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What Happens When You Call 911 in Washington, DC

After years of bad blood between District firefighters and emergency medical personnel, DC’s system is still broken. The suburbs do it much better.

By John Pekkanen Published Sunday, February 01, 2009

In DC, fire trucks are dispatched for medical emergencies as well as for fires—a costly practice that one expert calls “an absurdity, an attempt to preserve the fire budget in an era of fire-resistant buildings.” Photograph by Chris Leaman.

DC fire chief Adrian Thompson called the case of David Rosenbaum “an aberration.” Rosenbaum was the retired New York Times journalist who, attacked and severely beaten near his home, died after emergency medical personnel mistakenly assumed he was drunk and failed to provide appropriate care. But for many with inside knowledge of DC’s emergency medical service, the only aberration in Rosenbaum’s needless death was that the District’s inadequate emergency care had come to light.

“The incident with Mr. Rosenbaum came as no surprise to many of us,” says paramedic Kenneth Lyons, a 23-year veteran. “We’ve seen incidents like this all the time, and we continue to see them because we are a dysfunctional agency.”

DC’s emergency medical system (EMS) is dysfunctional, insiders say, because for decades it has been underfunded and its personnel often undertrained. EMS crews are sent to medical emergencies with old equipment, outdated medical protocols, and shortages of supplies, from oxygen to IV needles. They have to make do without vital anti-seizure and pain medications that EMS agencies elsewhere use.

Members of the civilian EMS also say they’re underpaid and disrespected by the fire-department officials under whom they work. EMS training is inconsistent and often unreliable—some EMS personnel can’t read blood pressure accurately, read an electrocardiogram, or make informed medical judgments at the scene of an emergency.

A quick survey shows that the Rosenbaum case was far from unique:

• In February 2006, a month after Rosenbaum’s death, Monica Yin, 54, fell on the ice in front of her Northwest DC home and struck her head. She bled profusely. Her housemate called 911. When a fire truck with firefighter emergency medical technicians (EMTs) arrived, they asked if Yin had been drinking. They were told no. A firefighter asked Yin her name. When Yin didn’t answer, the firefighter told her, “I’m going to tell them at the hospital that you are uncooperative, so when you die it will not be my fault.” Eventually Yin was transported to George Washington University Medical Center, where she had stitches to close her head laceration.

That was Yin’s second encounter with District EMTs. In 2002, she had become disoriented and sick to her stomach at home. Witnesses say the emergency crew treated Yin disrespectfully; at one point a firefighter shook Yin and said he thought she was “faking it.” At no time, the witnesses said, did the EMTs take Yin’s vital signs. Friends finally drove her to GW hospital, where a CT scan revealed a leaking brain aneurysm. She had emergency surgery and remained in the ICU for three days, then in the stroke unit another eight.

• In March 2006, two months after David Rosenbaum’s death, Cassandra Bailey of Northeast DC died after District Fire and Emergency Medical Services (FEMS) responders took 90 minutes to come to her aid. Bailey’s blood pressure had dropped sharply after treatment at a dialysis center. Staff at the center made repeated 911 calls and got repeated assurances from dispatchers that help was on the way—which kept people at the center from driving Bailey to the hospital. She died at the hospital that evening. She was 38.

• Last April 2, a DC fire company was dispatched to aid a man having a seizure at 10 G Street, Northeast, but it went to the wrong location. Finally arriving at the scene, the crew found 35-year-old Jeremy Miller on the ground in front of an office building with a security guard performing CPR on him. Miller arrived at the Howard University Hospital emergency room 34 minutes after the 911 call and was pronounced dead.

• On the night of December 2, 39-year-old Edward Givens was lying on his living-room floor in Northeast DC experiencing chest pain and difficulty breathing. He yelled for family members to call 911. Three DC firefighter EMTs arrived a little before midnight, checked Givens’s vital signs, and administered an electrocardiogram; they said the reading was normal. Givens told firefighters he’d eaten a hamburger earlier.

