We know D.C. Get our free newsletter to stay in the know.
When the green light flashes at Engine Company 22, on Georgia Avenue NW in Shepherd Park, Captain James Gordon, better known as Gordo, climbs into the black seat of Truck 11, the 40-foot ladder truck. Technician Mike Murphy climbs into the driver’s seat and they head toward the emergency. Murphy competed for the driver position at the station, a role he’s wanted since boyhood, when a rusty abandoned fire truck at Turkey Thicket Park sparked a dream.
Now the front cab of Truck 11 is real, and, like the fire station, a second home, one that Murphy shares with Gordo—a cockpit of mounted laptops, headphones, radio systems, flashlights, and a fire helmet. A heavy black coat, within reach when jumping in the truck, hangs on Gordo’s door.
Driving a 20-ton truck down thin urban avenues requires not just grace and technical skill, but a photographic memory. To earn the job, Murphy, then 28, drove the streets surrounding the station on his days off. He also got out and walked them. Addresses, alleyways, and “problem spots” that could blow up in flame—old churches, industrial wastelands—burrowed into his memory. Neighborhood familiarization, as this memorization is called, strengthens through nightly flash cards, so that how to get there is ultimately the last thing on a driver’s mind when the green light flashes.
It was surprising, then, two years ago, when Murphy was called to an address he had never heard of before. And to arrive and not see a house at all, let alone a person who had called with an emergency.
“Is there a house here?” he asked Gordo, surveying the lot of overgrown trees. “How is someone living here?”
Then, as the pair made their way beneath the overgrowth, a house and an address emerged, and inside, an elderly man who had been “living destitute for years to get this way,” Murphy says. “The guy was like, ‘I don’t need help.’” But clearly he did, and now that he had summoned the nerve to call 911 and the firefighters had responded, “then it becomes like, now I am going to call every day,” says Murphy.
There is no resignation or annoyance in his voice, but empathy.
Such is the role of firefighters increasingly in U.S. cities like D.C., as home and structural fires diminish, and senior caregiving needs escalate.
In 2017, only 4 percent of calls that firefighters responded to involved actual fires, according to the National Fire Protection Association. The vast majority of calls—80 percent in Washington, D.C. in 2020, for example—are for medical emergencies. Many times, an old person has fallen and can’t get up (a “lift assist,” in firefighter-speak). In 2020, the DC Fire and EMS Department performed nearly 4,000 lift assists, an average of 10 per day. In plain English: Firefighters spend a surprising amount of time picking our parents and grandparents up off the ground.
With the U.S. in the grips of a caregiving crisis, as 10,000 Americans daily turn 65, and aides are not only in short supply but often prohibitively expensive, are firefighters such as Murphy and Gordo becoming short-term senior caregivers on wheels?
When we think of fires, we often think of men in heavy beige coats standing before orange plumes swallowing the American West. But starting in the late 1970s, fires in the U.S. began to plummet, thanks to decades of prevention education, improved building regulations (think: sprinklers), and fire-resistant technology. Today, you are infinitely more likely to get hit by a car, felled by a gun, or drown in a pool than become engulfed in flames in your kitchen.
Some bad news, amid the good: When fires do occur, they are much worse, due to today’s building materials—primarily plastic—which serve as fuel. As a result, says Gordo, fires burn hotter and quicker. Fewer fires are breaking out but the ones that do are higher risk and hungrier. (One needs only to look at the tragic, ferocious blazes at Kennedy Street NW in 2019 and G Street SW this year, as examples. Truck 11 was the first ladder truck on the scene at the Kennedy Street blaze.)
The decline of fires coincided with the rise in paramedicine. The Vietnam War taught us that minutes matter; that a roving medic in a rolling truck can save a life. Many urban fire departments, no longer burdened by the nonstop work of actual fires, began filling the demand for 911 emergency calls in the 1980s by cross-training members as emergency service personnel and paramedics. This resolved two pressure points: municipalities that wanted to keep their force active and a union that wanted to keep members.
A hit TV show in the 1970s, Emergency!, ushered into U.S. living rooms the idea that paramedics—specifically, a hybrid ambulance-fire service—could soon be caring for you, when disaster strikes. (John Travolta had his first acting credit on the show, as a teenage hiker who falls off a cliff and bloodies his head. A fire truck careens up the canyon to save him.)
