In the early edition of yesterday's paper, Washington Deputy Fire Chief Ray Alfred was misidentified in a photo caption as ambulance service chief Thomas McCaffrey.
The District's ambulance crews are poorly trained and supervised, and the service is inadequately staffed, keeps poor medical records, uses substandard equipment and has virtually no quality control mechanisms, according to a task force report on emergency medical care.
The report found that 42 percent of 50 ambulance workers surveyed did not have current CPR certification and that there was inadequate equipment and medically trained personnel at all levels.
Some of the problems, the seven-member task force said, "are obvious and too urgent to allow significant time to pass without further deterioration in morale and patient care."
The task force, composed of doctors, nurses and D.C. fire officials, was established after doctors from local hospital emergency rooms sent a letter last spring to Mayor Marion Barry's Advisory Committee on Emergency Medical Services "expressing deep concerns" about the city's ambulance service.
The city's ambulance service, with about 260 employes, is a division of the D.C. Fire Department, and 20 ambulances are stationed in firehouses that are on call 24 hours a day. Last year, they responded to more than 100,000 calls.
When no ambulance is available, the fire department sends an engine company to provide emergency aid, but the report found that of the city's 1,700 firefighters, none had current CPR certification or training to give preliminary treatment, and 98 percent did not have training as an emergency medical technician, the lowest level of training required in the ambulance service.
The report blasts medical records that are kept by the department's ambulance workers.
"The lack of appropriate documentation can only result in the inference that the care being rendered is at best poor. The premise in medicine is that what is not documented has not been done," the report states.
In addition, the report says the fire department's training academy "fails to consistently offer adequate skill performance education at any level."
"Currently, individuals are being hired without appropriate medical experience . . . without appropriate personal screening interviews and without a minimum command of the English language," it states. "Apparently, the ability to pass the background clearance and the required drug screening is the only valid criteria necessary for hiring."
In all, the 38-page report, with 17 pages of attachments, found 82 deficiencies in the areas of hiring, quality control, training, equipment, medical control, supervision, staffing, communication and command organization.
The report, which makes about 140 recommendations, also said the service was burdened by widespread "system abuse" -- in which ambulances are summoned for minor injuries or even routine doctor's appointments.
The report recommends that D.C. ambulance workers be exempt from the city's residency requirement because "the pool of qualified, experienced personnel has dwindled significantly." It also recommends that ambulance workers, with a starting salary of $16,218, have pay parity with the city's firefighters, who begin at $20,644.
Other major recommendations include the immediate recertification of workers whose medical certifications have lapsed; more computerized record-keeping; appointment of a "strong, knowledgeable medical officer" whose performance would be evaluated by medical professionals; review of the D.C. police department's 911 system and the city's new "priority dispatch system"; supplying all fire department engine and truck companies and engine squads with "the minimum necessary equipment" to give emergency care, and giving the medical community a hand in evaluating the department's emergency care.
The task force, headed by Dr. Harry Chen of George Washington University's emergency medicine department, was formed by the Emergency Medical Services Advisory Committee, which regularly reports to Barry on public health concerns. The committee had been set to discuss the report at its monthly meeting yesterday, but Dr. Vincent Roux, chairman of the committee and director of emergency medicine at Howard University Hospital, declared the session closed and barred the public.
Roux declined to make the report public. He said the report was to be delivered to Barry later yesterday and that its recommendations were not final.
Deputy Fire Chief Ray Alfred, a member of the task force and a spokesman for Fire Chief Theodore Coleman, declined to comment. A spokesman for the mayor also declined to comment.
A doctor who attended yesterday's meeting, who asked not to be identified, gave a copy of the report to The Washington Post, saying, "It is important for the press to get this report so that people will pressure the mayor to make changes. It is a difficult thing for a group of medical professionals to see the city let the emergency medical system go into a state of decay and disrepair."
Bob Meehan, a private citizen who served on the task force, said, "I personally felt alarm about the information we found. I was upset to know that the medical community knew about this information for quite some time."
According to Dr. Craig DeAtley, a professor at George Washington University Medical School and director of the school's emergency medical services program for D.C. ambulance workers, the task force was set up after he and doctors from Georgetown University Hospital, Howard University Hospital and the Washington Hospital Center wrote to the committee "because we felt there were too many existing problems that needed to be addressed."
DeAtley said they came to that conclusion from their day-to-day dealings with the city's ambulance workers and after the poor showing of some employes in promotion tests.
There are three levels of ambulance workers in the city: emergency medical technicians (EMTs), who man ambulances with basic life-support systems aboard, and intermediate paramedics and paramedics, who are qualified to administer more advanced medical aid.
The report said 20 EMTs were selected this year to take courses enabling them to advance to intermediate paramedics.
Forty percent of the class failed the final written examination and "100 percent . . . failed to pass the practical exam in its entirety."
In terms of "system abuse," the report recommended that the city consider legislation that would give ambulance workers the right to refuse transport after seeking appropriate medical advice. It also recommended creating legislation so "system abusers" can be prosecuted.
In conclusion the report said, "There are many fine firefighters, EMTs, intermediate paramedics and paramedics striving to provide good care. However, without direction, training, equipment, and support, their impact on the overall care is minimal and diminishing daily."
Other task force members included Dr. Horace Lasiter of Howard University Hospital, nurses Midge Moreau of the Washington Hospital Center and Sherry Adams of George Washington University and Sue Brown with the Commisssion of Public Health.