Posted at Sunday, February 01, 2009 | By John Pekkanen

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Posted by: kate, Mar 23, 2011 01:29:01 PM

Lets see, a citizen dies and the Mayor (I’m going to separate EMS from the Fire Department campaign promise), promises change amid threats from the grief stricken family. An EMS task force is created with an out of town Fire Officer chairing the task force. Having no medical experience or EMS background (the chief’s not even a Basic EMT), must be pre-requisite for the guy. The final decision of this task force, no change but to further bury this vital emergency health service deeper within a firefighting culture that has demonstrated nothing but disdain for EMS for thirty years. Well not totally...EMS brings in dollars with little effort or oversight in providing care and better yet, provides job security for firefighters. Ooooh yeaaa, this is what we want. The next death that occurs because of these decisions should lay at the feet of Mayor Fenty and no amount of fancy PR should be allowed by those who deserve more than just broken promises and the mayor always available "thumbs up".

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Posted by: ForTheRepublic, Mar 19, 2009 11:25:19 PM

Emplyees at the Office of Unified Comm. just want what every employee of the D.C.ov. wants, direction and purpose and a need to feel and sense a commitment to them as they have provided everyday to the community. This agency must creat an atmosphere that acknowledges the value of its employees, individually and collecively and affirm the dignity and self worth of its employees. The OUC agency hires its employees as TERM not PERMANENT. this is stress on the employees.

Posted by: vfong@nage.org, Feb 26, 2009 12:53:08 PM

I’m deeply concerned that this article (and the comments made) will influence someone, causing them not to call 911 when they need it. At this time, half of the paramedics working for the city were either hired or graduated from the Academy after the incident with Mr. Rosenbaum took place. They come from all over the country, and were trained in a diverse array of settings, as the result of an active recruiting campaign. They should not be judged based on the problems of the past.

Mr. Lyons is a union president. It is his job to promote the interests of his members. It seems that he feels it is in their interests to denigrate their abilities in order to promote his idea for the future of EMS in the city. As a former member of his union, I could not get away from it fast enough. I never felt as if he had my best interests in mind, only those of himself and his cronies. It makes me sick that he cares so little about the welfare of the citizens that he is unable to admit to the progress being made.

In response to the person who suggested that hiring citizens of DC might create a more caring atmosphere, there is already a ten point preference on a 100 point scale for citizens of the city in the testing process for applicants. From observation, those who have to go the extra mile to get hired in spite of the preference have a love for the job that makes up for anything else they might lack. Many of them go on to move to the city despite the disconnect between the cost of living and the salary provided.

I am not afraid to admit that mistakes get made. There is no such thing as a perfect process, only ceaseless striving to become better. Despite ongoing issues, particularly with those whose agenda puts their own interests ahead of those of the citizens, progress has been made in the DC Fire and EMS Department, and continues to be made every day. There are a lot of good people in your fire department, who care about the city and its people, please don’t sell them short.

Posted by: DCFire, Feb 19, 2009 11:18:40 PM

For clarification Dr. Jim Augustine was the physician medical director for the Atlanta Fire Rescue Department until being hired by DCFEMS. This includes the Field Operations Division, or "downtown" fire department as well as the Airport Division located at Hartsfield-Jackson Atlanta International Airport. Grady Health System is the ambulance transportation provider within the city limits of Atlanta. Each agency has it’s own physician medical director as required by Georgia Department of Human Resources (the regulatory authority for EMS in Georgia) policy.

Posted by: ATL EMS Chief, Feb 17, 2009 10:29:06 AM

Fenty and Rubin are Liars... EMS deservers better. DCFEMS only wants to keep EMS for the budget. Fenty has run the city into the ground and Rubin will run the department into the ground as well.

Posted by: DC Firefighter, Feb 16, 2009 05:44:50 PM

This article is informative--I was unaware that the District’s EMS system worked this way and yes the system as it is is deplorable.

I don’t understand the resistance to changing this dysfunctional system? Is it political? If so, how is it political?

What kind of background does Rosenbaum’s son-in-law have and what influenced him to support the idea of a single service? The system as it is (unchanged) was clearly the cause of his father-in-laws death!

Clearly, a light has been shown on this mess so where is the outcry from District’s residents? No one should have to decide, in the midst of an emergency, whether to call 911 or a cab. This is insane.