Since 1987, all D.C. firefighters have been required to train as EMTs. Twelve percent of uniformed members are trained paramedics, and D.C. Fire and EMS seeks out paramedics heavily in its recruitment. They’re “fast-tracked,” says FEMS public information officer Vito Maggioli, in part because they have more training. EMTs average around 150 to 200 training hours, whereas paramedics average 1,000 to 2,000 hours or more. Both are equipped for life-threatening emergencies, but paramedics can provide more complex care and make medical decisions, whereas EMTs provide basic patient care and medical transport. All D.C. firefighters are essentially health-care workers, in this sense. And since the calamities an urban firefighter might face range from car accidents to terrorist attacks, fires, heart attacks, kids stuck in trees, toxic chemical spills, lift assists, baby deliveries, and many others qualms, urban departments like D.C. and L.A. are considered “all-hazards” forces, trained for any manner of emergency.
In D.C., since firefighters are trained as EMTs and paramedics and are usually closest to the emergency, they often arrive first after a 911 call is placed. If it’s life-threatening, FEMS aims to have an EMT arrive in four to six minutes. The call taker at the Office of Unified Communications follows a specific protocol, asking a series of questions: Is this a medical emergency, a fire, or a police problem? What is the address? Is the patient awake? Are they breathing? Based on the answers, a code recommends the exact emergency response team to be dispatched, by the severity and geography of the call.
We may still think of firefighters as doing fire-related activities, but the closer definition might be problem-solver, says Gordo. They’re in the business of solving your problem, and the reason most people call, he says, is that they have a problem and “they just don’t know who else to call.” One firefighter described the role as “general responder,” the “everyman of emergency medical workers.” Many described their work as going into the “unknown,” a murky situation that can be impossible to navigate.
The emergency that many are now navigating is elder care. Chase Lambert, 35, is a San Francisco Bay Area firefighter and part of the younger generation of firefighters who came to the job as paramedics, after first working in ambulances. He understands the job now involves responding to elderly calls related to respiratory and heart issues, dementia, and diabetes. He estimates that 40 percent of the calls his department responds to involve elderly residents. He checks their blood pressure, pulse, and uses a cardiac monitor; for diabetics, he checks blood sugar, and, if necessary, administers an IV. If this sounds like the domain of a nurse or health-care clinician, it usually is. He talks with them, since many are lonely. “Sometimes you can tell they want us to hang out. You can tell it’s hard being alone,” he says. If this sounds like bedside manner, it is that, too.
Susan Braedley, a professor of social work at Canada’s Carleton University who has spent 3,000 hours in fire stations and riding along in firetrucks and wrote her dissertation on firefighters, says firefighters are “being hauled into the care economy.” More than half of the calls she went on involved elderly residents, she says. Canada’s EMS system resembles the one in the U.S., and shifted to paramedicine soon after the U.S. did, in the 1990s.
The most common call was from someone who had slipped off the toilet and become wedged between the toilet and the bathtub. Some had been there for a day or longer, she says. The firefighters were called by frantic family members who couldn’t reach their loved one, and they performed lift assists. The calls had several things in common: Those in need were elderly, often isolated, often poor, and typically men.
“I’ve fallen and I can’t get up” became a catchphrase in the late 1980s and originates from a commercial for the medical alert company LifeCall, in which an elderly woman on the bathroom floor speaks into a necklace, alerting a dispatcher to her predicament. The line quickly became a punchline, but captured the phenomenon that elderly Americans were facing—they were living longer and living alone. D.C.’s elderly population grew to 80,000 in 2016, a 30 percent increase in just 11 years. Nearly 60 percent of elderly adults in the District live alone, significantly higher than the national average.
The sheer number of elderly people in the United States has skyrocketed to nearly 50 million, a 100 percent increase since 1950. And more than in any other country in the world, older Americans live alone, which poses severe health risks: increased falls, isolation, and chronic conditions worsened by missed doctor’s appointments.
According to a Kaiser Family Foundation brief published in February 2020, nearly a million seniors on Medicaid are on waiting lists for a home health aide. The average cost for a home health aide in D.C. is $64,000 annually. Family members try to fill this gap, but today’s family caregivers, who are predominantly women, are also working: 60 percent have jobs. Medicare covers a home health aide only for acute care, such as recovering from surgery, and usually for only 60 days.
The unknown that firefighters are increasingly entering, the problems they are asked to “solve,” can be a gray area: Who is responsible for the elderly when caregivers are not affordable and not covered by Medicare or Medicaid, and family members are working? Who will pick you up when you fall? Firefighters entered a job intending to douse flames yet learn that one of the most important skills is how to talk to an elderly person alone on a bathroom floor.
One truth about working in a firehouse is that it is part house—food needs to be bought, cooked, eaten; the place needs to be cleaned up; everybody sleeps there—and another is that it is an approximate family. Murphy and Gordo drive Truck 11 to the nearby Safeway to check for sales, steak and shrimp specials, roasts, spaghetti—enough to feed the firehouse three meals a day and extend leftovers to the next shift.
