D.C. Mayor Muriel E. Bowser will propose using private ambulances to transport non-serious patients to hospitals, a change that comes after instances in which no city ambulances were available in life-or-death situations.
Under a plan that Bowser (D) and her incoming fire chief, Gregory Dean, are expected to outline to the D.C. Council on Tuesday, a District paramedic or emergency medical technician would still respond to each 911 call. The first responder would decide whether the patient requires serious treatment or lifesaving care, and if not, a private ambulance could be called to take over.
Officials said the plan would ease the strain on a department overwhelmed by a growing number of calls for medical help, with about 2,000 more each month compared with last year. According to fire department estimates, about 200 patients a day could be transported by private companies, freeing city crews for the more serious cases.
Bowser will ask the council for emergency powers to begin the partial privatization, meaning that by year’s end, the experience for tens of thousands of D.C. residents and visitors who call 911 annually could be changed dramatically in the nation’s capital. Major outstanding questions about the mayor’s proposal include both the cost to the city and to any resident who calls for help.
If approved by the council, however, it would be a significant change for the troubled D.C. Fire and Emergency Medical Services department. The agency has struggled with broken equipment, personnel shortages and embarrassing failures to respond quickly to medical emergencies. In recent years, an injured police officer and a choking toddler had lengthy waits for help. Twice this month, when no ambulance was available, firefighters and paramedics hoisted young children onto fire engines to carry them to aid. One infant later died.
“The goal is to try to keep our units in service so they are available to respond to all of the other emergencies coming in on a daily basis,” said Dean, who was previously the fire chief in Seattle, which operates under a similar model. “The evaluation that I’ve done, coming in, is that the current model we have needs some enhancements.”
Since taking office in January and bringing Dean on board in March, Bowser’s administration has put part of the blame for the fire department’s failures on a deluge of medical-related calls. The city has a full-time fleet of just 39 ambulance and medical units and last month, with all its apparatus, responded to 18,000 emergency calls, over 15,000 of which were medical in nature.
Of medical calls so far this year, in almost half — over 56,000 — emergency responders determined that the patient needed only basic medical attention.
Any one of those calls, however, can tie up an ambulance crew for hours, as responders drive and wait at crowded emergency rooms.
While all of the city’s ambulances were in use during a recent five-week stretch, D.C. relied on Maryland ambulance crews 58 times to respond to medical emergencies inside the District — 10 times the norm of recent years.
Bowser’s privatization plan drew a warm reception, at least as a short-term solution.
D.C. Council Chairman Phil Mendelson (D) and the head of the city’s largest fire union said they would welcome the plan as long as it did not permanently outsource a key government responsibility and union jobs.
“My initial reaction is that this could be very helpful in the short term,” Mendelson said. “But it should be a short-term strategy, otherwise, this is essentially contracting out a government function.”
Edward Smith, president of the D.C. firefighters union Local 36, said the bulk of the department’s 2,000 firefighters acknowledged the need for some extra help until the department can recover from years of underinvestment in hiring and maintenance of its equipment. Bowser’s administration recently leased several ambulances to boost its number available to over 50 and has a plan to replace or refurbish dozens of ambulances during the coming 12 months.
“We’re not totally opposed to the idea, given the circumstances we’re in and how we’re overloaded on a daily basis,” Smith said. “Long term, as we increase staffing and units, we would like to cover those” 911 calls with permanent employees, he said.
Aretha Lyles, president of the union that represents the fire department’s civilian paramedics and emergency medical technicians, however, said she and her 165 members do not support the proposal. Lyles said the administration’s proposal would be dispatching dollars outside the city to private firms.
“We are the capital of the United States. We should have the best equipment, the best staff. In order to do that we should be hiring bodies,” Lyles said. She disputed the idea that city paramedics should ever focus only on major medical calls. “We’re here to take 911 calls, we’re here to do medical emergencies; it doesn’t matter if your neck has fallen off or your pinkie has a paper cut.”
Lyles said that from briefings with the administration, she understood that after dispatching its own paramedic or EMT, the fire department would give a private ambulance company 10 minutes to reach minor calls. If the operator failed to show, the department’s crew would transport the patient.
Dean said a specific timetable has not yet been set.
If the plan is approved, he said, the city should let the results speak for themselves.
“We’ll want to see the public’s reaction to the care that they are getting and what’s happening,” he said. “What we’ll be able to answer for everybody is should this be short term . . . or is this the appropriate model.”
Mendelson, who has launched a series of council hearings about whether the District has put too much power in the hands of contractors for homeless services, school construction projects and elsewhere said he would be inclined to push back.
He said the District must also look at city rules aimed at reducing calls by those who don’t need emergency help.
“The call volume, the number of responses, can be reduced,” Mendelson said. “The fact that an individual wants to be driven to an emergency room when it’s not medically indicated or necessary is unreasonable. There are strategies that can be put in place.”
Mendelson said the city should also revisit earlier proposals to station fire department employees at emergency rooms to limit the wait time for ambulance crews.
Lyles said she thinks that many District residents will reject the new system when residents see fire department personnel responding to a scene but waiting for a private ambulance to arrive.
“When they call 911, 911 is exactly what they expect. Residents will be looking at them asking why are they not doing anything,” Lyles said.
In a brief interview, Bowser said her concern is adequate 911 response.
“People are concerned about the fact that we have increased calls and need to address them,” she said.