It is hard to believe that it has been three years since the Rosenbuam tragedy and yet there has apparently been no movement toward a resolution. When is this family going to understand that nothing will happen unless they sue the city? Toby Halliday needs to understand that when the city creates a task force to investigate and make changes in a broken system that, if the truth be known, it is that they are tasked to simply appear that they have.

Unbelievable!

Posted by: Janell Shepard, Feb 12, 2009 04:14:12 AM

DC really resembles a third-world country in many ways. How disgusting!

Posted by: Concerned Citizen, Feb 11, 2009 03:50:36 PM

I wonder if there was a residency requirement and the District only hired individuals from the city would the fireman have a better attitude about how they treat the citizens. I wonder if some of the problems stem from the District hiring a bunch of volunteer fireman from the mostly white suburbs? I wonder if someone were raised and live in the District would they look at the citizens differently, like family or a neighbor?

Posted by: JustWondering, Feb 11, 2009 05:55:24 AM

Totally separate EMS from the Fire Department, make EMS it’s own agency. When it comes to funding Public Safety make Police the number one priority, followed closely by EMS. Start investing in the EMS system by hiring smart people, paying them well, training them well and equipping them well. The fire department wants to be just dumb old firemen fine, and then they should be third string. You would think a city with the amount of media, so many high profile dignitaries, the most powerful place in the country possible the world would operate with the best of the best, the situation is on going in the district, shameful, just shameful.

Posted by: Veritas, Feb 11, 2009 05:47:11 AM

The Rosenbaum family very courageously and selflessly agreed not to sue DC if the city made good-faith efforts to improve its EMS system.

Three years later, DC EMS hardly seems any better.

Time for the Rosenbaums to bring their lawsuit.

Posted by: Jay Reeder, Feb 10, 2009 02:03:07 PM

This is abhorent. I have known that the fire side was a disaster since we started, and continued to lose buildings due to broken fire hydrants and lack of proper water supply, but now this means that the entire system is corrupt and essentially unusable.
As a former EMT with Montgomery County MD, I find it amazing that DC cannot find, train and employ literate candidates who care about their fellow human beings. Why aren’t there volunteers staffing any of the shortages? I was told it was because of the union rules when I inquired about volunteering my services and skills. Well, the union isn’t working if it’s protecting the positions of people who aren’t doing their jobs whether they be unwilling, or unable.
Take some leads from Montgomery County MD. We seemed to do it right and never questioned things as simple as where the best treatment was for a particular problem or how to get the patient there as quickly and comfortably as possible. Get off of the money DC government and be accountable for your actions, this is important!

Posted by: squirrelbaitdc, Feb 10, 2009 01:18:31 PM

Thanks to the Washingtonian and John Pekkanen for this article - hopefully the Mayor, the Council, and others with influence in the District will realize soon that our shameful city services are not only dangerous, but a HUGE THREAT TO THE CITY’S ECONOMIC VIABILITY.

Economic growth is the only thing that really gets their attention - no ambulances, lead in the water, failed schools, flaccid policing = far fewer affluent residents willing to put themselves and their children at risk. I hope this article is read widely.

It’s appalling, but that threat may be the only one that produces real action.

Posted by: easternbranch, Feb 10, 2009 11:57:03 AM

Actually, the article on JEMS reads like a PR fluff piece and doesn’t make much sense. This article is heavily researched and very informative. Next time I need to call 911, I’ll think about alternatives.

Posted by: anon, Feb 10, 2009 11:14:25 AM

I am glad someone is finally on to these guys. This must stop. It truely is a cultural change they need to foster and adopt in the DCFEMS. They should be ashamed where they are today, they used to be envied by even FDNY as a top knotch Fire Department. Now, they are called to task, lets see how they bury this problem. I am certain I will draw criticism for this and funny thing, I am 100% a Fire Officer but also an EMT and know better.

Posted by: SammyTheStoryStraightener, Feb 09, 2009 05:17:02 PM

Unfortunately, much of this information is out of date. Some of the issues brought up aren’t things the fire department can control, such as the pain-killers it has been asking to have for many years, only to run into legal barriers. Please contrast this article to the one in JEMS Magazine (an industry journal) http://www.jems.com/news_and_articles/articles/jems/3401/from_worst_to_first.html and remember that there are always more views.

Posted by: Me, Feb 08, 2009 08:42:37 PM