“I knew our EMS system had problems, but had no idea it was this bad”

by Prince Of Petworth February 10, 2016 at 10:04 am 63 Comments

ems emergency
Photo by PoPville flickr user Miki J.

Starting to get a few emails about this – Susan comments:

“Just read the resignation letter of Jullette Saussy. OMG I knew our EMS system had problems, but had no idea it was this bad. Why can’t the city keep people like her employed? Our EMS system needs a major overhaul, but likely the Mayor will appoint another person from within and we’ll be stuck with the incompetence.

Here is her letter.”

say what

this has been ongoing for decades. I had hoped the lawsuit from the Rosenbaum family would have pushed the city to make improvements. Some of its bad leadership and a lot of it is the union not willing to change.
- Philippe Lecheval
  
  Clearly it’s so bad that it doesn’t matter if you’re a rich old white man living in upper NW, or a poor black kid in deep SE. They don’t care and if you’re in great distress, there’s a very good chance you’re gonna die.
H Streeter

I had no idea. It sounds like the recommendation to create a separate department for EMS outside of the Fire Department makes perfect sense. Its clear reform is needed.
- anon
  
  In one way it does make sense given the absurd obstructionist culture at our FEMS. However, although I’m not an expert on this issue, it seems that every major body and jurisdiction that looks at the issue recommends a combined agency with employees that are cross-trained in multiple functions. I’d be interested in comments from people who know more about the national perspective and trends on the issue.
anon

Given that it was Mayor Bowser who appointed Saussy, what indication is there that she is will just appoint someone from within and settle for mediocre? She is the one trying to change FEMS after Gray let it decay and fester under Chief Ellerbe.
- stacksp
  
  +1
- Anonymous
  
  I’m no Gray apologist, but let’s be fair: the agency in decay long before Gray took office. The Rosenbaum Task Force was created 10 years ago, e.g.
  - CPT_Doom
    
    It’s been 20 years since Tyra Hunter, a transgender woman, was left to die by DC EMS after they discovered her gender identity, and as far as I know, the agency has never implemented the training required as part of the settlement agreement.
    - Justice for Tyra
      
      Those EMT’s should have been charged with murder.
  - Anon
    
    You are absolutely correct. He inherited a broken agency, but then appointed one of the worst of all possible managers to run it and never held him accountable.
    
    And I don’t have it out for Gray…I just thought this was one of the most unforgivable leadership decisions during his tenure.
- textdoc
  
  “[Bowser] is the one trying to change FEMS” — Ostensibly, yes, but what Saussy’s letter says is that the Mayor’s stated goal is not achievable under the current system.
Formerly ParkViewRes

Damn I knew it was bad, but this is just scary. It needs to be on the news when people die due to their incompetence!
- LittleBluePenguin
  
  +1!
Teddy

Every single resident of the district should read that entire letter.
- textdoc
  
  +1.
- HillM01
  
  +1,000
stacksp

One thing that stands out is that she was only at the job in an invested capacity for maybe 6 months. I am not sure you can change an entire culture, organizational structure, and overall operating procedures in that amount time especially being the new face on the job. It had to take her at least a little while to discover all these inadequacies to even begin to know what to address. Additionally, it takes time to build up equity in a new organization to which you get everyone to buy in. Obviously, I do not work in this culture but it seems that it may have taken more than 6 months to make all the necessary changes that she desired in this organization with the culture that it had probably been operating for years or even decades. Change is tough and doesnt come easy
- anon
  
  Agreed that it takes time to build equity and enact change but two points (1) it’s her license and ethical obligation to attest that these individual workers have been trained and can deliver adequate services and from what she’s seeing, she can’t make that representation and (2) if the organization is blocking even basic internal reform, she may have felt obligated to act as a whistleblower and let the public know that the system is dangerously inadequate.
- Formerly ParkViewRes
  
  Have you ever worked in a toxic culture? It takes way more than a year to make a change, yes, but it does not take long at all to see the problems. For some people it takes very little time to become overwhelmed and depressed in a situation like this.
  - stacksp
    
    Sounds like we are in agreement. I sure the problems were apparent almost immediately, maybe a month in. I think we both agree that it takes longer than 6 months to see change.
    - textdoc
      
