The mother from Northeast Washington complained of stomach pain and had been vomiting. She’d recently had foot surgery, and her daughters were concerned enough to call 911.
D.C. Fire and EMS ambulance Medic 17 and Engine 8 pulled up to a housing project along Interstate 295, where Kianna Lofton, a paramedic, and other city emergency responders checked on the 43-year-old woman.
Lofton pricked the patient’s finger to test the woman’s blood-sugar level after team members noted that their patient suffered from high blood pressure, arthritis and diabetes. The woman appeared a bit disoriented but was able to describe her symptoms and request a trip to George Washington University Hospital.
“We are going to get you a ride in a brand-new ambulance,” Lofton said reassuringly. “You will be back bothering your kids before you know it.”
The city crew didn’t take the woman to the hospital themselves; instead, they waited with her until an ambulance pulled up from the private company American Medical Response (AMR).
Late last month, the District began using the commercial service to transport patients with less-serious symptoms. The new system is intended to free up city medics and ambulances for more dire cases and ease the strain on a department that has struggled to handle a growing number of medical calls.
City paramedics or firefighters still respond to each 911 call and assess each patient’s condition. In the more serious cases, they transport patients as usual. During the first week, 2,135 people were taken to hospitals; 678 were transported by the private service, or about 32 percent of the overall cases. They represent about half of the patients with less-serious conditions.
D.C. Fire Chief Gregory M. Dean proposed the plan, based on his experience as fire chief in Seattle, as the first step to help the District deal with a system that ran out of available ambulances on a daily basis. In the first week of supplementing the agency’s fleet, Dean seemed pleased but remained circumspect in his analysis. He said his staffers are still adjusting and chose to transport hundreds of patients in instances in which the private service could have been used.
“My initial assessment is, even though our people have been a little bit shy, is that they are embracing this,” Dean said. “We are not running out of units as quickly, we are achieving our mission and we have a lot of training going on.”
The new system faced a tremendous test on its first day, March 28, when authorities were called to four fires, rescued 17 high school boaters from the Potomac River and then rushed to the U.S. Capitol after police shot a man with a gun.
In a rare twist, the head of the city’s firefighters’ union, often critical of top officials, praised the department’s plan and leadership.
“Monday was just a really crazy day. Can you imagine if we didn’t have those extra units in place? Somewhere, some way, someone would have been waiting for an ambulance,” said Ed Smith, the chairman of the union.
“It could have been a national embarrassment. Instead, we were there.”
Though the start has been promising, fire officials acknowledge there have been some glitches as the effort launches.
AMR ran out of available ambulances six times in the first 10 days of operations, and each episode lasted between four and six minutes, D.C. fire officials said. The contractor operates between 7 a.m. and 1 a.m. daily.
The city and AMR are trying to pin down the data on response times, as preliminary statistics show that the company failed to reach calls by the contracted 10-minute window during 30 percent to 40 percent of calls during the first week.
Some of those apparent delays could be the result of drivers failing to accurately time-stamp their arrivals with dispatchers, and others could be the result of drivers still learning to navigate the city, officials said.
Under the new protocols, certain groups of patients are still transported by the city, even if their illnesses or injuries are not deemed serious. They include anyone under 18, any woman with issues related to pregnancy, anyone in law enforcement custody and anyone who is in need of a mental-health evaluation.
On the first day of the new system, D.C. Fire and EMS Capt. Alex Capece crisscrossed the Anacostia River responding to calls for people suffering from abdominal cramps and issues related to hyperglycemia, and one to help a man who refused to go to a hospital after vomiting during his dialysis treatment. Capece’s job is to ensure that medic and firefighter crews arrive at calls and make proper assessments of patient symptoms.
At 29, he is the youngest captain in service, but in eight years on the job he has experienced plenty of instances in which the system has been overwhelmed at times when patients “are having their worst day of their lives.”
“They have just been shot or had just had a heart attack,” Capece said. “We have been stretched to the limit. It’s not fair to the providers on the street or to the residents.”
He thinks the addition of private ambulances can help relieve the strain. “If we can buy into this, and the provider can do what they are supposed to, this can work,” Capece said as he drove on patrol.
At 1:33 p.m. that Monday, his SUV radio echoed a shrill beep, in contrast to the steady drone of addresses and ailments relayed each minute, and a dispatcher declared that the city was in “Alpha Hold” mode. The call initiates multiple protocols and procedures, but in simple terms it means one thing: The District just ran critically low on the number of available ambulances, and patients with less-serious afflictions will wait longer for transport.
It showed that the system remains stressed at times, but officials note that it now takes a higher call volume to reach the tipping point and that they have the ability to rebound sooner. It’s not just the transports that tie up ambulances, they note, but also the time that crews must spend at hospitals.
“Having AMR allowed us to recover quicker,” Dean said. “AMR’s response times are getting better every day.”
Dean expects the “Alpha Hold” code to eventually disappear as they find the recipe for the accurate number of medical units needed each day.
Dressed in his blue uniform with his cap cocked sideways, D.C. paramedic Max Storey stood behind his parked ambulance in the middle of the 400 block of Burbank Street SE that Monday afternoon waiting for an AMR ambulance. He had concluded that a 60-year-old woman who was confused from a hyperglycemic episode faced no serious danger. Storey requested the private dispatch at 1:56 p.m.
At 2:03 p.m., the paramedic saw flashing lights turn the corner. He flashed two thumbs up.
“Here’s AMR already!” he shouted. As the two-man crew emerged from the ambulance, Storey complimented them. “Hey guys, great response time.”
The group immediately got to business as Storey relayed the diagnosis. The fire department crew and the AMR team together moved the patient from her apartment to the ambulance, where she arrived at 2:10 p.m.
Eight minutes later, Storey and his crew were back in service and ready for the next 911 call.