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Sarah Godfrey’s story “The Sounds of Sirens” (6/29) leaves readers with the impression that ambulance diversion from emergency rooms is somehow dangerous and that the mayor’s new health-care plan for the city’s most disadvantaged is experiencing an “awkward transition.” This is inaccurate, and her use of the case of the young man shot at RFK Stadium to illustrate her point is an egregious distortion that requires comment.

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As pointed out in the article, emergency-room closure and diversion are common occurrences both here and nationally and are the result of increasing use of emergency rooms for many nonemergency cases. In D.C., and in most cities, the result is to merely go to the next closest open hospital emergency room. D.C. has an extensive array of hospitals, and there has been no adverse outcome documented as a result of the closure of hospital beds at D.C. General. The full-service emergency room continues to operate 24 hours a day, seven days a week. Survival from critical illness and trauma is directly related to how rapidly emergency procedures are implemented to support breathing, by getting emergency personnel to the scene as quickly as possible. Published data indicate that trauma survival is also related to the number of cases the trauma center handles—the more one does, the better it gets at it.

The transition to the new HealthCare Alliance has proceeded quite smoothly over the past two months. Under the supervision of the D.C. Department of Health, the D.C. HealthCare Alliance partners (Greater Southeast, Unity Health Care, Chartered Health Care, Children’s Hospital, and George Washington University Hospital) are implementing an integrated system of care that will soon be a credit to this city, its residents, and its mayor. While there are daily challenges to be resolved, the Department of Health and the D.C. HealthCare Alliance are responding expeditiously and professionally.

Finally, it must be understood that, unfortunately, not every victim of an illness or traumatic injury will live. In the instance cited in the article, the young man had a fatal gunshot wound to the chest and cardiopulmonary resuscitation (CPR) was started at the scene—which is an ominous sign. Emergency personnel arrived within a few minutes and found the victim to have no pulse or blood pressure and not breathing. He was clinically dead at the scene. Emergency Medical Services procedures require that once CPR has been instituted, it must be continued until the victim is pronounced dead by a physician. In this instance, that protocol was followed, and the young man was pronounced dead on arrival at Howard University Hospital. To imply that this was in any way related to the D.C. General Hospital transition or the readiness of its emergency room is a great disservice to this community and only increases the fear and negativity that too much demagoguery has already fostered.

Senior Deputy Director for Medical Affairs

D.C. Department of Health

Fernando Daniels, M.D.

Medical Director

D.C. Fire and Emergency Medical Services