      Her letter describes how the culture is completely resistant to change, how the reporting structure hindered her ability to hold people accountable, and how she was repeatedly stonewalled by middle management.
- wdc
  
  Did you read the letter? She said that she was obstructed and ignored. This isn’t a matter of “change takes time”. Change takes will, and six months is more than enough time to determine the presence, or in this case total lack, of will to change.
  - stacksp
    
    Sometimes the obstruction and being ignored is due to the lack of equity built up. Trust me, I am not blaming her. She has her right to leave a toxic situation. Its good that she identified these issues for the next person that is appointed for the job.
    - dno
      
      Equity building sounds like feel good consultant babble that may be tolerable in an organization not tasked with saving lives. Here, changes not made while she patiently builds that “equity” will likely result in preventable death.
- textdoc
  
  Stacksp, I’m assuming you haven’t read the actual letter. It’s pretty damning — anon 10:50 and wdc summarize why.
  - stacksp
    
    Admittedly, I skimmed after the first page or so after I realized how long she had been there.
    - Accountering
      
      Oh come on – you have got to be kidding me. You didn’t even read the letter and are then commenting on the content of it? You should know better than that.
      - CRT
        
        You expect more from someone that actually uses the phrase “equity build up” to discuss a life and death situation?
    - MR
      
      Seriously…you took the time to comment but you didn’t even read the letter before doing so? You’re the reason I avoid most comment sections on the internet.
      - stacksp
        
        I read enough of the letter. I hope Muriel can find someone with the wherewithal and fortitude to see that the necessary changes are made within EMS and supports that individual as people are still needlessly dying. There has to be a culture shift and the incumbent will have to see it through.
      - textdoc
        
        You need to read more of the letter. Saussy described her efforts at change, how they were met with resistance, and how the reporting structure meant she had no “teeth” to hold people accountable.
      - MR
        
        Stacksp, I agree that someone will have to “see it through” in order for there to be change. But she was in danger of losing her license (and acting unethically) if she continued in that job. Her letter should be a wake-up call to those who have the power to actually make change in this city. But I don’t fault her for leaving, and it’s exactly what I would have done had the choice (and the potential consequences) been the same.
- say what
  
  Ever since Rosenbaum was left to die on a Gurney or the other guy was left to die on the street outside the firestation even though his daughter was begging for help AT THE FIRESTATION or the two year died because a truck close by was never called…how much more time do we have? These problems are well known and documented for decades. The Mayor needs to take it over completely the way Fenty took over schools,. void the existing contract and start firing people left and right.
- temporarilyablebodied
  
  I agree that changes doesn’t come in 6 months, but I read her very well-written and quite blunt letter (kudos to her) as saying that attempting to make ANY change was fought with hard resistance from every level of her organization despite blaring errors such as…PEOPLE NEEDLESSLY DYING being the status quo. She was put into a culture where management was defending and partaking in very bad behaviors with the most devastating results. Shameful.
Anon

Color me completely unsurprised. This letter has the same general tone as what had been written about the WMATA, and several other DC agencies. There seems to be nearly zero accountability at just about every level, to the point where employees come in only to collect a paycheck. We need real change.
- Anonymous
  
  “…to the point where employees come in only to collect a paycheck.”
  That’s really the gist of her letter, without her actually saying it. It’s unconscionable that EMS techs and drivers are “disappearing” during their paid shifts and she has zero authority to discipline them. Um, that probably explains why it can easily take 20 minutes for an ambulance to arrive. WTF.
  - Ted
    
    Not that you should expect much competence when they finally do arrive:
    
    https://www.washingtonpost.com/local/public-safety/two-dc-firefighters-reassigned-after-missing-gunshot-wound-on-patient/2016/02/04/fcce193e-cba2-11e5-88ff-e2d1b4289c2f_story.html
- petworther
  
  WMATA is not a DC agency.
  - textdoc
    
    Yes, but it does share many of the problems that D.C. agencies have.
Kathryn-DC

I think what is most significant about her letter is her statement about distancing herself. She is actually worried about her own reputation going down the tubes, and that is something I have never heard before from a government official.
- Anon
  
  More significant than people needlessly dying and an organizational refusal to make necessary change? Thank you for your insight, Kathryn.
  - textdoc
    
