often than not fruitless.

If the city can't afford to recruit, train and maintain an emergency ambulance system that responds quickly and effectively, maybe it's time to see what a private outfit could do. Or perhaps people somewhere on the city payroll can be shifted to this mission. And if there is no way to increase the fleet of ambulances, maybe some other siren-equipped vehicles can be assigned for use by medical technicians now arriving on firetrucks (which are expensive to deploy, anyway). There must be ways to stop chronic abusers of the 911 system too.

To his credit, Chief Alfred remains open to ideas and eager to improve the service, which surely is fixable. But right now it is a life-or-death issue and a challenge for Mayor Dixon, who insisted throughout her campaign and her first days in office that the city government should pay attention to "basics" -- services that are essential to the general public. This is about as basic as a service can get -- but it's no service unless it works.