Evolution of EMS
The DC Fire Department started providing medical services on October 15, 1928, with the addition of an ambulance to the Department’s first rescue squad. For the next 50 years, firefighters with first aid training staffed the city’s ambulances, but the focus was almost entirely on providing transportation of patients to hospitals, rather than providing pre-hospital patient care. In 1966, the federal report, Accidental Death and Disability: the Neglected Disease of Modern Society, also known as the White Paper, was published. It highlighted deficiencies in mobile medical care provided to motor vehicle accident patients; in response, jurisdictions around the country started building professional Emergency Medical Services (EMS) programs.
As part of this movement, and as EMS call volume continued to rise, in November 1974, the DC Fire Department started hiring non-firefighter “civilians” to staff the Emergency Ambulance Service (EAS). In early 1975, the first DC Emergency Medical Technician (EMT) class graduated and started staffing DCFD ambulances. In July 1976, the first DC paramedic ambulance started operating out of the Washington Hospital Center; it later transitioned to become a Department-run unit.
Immediately beginning with these early years of treating EMS as a discipline separate from firefighting, civilian EMTs and paramedics fought to be treated fairly within the strong fire-focused culture of the Department. Their pay and benefits were less than that of firefighters, the EMS budget often was curtailed in favor of the budget for fire suppression and technical rescue, and there was uneven and frequently unsupported medical leadership of EMS.
EMS Providers, Emergency Ambulance Bureau
Date: 1990s
Source: Chris Zervas Collection
Following a series of name changes and reorganizations of the EMS bureau, in 1990, the Department’s name finally changed to include what by then was 80 percent of its workload: the DC Fire and Emergency Medical Services Department. Going forward, all hires, including firefighters, were required to obtain EMT certification as a condition of employment. As the years progressed and the EMS call volume increased, the number of EMS units, personnel, and supervisors rose as well – but it was rarely sufficient to meet the call volume. During the District’s financial crisis in the 1990s, patients often waited an hour or more for ambulances and there were regular media stories of the harm caused to patients by both resource shortages and deficient patient care. Nonetheless, the Department’s EMS providers persevered to operate within a system that was culturally resistant to their service.
In the following decade, a gradual transition to operationally merging the two services began. In 1996, the Rapid Response program was launched as the first non-transport EMS response initiative. In the early 2000s, the Department adopted a paramedic engine company (PEC) model, with eventually 21 out of 33 engine companies having a paramedic assigned to the engine. This enabled critical patients to receive medical care as soon as the (usually) first responding engine company arrived, and while waiting for an ambulance, if transport to the hospital was required.
The below 2000 Special Order issued by then-Interim Fire and EMS Chief Thomas Tippett announced the introduction of a plan to accomplish a unified department; many of the steps outlined here framed DC’s EMS system as it exists today. As Chief Tippett said at the time, “We are the Fire and EMS Department. What we do over the next few months and years will make us function that way, not merely bear the name. None of us can let our attitudes – cherished, or old and comfortable, or even justified – stand in the way of our mission.”
Thomas Tippett served the DC Fire and EMS Department for 32 years before retiring at the rank of Interim Fire Chief in 2000 (he was never confirmed by the DC Council). Prior to entering the management ranks, he served as the President of Local 36 of the International Association of Firefighters for many years. He resigned as Interim Fire Chief after the financial control board refused to reinstate funding for the fifth person on the ladder truck and battalion chief aides, cuts that were followed by the death of three firefighters in fires between 1997 and 1999. In his resignation letter, he said, "I have made a solemn promise to the firefighters of this city and to their families that I would do everything in my power to improve safety and not unnecessarily place my employees in harm's way. Therefore, I cannot in good faith carry out the directive."
Nonetheless, deficiencies in the Department’s provision of EMS remained. A transformative moment arrived in 2007 in the form of a settlement agreement with the family of David Rosenbaum, who tragically died after being robbed and assaulted and receiving substandard care from the Department and the treating hospital. The settlement agreement required that Mayor Adrian Fenty convene a Task Force on EMS and implement its recommendations. One of the most pivotal recommendations was to unify the workforce by hiring only Firefighter EMTs and Firefighter Paramedics. Prospectively, all employees would have the same all hazards training, schedule, union, pay, and benefits.
David Rosenbaum
Date: 2000s
Source: © New York Times
Over the next 15 years, the Task Force recommendations were implemented in fits and starts. Thanks to the hard work of Department personnel, strong leadership, and the financial and policy investment of the Mayor and Council, today the DC Fire and EMS Department is one of the best-performing and most innovative EMS agencies in the country. In 2023, DC tied with Washington state for the highest survival rate among those sudden cardiac arrest cases where EMS is most likely to impact the patient’s outcome. The Department’s Right Care, Right Now Nurse Triage Line and Whole Blood programs are changing the national landscape of pre-hospital medicine.
Even with this progress, challenges in DC EMS remain and there will always be room for improvement. The evolution of EMS throughout the Department’s history offers lessons for any leader trying to effect change. It is also a cautionary tale that progress in this life-saving service should never be taken for granted.
