EMS Task Force Recommendations
Title: Recommendation 5a
Action Item:
The Chief, in partnership with other District agencies and providers, shall develop and begin to implement, no later than March 31, 2008, an outreach program for patients with chronic needs.
Progress:
On March 27, 2008, the Fire and Emergency Medical Services Department (FEMS) initiated the “Street Calls” Program, designed to perform mobile outreach and intervention for high-volume individual users of 911 services, including the homeless, hoarders, mentally ill, and chronic public inebriates. The Street Calls Program is staffed by FEMS paramedics that reach out to other DC government agencies, Hospitals and Healthcare providers to mitigate repeated use of 911.
In 2013, a Public Health Coordinator was hired to assist with program and case management.
Status: Complete
Title: Recommendation 5b
Action Item:
The Chief, in cooperation with other District agencies, shall develop and implement, no later than March 31, 2008, a public education program regarding appropriate use of the 911 system.
Progress:
FEMS has updated the campaign and is partnering with the Office of Unified Communications to distribute material to all District households on the proper use of 911 and 311.
Status: Complete
Title: Recommendation 5c
Action Item:
The Chief and the Director of the Office of Unified Communications shall, no later than December 31, 2008, collaborate to improve the 911/311 dispatch process so that call takers and dispatchers have improved training and enhanced ability to distinguish between emergency and non-emergency medical calls.
Progress:
The Office of Unified Communications (OUC) and the Fire & EMS Department are jointly implementing EMD-Q™ (Emergency Medical Dispatch Quality Assurance) and AQUA™ (Advanced Quality Assurance) for the Medical Priority Dispatch System (MPDS™). Certification for supervisory personnel at the OUC has been completed, and DC Fire & EMS and the OUC will continue to train additional personnel as needed to provide robust quality assurance of the medical call-taking and dispatch process.
Status: Complete
Title: Recommendation 5d
Action Item:
The Medical Director, with the support of the City Administrator shall, no later than November 20, 2007, establish and clarify roles and responsibilities for the Department and the Metropolitan Police Department for treatment of uninjured intoxicated patients and for transport of patients to the District's detoxification facility.
Progress:
More work in this area is needed. There are no current sobering centers that will accept patients from DCFEMS. All such patients are transported to area hospitals.
Status: Complete
Title: Recommendation 5e
Action Item:
Effective immediately, the Medical Director should exercise his full authority to order hospital emergency rooms within the District not to close to Department transports, and to require hospitals and medical providers to accept the transfer of care of a patient or patients within a specified period of time.
Progress:
A new Closure/Diversion policy was issued on June 12, 2008. This was developed with the active participation and endorsement of the hospital working group formed under Recommendation 5 (f).
Collaboration with the ED Leaders Meetings, attempts to mitigate delays in patientCurrent transfer. Hospital Closure is now a rare occurrence for extreme circumstances only and must be approved by the DC FEMS Medical Director. Numerous initiatives have been implemented in 2012 to strive for a less than 10 minute time until transfer of an EMS patient to hospital-owned equipment. Further metrics and initiative are needed in this area.
Status: Complete
Title: Recommendation 5f
Action Item:
The City Administrator shall, no later than November 20, 2007, convene a working group including hospital CEOs, DOH, and the Medical Director to meet quarterly to address and develop standards for drop times, diversion, and closure, and to improve procedures for tracking patient outcomes. The Medical Director should consider the results and recommendations of this group in exercising his discretion under the previous paragraph.
Progress:
Closure rarely occurs and requires DC FEMS Medical Director approval prior to a hospital closing to EMS units.
A drop-time reduction initiative was implemented in 2012 with collaboration with District Hospitals. Robust data management and reporting systems are being developed.
Special Order 2013-06 was implemented that enhances the tracking of Drop time intervals and provides an action plan to report and mitigate challenges with extended drop times in real.
Status: Complete
Title: Recommendation 5g
Action Item:
The Medical Director shall, no later than September 30, 2008, develop a procedure to authorize patients to be transported to a pre-approved clinic or other non-emergency medical facility, appropriate to the patient's need.
Progress:
Since the Task Force issued this recommendation, F&EMS has partnered with the Department of Health (DOH) to identify outpatient primary care medical facilities to serve as delivery points for patients with non-emergent conditions. At this time, however, there are very few facilities in the District that F&EMS can immediately bring non-emergent patients to when responding to a 911 call that may not necessarily merit transport to an emergency room. In the absence of such destinations, it is not yet feasible to implement the procedure called for by this recommendation, although doing so remains the long-term goal of F&EMS.
At present DC FEMS transport units may transport Police and Fire employees to the Police and Fire Clinic instead of a Hospital ER.
DC FEMS transport units are now able to transport pediatric psychiatric patients directly to Psychiatric Institute of Washington when emergency department assessment is not needed
Status: Incomplete
Title: Recommendation 5h
Action Item:
The Medical Director and the Director of the Department of Health shall develop and implement, no later than September 30, 2008, a system of alternative transportation options (such as scheduled van service, taxi vouchers, or MetroAccess vouchers), as well as protocols to refuse transport for non-urgent patients, when appropriate, subject to the authorization of a medical supervisor.
Progress:
The DC FEMS Patient Bill of Rights implemented in March 2011 specifically does not allow the Department to refuse transport by ambulance to those requesting service.
This policy change is in contrast to this recommendation at this time.
This should be removed or vigorously pursued.
Status: Complete