    I didn’t think Kathryn was criticizing her (although maybe she was?) — more saying “I’ve never heard a government official say that the situation is so bad that he/she is worried it’ll affect his/her reputation.”
  - Accountering
    
    Yes, I think it is quite significant that the culture is so bad, and unwilling to improve, that she is unwilling to go down with the ship. I would do the same, absent any ability to improve, I am not going to flush my career down the tubes for a bunch of people mailing it in.
  - Kathryn-DC
    
    I happen to be a former EMT myself, so I know a bit about people dying, thanks.
  - Kathryn-DC
    
    I’ve explained that so many times in this forum it starts to feel like bragging on myself, I’m not comfortable with it
textdoc

The AP article on the resignation (https://www.washingtonpost.com/politics/medical-director-resigns-calls-dc-fire-department-toxic/2016/02/09/c3b5640e-cf99-11e5-90d3-34c2c42653ac_story.html ) quotes a Bowser spokesman as saying that many of Saussy’s claims were “highly inaccurate.”
.
Sheesh. Maybe Bowser feels obligated to (implicitly) defend her choice for fire chief, but that is a really damning letter and I’d expect something more like “These are very serious issues and we’re looking into it.”
- textdoc
  
  The response from Bowser’s spokesman seemed more measured in the Washington Post article (https://www.washingtonpost.com/local/public-safety/dc-fire-departments-medical-director-resigns/2016/02/09/e8c8edd0-cf6f-11e5-88cd-753e80cd29ad_story.html ) on the resignation. Maybe someone realized that attacking the credibility of the source just makes you look defensive?
  .
  “Chief Gregory M. Dean declined an interview request.
  .
  “Bowser’s chief spokesman, Michael Czin, issued a statement saying that the administration ‘is committed to reforming’ emergency medical services and that the fire chief, hired nearly a year ago, and his team have made progress. ‘We are committed to improving patient outcomes and delivering the change that residents expect and deserve,’ the statement says.”
  .
  Of course the above is just pablum. Typical Bowser — “I am committed to [insert goal here].”
  - Anon
    
    Thanks for posting these, textdoc! This story is disturbing on many levels. I hope that the local media stays on the case.
MrTinDC

In the meantime, I highly recommend everyone purchase a good, well-equipped First Aid Kit for their home. Maybe even get a home AED if you’re over a certain age and/or have a family history of heart disease. This one looks good: http://amzn.com/B00064CED6
- anono1
  
  Good advice. I’ve also previous told my partner that if I need medical assistance and can be safely moved, drive me to the ER, don’t call 911 unless there is no other option.
- jdegg
  
  In my previous job, we were advised to hail a cab to take any co-worker who might be having a heart attack directly to the hospital, rather than wait for EMS.
BW

When you have a poor education system, cronyism, etc. these are the outcomes. When you hire people based on profiles/familiarity rather than competencies, this is the result. The DC government and its institutions have been highly resistant to PERFORMANCE BASED measurements. When you erode standards THIS IS WHAT YOU GET.
- Jeff
  
  you nailed it!!!
MPD ANNON (2)

As someone that works with DCFD almost every day here’s my two cents, which concedes with MPD’s response time too. Most places in the USA the call taker can take a call and determine if it’s an emergency that needs police or fire assistance. BUT. This city doesn’t allow dispatch that discretion, I remember being on a scene of a car wreck and I was listening to DCFD radio. I heard a unit asking for a hospital for a priority three (lowest priority, a cab would suffice) and the paramedic goes “a patient is complaining of finger pain and its priory three.” Then their dispatcher calls out for a priority one stating Someone wasn’t breathing but no one answered up, there were no units because they go to every call a person calls 911. Every person that flags down an officer saying they’re too “drunk” has to be transported to the hospital by DCFD. They either need to buy a Ton more ambulances and employees or start using discretion who needs an ambulance or the police. All major cities are like that with both police and fire. To my knowledge we are the only city that is “full service”. Which can be left to the citizens discussion but that is what I see. Mad as a resident of dc, I’d rather have dispatch have discretion so if I ever need an ambulance there would be one for me.
- MPD ANNON (2)
  
  Also side note, if am ambulance has a priority three in it and a priority comes out they can’t just kick out the person already in the ambulance.
- Anonymous
  