Miracle on Missouri Avenue
On August 30, 1988, fire ripped through a house on Missouri Avenue, NW. The DC Fire Department rescued four people, including three children who were sleeping when the fire started. Tragically, two of the victims died. But the firefighters, EMTs, and paramedics, including DC paramedic Wilmer Scott, were able to save two of the children, Jackie Kotei and her cousin. These rescues were a morale lift for the Department, which at the time was the subject of relentless negative media coverage of its operations, especially in EMS. Sheldon Levy captured award-winning footage of the rescues that was then featured on the following episode of Rescue 911, hosted by William Shatner:
WUSA9 caught up with Jackie Kotei 36 years later:
Chris Zervas
Chris Zervas, a retired EMS Captain, was born on Long Island, New York, and raised in Brooklyn. Following his active service in the U.S. Army during the Vietnam War Era, where he was trained and served as a photographer, he briefly pursued a career in photojournalism. In 1973, Zervas became one of the first New York State certified Emergency Medical Technicians (EMTs) within the New York City EMS system, marking the beginning of a long and distinguished career in emergency services. He relocated to Washington, D.C., where he completed his undergraduate degree at American University. In 1978, Zervas joined the DC Fire Department as an EMT, just as the department was in the early stages of modernizing its EMS operations. He then became a Nationally Registered Paramedic and Sector Supervisor. Over the years, he held various assignments, including serving as a field EMS provider stationed at Engines 21, 1, 6, and as an EMS Sector Supervisor.
Throughout his career, Zervas was deeply committed to improving the working conditions, pay, and benefits for EMS personnel, as well as enhancing patient care. He did so by contributing to the development of career ladders and expanded position descriptions for both the EMS and Communication personnel, and assisting with creation of paper and ultimately electronic patient care reports, improved work schedules, organizational performance evaluations, data analysis processes, unit deployment strategies, and enhanced supervisory and management practices.
Zervas briefly served as the first non-uniform Deputy Chief of EMS during the tenure of Interim Fire Chief Thomas Tippett, providing leadership during a turbulent transitional period in the Department. In addition to his operational and administrative work, Zervas co-founded the Association of Pre-Hospital Emergency Medical Practitioners (APHEMP) along with Paramedic Jeff Goldstein. Recognizing the need to acknowledge and celebrate the achievements of EMS personnel, Zervas and Goldstein collaborated with AFGE Local 3127 leadership to co-host annual award ceremonies for EMS professionals, because at that time the DCFD Medals of Honor and Valor were exclusively for firefighters.
After over 35 years of service, Zervas retired in 2014 at the rank of EMS Captain. He has played a pivotal role in preserving the history of EMS in Washington, DC and we are very grateful for his contribution of photos, documents, and memories to this project.
Rafael Sa’adah
Rafael Sa’adah grew up traveling around the world following his father’s Army career. His family first moved to DC in 1968, after his father returned from a year serving in Vietnam. Sa’adah attended Shepherd Park Elementary School for four years and has maintained deep ties to the Shepherd Park neighborhood ever since, including serving for many years as a board member of the Shepherd Park Citizens Association.
Sa’adah began his public safety career in 1989 as a volunteer Emergency Medical Technician (EMT) for the Bethesda-Chevy Chase Rescue Squad (BCCRS). He received his EMT certificate from Georgetown University and his Paramedic (EMT-P) certificate from the George Washington University. He joined the DC Fire and EMS Department as a Firefighter EMT in 1991, assigned to Engine 30 in Northeast. His experience working at Engine 30 during historically high rates of EMS demand and community trauma had a formative impact on how he would approach the reform of the District’s EMS system, a passion for the rest of his career. Sa’adah was assigned to Rescue Squad 2, a city-wide technical rescue unit, in 1995 and also served on the Metropolitan Medical Strike Team (MMST), the Department’s Critical Incident Stress Debriefing (CISD) Team, and as a paramedic instructor in the George Washington University EMS Degree Program. As a sergeant, he was assigned to the 3rd, 4th, and 5th battalions, and then to the Training Academy where he was lead recruit training instructor.
In the early 2000s, during the administration of Mayor Anthony Williams, then-Lieutenant Sa’adah was detailed to the Office of the City Administrator twice – once to help implement a performance-based strategic planning and budgeting process for the city, and a second time to act as the chief of staff to Deputy Mayor for Public Safety and Justice Margret Nedelkoff Kellems. He has served on numerous boards and committees in the District, including the DC Council Committee on Public Safety and the Judiciary’s EMS Commission, and as Co-Chair of the Domestic Violence Fatality Review Committee. As the Assistant Fire Chief of EMS, he was tasked with implementing the recommendations of the Task Force on EMS that came out of the city’s legal settlement with the family of David Rosenbaum, work that resulted in his receiving the prestigious James O. Page Leadership Award from the Journal of Emergency Medical Services (JEMS). Sa’adah has a bachelor’s degree in fire science, a master’s degree in public administration, and a juris doctor degree, all from the University of the District of Columbia. He retired from the Department in 2018 as the Deputy Fire Chief of Training.
DC EMS in the 1990/early 2000s
This video shows the chaotic working conditions of the 1990s in DC streets. The scene was a result of a car chase and shooting spree that left two people dead and many injured. In this video you see firefighters, rescue squads, EMS, and law enforcement all working together.
This video shows the response to a fire in a group home for the elderly on August 16, 2001. One resident was dead on arrival and seven residents were rescued. This scene demonstrates how EMS crews often must deliver life-saving care on par with treatment in hospital emergency departments but on the streets of the District, triaging and treating patients on sidewalks and stoops. This content may be disturbing for some viewers and is only for mature audiences.