Murphy and Gordo grew up around D.C—Murphy in Brookland and Gordo in Fort Belvoir—and dreamed of becoming big city firefighters. For Murphy, it was D.C. or nothing; he wanted to give back to the city that raised him. For Gordo, his awe for fire trucks began at 9, after accidentally igniting a lamp at his home and watching the engines arrive. A fire prevention class, taken as punishment, only fanned the flames of this spark. (After working together for five years at Engine 22, Gordo was promoted to battalion chief, Third Battalion, based in Anacostia, in January.)
Working 24-7 is a frequent complaint of American life and employment in a wired age. Murphy and Gordo work a 24-72: a 24-hour shift followed by three days off. A shift, called a “tour,” begins and ends at 7 a.m.
On days off, they fish and talk on the phone about firehouse projects; with all this togetherness, Gordo quips that his wife is slightly jealous of Murphy. But they’ve created a family, Gordo says. “I spent a quarter of my life with these people. If the roof blows off my house tomorrow night, the guys will be there to put a new roof on.”
It also stands in contrast to the solitariness of the elderly residents they visit when they drive Truck 11 to solve problems in the neighborhood. Often the elderly residents are alone, says Gordo. “That’s why we’re doing it,” he says, adding that most lack aides and regular family visitors. “It seemed like people weren’t being looked after.”
John Donnelly, Chief of the DC FEMS, noted, “They’re not calling us because they have other options. We’re the front line of health care for a lot of people.”
The problems for the residents of Shepherd Park range from faulty air-conditioning to carbon monoxide and gas leaks, from food burning on a neighbor’s stove to actual fires. A fire could occur a few times a week, or once a month.
What happens every day, once a tour, is a lift assist, Murphy says. Shepherd Park is a historically middle-class, predominantly African American neighborhood with a large elderly population. Many residents have lived here for generations, bought their first house and lived in it for 60 years. With that comes pride. “When we show up, it’s a realization that they no longer control a part of their life,” Murphy says.
They often witness extreme vulnerability—an elderly person alone on a bathroom floor for 12 hours or more. They use the bedside manner that Lambert spoke of, developed from years of helping seniors in decline. “If you walk in, and appear shocked, imagine how you are making that person feel,” says Murphy. Many residents apologize, feeling as if they’ve failed in some way. To which Murphy says, “It’s OK, I got you, darlin’. We’ll just help you up here.” They haven’t failed. They’ve simply grown old.
“We all have parents or grandparents, right?” adds Gordo. “My attitude is, we’re going to treat them the way we want our parents to be treated.”
So, en route to Safeway, two years ago, they drove Truck 11 to carry a wheelchair-bound woman in her 80s down two sets of stairs, twice a day, three times a week, for a year. She was recovering from surgery, and had no way of getting down her front stairs to the Metro Access van that would transport her to rehab appointments. In the afternoon, they would return to carry her back up the stairs. “We’ve had a few addresses that we’ve run every day, nonstop for years,” Murphy says. This was one.
The woman eventually exchanged phone numbers with the firefighters at Engine 22, so they could plan their day to include this run. “We went through the entire process—how can we make it so we’re not sending a fire truck to this address?” Gordo says. “Because it’s a big, expensive piece of machinery. It’s not the best option that the city has.”
Some fire departments are experimenting with sending SUVs to medical calls, for just this reason. What if a fire were to break out when the ladder truck was tied up? A truck from the neighboring battalion would have to be sent, and if fires burn hotter and quicker, doesn’t every second count to get there and douse it?
But sometimes they’re the solution, after running it up the chain of city options. As the woman continued to call regularly, Engine 22 referred the case to Street Calls, a division within FEMS that coordinates home-based support and interventions, founded in 2008 to address nonurgent, frequent 911 callers. Solutions come down to the caller’s insurance type, but also what sort of apartment they live in, and whether they are able to move, says FEMS Captain Lakisha Lacey, operations manager for Street Calls. Many real-estate management companies are not obligated to install ramps or make property alterations for renters who are elderly or disabled, she says. “We are the fall back” for elderly who call in need.
“It came down to—we are the default agency for the city sometimes, when there is no other solution. She didn’t qualify to be able to move into another apartment building, or another one in that building, where she would have walk-out access,” Gordo says.
It’s a problem across geographic and economic lines in D.C., Maryland, and Virginia.
