Ellerbe may be ahead of his time

DC FEMS Chief Kenneth Ellerbe unveiled a plan for EMS redistribution in the Nation’s Capital and it is getting some nasty comments online and from the local Firefighter’s Union.

I can’t necessarily comment on Ellerbe’s reasoning for his move, since I don’t know what it is, but I can tell you that he’s WAY ahead of his time.  I just think he doesn’t know it yet.

You see, DC FEMS will be down staffing ALS transport units from 0100 to 0700, a time when calls for service are drastically less than the daytime hours.  On the surface, it makes perfect sense.  Cut extra resources when they’re not needed.  If it can be done and still meet the demand for quality ALS transport, great.  If it can be done while still meeting all the guidelines set forth by the local EMS regulatory agencies, great.  (Now our UHU calculations come in handy, don’t they?)

But what happens when your calls for service are ALS?

Ellerbe’s answer is to staff up that ambulance for the transport with one of the 21-25 ALS engine resources and 7 ALS supervisor units.   That also makes sense, until that fire engine is doing something else, like already transporting an ALS patient.  Forget being on a fire or an alarm or rescue, these resources will be BLS as their extra member attends another transport.  now units are scrambling to pick up medics at hospitals or BLS ambulances are out returning medics to their company.

My agency could consider such a move in the future, but it will be doomed for failure because of the high call volume of seemingly ALS calls as defined by the local EMS regulatory agency.  Without decreasing the number of patients, we can’t decrease the number of transports.

If DC FEMS can also flex their ALS Supervisor resources to augment the system of transports, they will also soon run out and someone from the engine will need to return their buggy to the hospital or the BLS unit give them a ride back to their buggy parked back at the scene.  More time will be spent returning units than responding in many cases.


Ellerbe’s plan is ahead if it’s time, but as far as I’ve been able to find it will not be as efficient as it needs to be.

Why you ask?

Because it needs to be coupled to a “Respond Not Convey” program, or as we call it on the street, the Paramedic Initiated Refusal.  Refusing transport to certain patients who do not need it is the relief DC FEMS needs to better serve the population.  So long as every stubbed toe and runny nose that wants transport gets it, you will continue to have 4 person ALS engines or ALS supervisors at the scene of incidents waiting for an ambulance.  We call it “Medic to Follow” and it is the number one drain on our system. “But Happy, that’s a BLS run!” Not if they used the magic word “Chest pain” to get triaged faster.  And we all know that NEVER happens…right?


With the sudden interest in the Community Paramedic model, many systems will have to address the issue of Respond Not Convey if they want to increase services without increasing resources.  I would love nothing more than to deploy our fleet of ALS supervisors to handle community paramedicine, but we’re dealing with an increase in call volume and market share.  And we have less than HALF the amount of ALS supervisors DC FEMS deploys.


Ellerbe’s plan seems like a slap in the face to some, but I see it as a new way of deploying resources.  Thing is, it will work.  That is until a second call comes out.  Then a third, then a fourth and next thing you know Engine 99 is sitting on the curb IFO the clinic awaiting a second engine to respond with a medic so the BLS unit idling at the scene can transport.


Just a gentle reminder: These views are my own, not those of the SFFD, the City or any one else, just me.

cilais online

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6 thoughts on “Ellerbe may be ahead of his time”

  1. You make some seriously compelling points in this piece. This is something I’d like to discuss with you further via skype/phone/email/conch shell.

  2. I like the idea of getting als intercepts and als to the scene in that way, but i probably wouldnt delay transport to wait for als for chest pains. In a major city like that the hospitals are probably close enough that the als at the hospital is just as close as a medic. Then if you get a medic great if not just treat and transport.

  3. Not sure community paramedicine is ever going to happen in DC or even needed. Lots of hospitals well distributed – why expend the higher training, QI resources, legal and regulatory fights when already trained folks providing the same services are just down the street? Easier just to transport everyone (I would bet that the time spent to reasonably document your RNC is probably lengthier than most DC transport times). I’m not going to comment on Ellersbe’s motivations except to say that I don’t think his actions are motivated by a desire to improve his service or be progressive.

  4. EMS BC Al,
    I certainly agree about the intentions. This is looking at the bottom line, plain and simple, but as I said, it begs the question…why use the most expensive option transporting to the most expensive option if the patient doesn’t need it? We in SF are similar to DC in that we have 13 destination facilities in 49 square miles, yet transporting a patient to an overcrowded ED is not always the right answer. “Transport them all” is the easiest answer and appears to satisfy our definition of liability (pass the buck) but more options can only mean better outcomes. Not every line medic is ready for the future of EMS, not even every middle manager, but even just opening the dialogue can be beneficial.

    Thanks for reading and taking the time to comment.

  5. We have similar problems in the UK. We have Rapid Response Vehicles that respond to different jobs, dependent on past & predicted demand (Google ‘UK ambulance REAP’). We spend some time waiting for backup, although we do have the autonomy to discharge or refer down an alternative care pathway. We also have a clinical support desk in control to assist us with referrals.



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