EMS system found deficient
Study cites 'negative culture'
By Jacinthia Jones

February 16, 2005

The Memphis Fire Department suffers from a "negative culture" that has resulted in the deterioration of the city's Emergency Medical Service system, a new assessment has concluded.

The study, released to the City Council on Tuesday, describes a department that for years has valued fire-fighting skills over its ability to effectively deliver emergency medical service.

The study found a lack of supervision over medical services, little or no continuous education for paramedics, longer-than-average response times for emergency calls and virtually no quality measurements in place to ensure standards are being met.

"In order to address the challenges, ... a top-to-bottom cultural attitude change toward EMS needs to take place within the fire department," reviewers concluded.

The study was conducted by The Ludwig Group, LLC, a Missouri-based consulting firm. The 108-page report noted numerous deficiencies in the EMS system.

Nearly 80 percent of calls to the fire department are requests for emergency medical services -- the department answered 91,620 EMS calls compared to 28,315 fire runs last year -- yet there is no EMS supervisor on staff. Fire battalion chiefs investigate medical claims, even though they have no medical expertise, said consultant Gary Ludwig.

Additionally, he said, beyond the physical testing, paramedics are hired with little or no competency-based screening to weed out individuals who are deficient in certain areas.

And he said quality management is done after the fact and then only in cases involving cardiac arrests, which account for just 2 percent of the department's medical calls. "You need to get paramedics remedial training, if necessary, before there is a death," Ludwig said.

As evidence of the problem, Ludwig pointed to four major lawsuits against the city, three of which involve patient-care deaths. "That's well above the norm," Ludwig said. For comparison, he said that the fire department in Brooklyn, N.Y., didn't have a single lawsuit concerning patient care over an 8-year period.

City Council member Jack Sammons criticized previous fire department leadership for failing to meet quality standards. "Perhaps it should be changed to the Division of Fire and Emergency Medical Services ... to send the message that this is a vital part of the fire department," Sammons said.

Fire director Richard Arwood acknowledged the problems Tuesday and said the department is searching for a new EMS deputy chief. He expects to name that person in the next 60 days.

Additionally, Arwood said the department is beefing up its staffing to help relieve overworked paramedics. And he said the officials will have to do some public education so that citizens "don't call us because they need a ride to the doctor."

But Arwood said it would take an additional $1.7 million to fully implement all recommendations.