“There’s one on every street,” says Aaron Webster, a captain with Bethesda-Chevy Chase Rescue Squad, waving an arm at the surrounding Bethesda neighborhood and referring to a house with an elderly person in it, who regularly calls 911. The elderly alcoholic couple. The hoarder. The man living alone, whose wife died and who, due to pride or income, does not believe he needs a caregiver, or anyone else, for that matter, to help him.
The young volunteers of the squad gather at dusk with plastic takeout boxes around a picnic table. At 11 p.m., they’ll try to get some sleep in the station bunk room as they wait for night calls.
Mark Andersen, a co-founder of the punk activist organization Positive Force and co-director of We Are Family, a senior outreach organization in D.C. that pairs seniors who live alone with volunteers who visit them, thinks firefighters should not be doing this work. Not because elderly residents are not in real danger—he knows they are. And not because he hasn’t seen firefighters handle with extreme grace and patience many extreme emergencies involving the one thousand low-income seniors he works with monthly. But it shouldn’t come to this, to an emergency, to receive care—there should be home health aides, he says. At the least, there should be “chore aides,” to fetch basic necessities and check on safety.
Andersen is thinking of Ms. Jackson, the 90-year-old woman who said “no, no, no” behind her apartment door for three months, as he pleaded on the other side for entry. She had not been seen at St. Augustine, the historically Black Catholic church on V Street NW, for weeks, had not eaten, and was fearful that whoever was on the other side of the door would send her to a nursing home.
Sister Alma noticed her absence in the pews and attributed it to Ms. Jackson’s blindness and increasing paranoia. She asked Andersen, who is known in the neighborhood as a trusted resource, to check on her. He slowly won her trust from the hallway, until one day, that trust disappeared, and fearing for her safety, he called 911.
A routine developed—Ms. Jackson began falling almost daily, and the firefighters and EMTs were called to lift her. They would ask to transport her to a hospital, and she refused. Part of it was paranoia, Andersen says, which could have been treated had services reached her earlier.
“Finally, we just accepted that the only way she would get taken to the hospital was when it got so bad that she passed out on the floor and couldn’t refuse to go,” Andersen says. After about a week, Andersen couldn’t reach her, the building management let him in, they found her unconscious, and he called 911.
Six firefighter-EMTs and two civilian EMTs soon joined him on the 10th floor of the brown stucco subsidized senior apartment building, and Ms. Jackson was taken to the hospital.
But he doesn’t see this in the rescue TV show, save-the-day sense.
The firefighters were very patient, very caring, but they shouldn’t have been needed, says Andersen. “There should have been in-home medical support—folks paid to be watching over her,” he says.
His organization is committed to reaching seniors pre-emergency, but it’s a lonely fight. President Joe Biden’s Build Back Better initiative will help by sending more than $1 billion in grants to support direct care workers, including nurse aides and home health aides for seniors. Without regular caregivers, outreach groups such as We Are Family pose a radical idea: Your neighbor is your family.
This is an idea D.C. Fire and EMS Department Chief John Donnelly echoes. “If you have an elderly neighbor, everybody should be looking out for them,” he says. “It takes a community for you to raise a child. It also takes a community for you to age in place.”
Perhaps the word to best describe urban firefighters is “eyewitness.” They are unique, frontline eyes into elderly homes that “police would need a search warrant for,” Michael Dolinger, a D.C. firefighter, says. They see whose isolation has become perilous, who is just barely getting by.
This reimagining of the firefighter’s role is necessary, says Erik Blutinger, an emergency medicine physician who regularly interacts with firefighters in New York hospitals. “Firefighters are perceived as some of the heroes of our society, and if there was a way [of] harnessing their public image and going on some kind of media campaign illustrating what they are seeing, I think that may educate policy makers on the need for more community help.”
Firefighters, in the public imagination, are brothers bound by the commitment to put their lives on the line for each other, Gordo says. They’re heroes, bounding into the fiery World Trade Center, and working atop “the Pile,” a heap of smoldering steel, for months afterward. Every autumn, they are “smokejumpers,” quelling wildfire infernos burning in the west. And they are also senior caregivers, and will be stretched in this capacity as the elderly population in America grows to 90 million by 2050.
Elder-care experts emphasize the importance of aging in place to preserve dignity and agency. Most seniors want to—and do—live at home as they age. But what it takes is other people, something John Dunne knew, in 1623:
No man is an island
Entire of itself
Every man is a piece of the continent
A part of the main.
This is where the elderly residents of not just Shepherd Park, but all of D.C. and much of the nation, are in trouble. For them, Build Back Better, and anything to improve access to home aides, would be a much-needed lift assist.
Alexandra Moe is a writer based in Washington. Follow her on Twitter @alexandra_moe.