  Can you discuss the rivalry between EMS and the FD? Why aren’t they separated with different chains of command and budgets? It seems like the Fire staff hold way too much sway over the department, to the detriment of EMS services.
  - Fitz
    
    EMS used to be separate. The FD had to take it over due to their problems. After Rosenbaum firefighters were put on the ambulances and the department was to become “all hazards” where everyone would become dual role, both a firefighter and an EMT or medic. This was stopped under Ellerbe, who used the department as a jobs program. EMS employees wear the same uniform and work out of firehouses but have different rules than firefighters. When the medical director talks about employees calling in sick repeatedly she is talking about them. Fire officers have no control over them and their isn’t much of an EMS rank structure.
    The all hazards approach would have solved some of this but is still not fully implemented.
    The fire chief seems to really be trying to fix some of these issues. The department has been run into the ground over thepast few years and will take more than the 8 months he’s been here to fix. While the medical director has some valid points it seems she is angry she doesn’t get her way on everything. In her previous jobs she only had to answer to the mayor and was in departments that were set up differently. 7 months is not enough time especially in this city where everything is in some beaurocratic tie up.
    Also, MPD is correct on a number of things. The dispatchers are terrible. The ridiculous amount of nonsense calls that tie up ambulances are probably the biggest problem.
    The lack of hiring quality employees for quite a few years and the complete lack of maintenance or replacement of fire trucks and ambulances has also crippled the department.
    - textdoc
      
      Thanks for this backstory.
      .
      How is the fire chief (supposedly) trying to fix these issues?
      - Fitz
        
        They are getting a contract with a private ambulance company to handle some of the lower priority calls. This has taken quite a while because it has to go through many levels of DC Government to be approved. Then there is a bidding process and so forth.
        
        The department gave a test for the first time in 8 years. They are starting classes of new hires soon.
        
        They are ordering new apparatus. This will take a while, usually around a year from design to in the firehouse. The last chief did order a few trucks but screwed them up so bad they had to be reworked. Those trucks are finally arriving after being ordered almost 5 years ago.
        
        The department is trying to work with the communications center to better train call takers. Communications is a separate agency from the police and fire departments.
        
        Morale in the department is up. Things like this don’t help. The majority of the members in the department are hard working and do the best they can with what they have. Seeing stuff in the news constantly is maddening to us too. The chief is actually engaging employees and listening to them which hasn’t been done in a long time.
        
        There is a long way to go but the chief seems to really care and wants to fix it. Unfortunately, a lot of things are out of his control. (Communications, typical DC BS, etc.)
- BKDC
  
  I’m amazed at what always appears (at least to me) as an over response by emergency personnel when responding to a minor car accident in this town. I understand that you’ll need people on the scene to investigate the crash, help direct traffic and clear the road, etc. But do you really need 3+ firetrucks for a a fender bender? As a parent, I’m terrified that an ambulance won’t come in time.
  - Annon MPD (2)
    
    I do know all DCFD employees are paramedics and firefighters. They all work for DCFD but I believe we have a chief for DCFD and then a civilian (who just resigned) that is in charge of strictly the medic side. The reason three truck show up is because it goes back to them dispatching ambulance to people that need an ambulance for a “hurt finger”. I don’t know if you remember a few years ago a DCPD officer got ran over and waiter 30-40 mins for an ambulance to come and MD ambulance came instead. It’s because they have to go to every single 9-1-1 call. They need descretion or many more ambulances and units.
DSB

One of the things that I think everyone should take away from this letter is that we have a competent administrator who is leaving our system because she feels ineffective. By all rights, this woman knows her business. How are we as a city not finding every way possible to keep and empower this person? How are we not NOT listening to these ideas? This is the same type of systemic bullsh*t that has plagued this city for decades. No accountability. We have congress to thank for that. We don’t have to let our city turn out to be this way! Say something with your vote people!
- On Capital Heels
  
  I completely agree! Assuming that everything she wrote is true, I can’t for the life of me understand why the Administration is not bending over backwards to get this woman the resources, authority, and support she needs to do her job well. This was a well-written, detailed, and insightful letter and a searing indictment of the current system. I am very sad to see her go, and I am saddened to think of how many additional lives will be needlessly lost as we wait for her replacement to take the post, get up to speed, and then be confronted with the exact same challenges. We need a mayor that is going to address this issue once and for all!

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