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Emergency Medical Services Bureau
Fernando Daniels, III, M.D.
District of Columbia Hospital Closure Memorandum
September 15, 2000




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Government of the District of Columbia

TO: Department: Fire/EMS
Agency, Office: EMS Bureau
FROM: Fernando Daniels, III, M.D.
Medical Director
Date: September 15, 2000

SUBJECT: District of Columbia Hospital Closure

The District of Columbia Fire and Emergency Medical Services Department (DCFEMSD) has been tasked with providing an estimate of the cost that would be incurred if D.C General Hospital were to close. This task is undertaken assuming that DCFEMSD would continue providing the same level of quality care and transportation for our 911 customers.

On March 26, 2000 DCFEMSD redeployed its Emergency Medical Service EMS) fleet for the entire city. Through the redeployment plan and other innovations a reduction in response time, during this fiscal year, of approximately four (4) minutes, to critical calls 90% of the time was realized. In areas east of the Anacostia EMS transportation units are averaging six (6) responses within a twelve (12) hour shift.

With the closure of D.C. General, it is important that the DCFEMSD continue striving towards its goal to arrive at the scene of critical calls within eight (8) minutes ninety (90) percent of the time. With this in mind a preliminary study of data available for the preceding nineteen (19) months was reviewed.

The recommendation for additional resources is based on the remaining hospitals availability to receive patients and release DCFEMSD units in a timely manner.

Statistics for July 2000 indicate that Hospitals were either on closure or diversion for a significant amount of time. Closure or diversion time has a dramatic impact on response time.

Some examples of hospital closure or diversion for the month July 2000 are listed below:

Hospital Closure or Diversion Hours
Greater Southeast 8.5
Medstar 16
D.C. General 15.4
Providence 64
Sibley 42

The method used to make a recommendation was to identify the transports to D.C. General by Census Tracts (the darker the shade, in the color exhibit, the greater the number of transports). In an effort to determine the additional time required to transport from the same census tract to hospitals other than D. C. General exhibit 3 was developed. Exhibit 3 identifies census tracts and the additional time it took, on average, to transport from that census tracts and the additional time it took, on average, to transport from that census tract to a hospital other than D.C. General. Using this analogy, on average, it will take approximately four and one half (4½) additional minutes to transport from the census tracts identified to a facility other than D.C. General.

With the average figure of 4½ additional transport minutes, assuming hospitals are not on diversion or closure and able to release transport units in a timely manner additional consideration must be given for the time it takes the unit to return to its regular geographical area, in a non-response mode, approximately nine (9) minutes. Exhibit 4 illustrates time differences in transporting to hospitals other than D. C. General. The darker the shade the more time that is required. The following recommendation is for your review.

Five additional Advanced Life Support (ALS) units 24 hours a day 7 days a week for 365 days. Costs includes initial start up cost in the following areas vehicles, supplies radios, telephones, salaries $ 3,742,265.00
Two additional Supervisors positions (8 people) 500,000.00
One additional evaluator 62,500.00
One additional training instructor 62,500.00
One additional field training officer 62,500.00
Annual fuel usage $5,000.00
TOTAL $ 4,434,665.00

The issue of inter-facility transports, if added as a responsibility to DCFEMSD will require additional resources.

The following contingency plan addresses the areas of patient evacuation and EMS operations in the event that D. C. General Hospital closes with limited prior notice.

Patient Evacuation:

This addresses the EMS Bureau's role and responsibilities for patient evacuation:


  1. Loading Group
    1. Coordinate patient order with DCGH staff.
    2. Provide patient name and room number to transport units as they arrive
    3. Confirm patient loading with tracking identifier (Triage Tags).
  2. Transport Group
    1. Meet with Loading Group Officer to obtain patient name and room.
    2. Meet with attending nurse to obtain report.
    3. Transfer patient to transport stretcher and proceed to loading area.
    4. Check with Loading Group Officer at time of loading to ensure tracking.
    5. Transport patient to designated receiving facility.
    6. Directions will be given to transport unit of patient designation, i.e.; ER, room number or receiving point of contact (POC).
    7. Contact receiving POC upon arrival and obtain destination location.
    8. Transfer patient to proper location and provide report to receiving nurse.
    9. Transfer paperwork.
    10. Return to DCGH for next assignment (Loading Officer)


The EMS Bureau will maintain a twenty four (24) hour presence at DCGH until all patients have been evacuated and transferred. EMS command and control will be staffed by senior EMS Officers and will operate in twelve (12) hour shifts.

Incident Commander: Located in the command

Loading Group Officer: Located in ER (Forward Command)

Transport Group Officer: Floor to Floor

Loading and Transport Officer responsibilities may be shared with outside entities, i.e.: PGFD, private ambulances, military, etc.


Two (2) additional transport units will be placed in service for patient transfers. Two (2) units will be held in service at the ER for walk up patients that need to be transferred; These units may remain on site 24/7 for an extended period of time. These units will be placed in service in the D.C. General catchment area that will be placed in a system status management basis.

Portable radios will be needed and used for communications between all groups.

Triage Tags

Patient Tracking Log Sheets

Notification Procedures:

When notification is made to the EMS Bureau of closure, the following actions will occur:

The on-duty Chief Supervisor notifies the on-duty Watch Commander to place DCGH on closure.

The Chief Supervisor notifies the Sector Supervisors, Senior Staff and Special Operations of the closure

System Status Management (SSM) may be implemented for increased coverage in Wards 6, 7, 8.

Special Operations will notify the Equipment Repair staff at E-6 to ready five reserve units. Depending on time, the Special Event Units will be utilized.

Special Operations will notify Medical Supply for additional equipment and supplies as needed.

The Staffing Specialist will start calling off duty members to staff these additional units.

Operations Plan:

The possible closure of DCGH will severely affect how the EMS Bureau and Communication Division routes patients from the far NE/SE quadrants of the city, especially east of the Anacostia River. The impacts on daily operations include, but not limited to;

  1. Possible longer transports to other available facilities.
  2. Increased utilization of P. G. General Hospital.
  3. Increased utilization of helicopter transports.
  4. Longer down times at receiving facilities.
  5. Increased reroute and/or closure requests from existing available facilities.
  6. Decreased unit availability due to longer transport times and facility back ups.
  7. Increased scene time for 1st Responders waiting for available units.
  8. Prisoner transports.

Transport Guidelines:

1. All unstable code 1 patients east of the Anacostia River, within the boundaries of Pennsylvania, Eastern, Southern, and Kenilworrh Avenues are to be transported to appropriate available hospital.

2. All unstable code 1 patients east of the Anacostia River and south of Pennsylvania Avenue are to be transported to the closest appropriate District Hospital. Medivac transportation of unstable code 1 major trauma patients must be considered.

3. All code 2 & 3 patients east of the Anacostia River are to be transported to the closest appropriate District Hospital.

Currently, EMS providers are making decisions where to transport based upon protocol transportation criteria. Because of the possibility of DCGH closing, this practice must temporary cease.

The Communications Division in conjunction with the EMS Bureau must play a role in directing units with code 2 & 3 patients to hospitals that are not backed up. This will help evenly control the flow of patients and assist in lowering additional down time problems, with special attention placed on hospital utilization in the northwest quadrant of the city. This will also help evenly distribute the influx of patients coming from areas of the city normally served by DCGH, especially code 1 patients to other facilities within the system.

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