FDNY EMS Priority Levels

[Elmerj]

So, in MCIs where an HTO is assigned, is it only 1 as a whole, or is it 1 per hospital if there’s enough concern (or common sense) to distribute among 2 or more hospitals to avoid a single ED/OD from getting creamed by critical cases/rapid increase in patient volume?

The HTO is a single individual. One could be assigned/ in place during the course of normal business. Take for example on a normal day you have an HTO at Lincoln, Harlem and Jacobi. All very busy places.

You get a multiple alarm fire in a large occupied multiple dwelling in central Harlem producing multiple 10-45’s with a couple of jumper down , several burn victims and another suffering from significant smoke inhalation all code 2’s and 3’s and that’s not including the inevitable Firefighter injuries.

So it’s either Lincoln or Harlem for the trauma patients, Harlem for the burns if beds are available or maybe Jacobi for burn and hyperbaric if they can make the ride without arresting. Anyone in extremis , is going to the closest.

Jacobi is out for the traumas in this scenario based on distance but could be used for the burns / hyperbaric.

Remember unaddressed trauma will likely kill the patient before the burns and you always address the trauma first when patients have both burns and trauma.

So in the aforementioned scenario you would/could have an HTO already in place and not need to dispatch one to the receiving hospital(s).

So yes in theory, you would want to staff the primary and adjacent ER’s if not already staffed to ensure patient load balancing and tracking preventing overwhelming conditions in the involved/ adjacent ER’s.

Remember the fire isn’t likely going to be the only significant thing happening in the general vicinity and the system will still have the normal 911 call volume and associated patients to manage concurrently.

The responsibility for setting the HTO in motion if not already in place would fall on the Citywide EMS dispatcher and Citywide Dispatch Supervisor.

Could also be prompted by the Medical Branch Director at the fire but not likely as they would be quite busy or could be at the direction of an EMS chief officer who is on duty but not directly involved in the MCI operations or FDOC.

Sorry if that was long winded but I wanted to paint the clearest possible picture.

 

[F117AN]

The HTO is a single individual. One could be assigned/ in place during the course of normal business. Take for example on a normal day you have an HTO at Lincoln, Harlem and Jacobi. All very busy places.

You get a multiple alarm fire in a large occupied multiple dwelling in central Harlem producing multiple 10-45’s with a couple of jumper down , several burn victims and another suffering from significant smoke inhalation all code 2’s and 3’s and that’s not including the inevitable Firefighter injuries.

So it’s either Lincoln or Harlem for the trauma patients, Harlem for the burns if beds are available or maybe Jacobi for burn and hyperbaric if they can make the ride without arresting. Anyone in extremis , is going to the closest.

Jacobi is out for the traumas in this scenario based on distance but could be used for the burns / hyperbaric.

Remember unaddressed trauma will likely kill the patient before the burns and you always address the trauma first when patients have both burns and trauma.

So in the aforementioned scenario you would/could have an HTO already in place and not need to dispatch one to the receiving hospital(s).

So yes in theory, you would want to staff the primary and adjacent ER’s if not already staffed to ensure patient load balancing and tracking preventing overwhelming conditions in the involved/ adjacent ER’s.

Remember the fire isn’t likely going to be the only significant thing happening in the general vicinity and the system will still have the normal 911 call volume and associated patients to manage concurrently.

The responsibility for setting the HTO in motion if not already in place would fall on the Citywide EMS dispatcher and Citywide Dispatch Supervisor.

Could also be prompted by the Medical Branch Director at the fire but not likely as they would be quite busy or could be at the direction of an EMS chief officer who is on duty but not directly involved in the MCI operations or FDOC.

Sorry if that was long winded but I wanted to paint the clearest possible picture.

Yeah, these kinds of logistics are unheard of up here on the prairies. We’ve got 6 (technically 7) hospitals citywide, 3 are urgent care and 3 (technically 4, because 1 includes the only children’s hospital province-wide afaik and has a separate pediatric ER) ERs, so it’s pretty cut and dry that minor injuries go to urgent cares, anything orthopaedic goes to Grace, anything major but non-specialist goes to St. Boniface, and major+specialties (or pediatrics) go to Health Sciences Centre.

We’re already creamed, just not enough doctors and nurses after a whole bunch got fired with the 3 ERs at Victoria, Concordia, and Seven Oaks being closed along with the accompanying surgical infrastructure, and patients don’t get processed fast enough for ambulances to spend less than an hour waiting for hand-off to ER staff, so we’ve got no HTOs. That’s why I was curious. Thanks for answering.

However, I do have an additional question. If that fire in Harlem, as per your example, went to the 5-5, then a structural collapse trapped a member in the rubble, (60+66), would the total EMS resources be everything on the 5-5, everything on the 60, and everything on the 66?

 

[NikFDNY]

However, I do have an additional question. If that fire in Harlem, as per your example, went to the 5-5, then a structural collapse trapped a member in the rubble, (60+66), would the total EMS resources be everything on the 5-5, everything on the 60, and everything on the 66?

Not sure as for the MCI60 but upon the transmission of the MCI66 they should atleast be getting the BLS, ALS, Rescue & the chiefs

 

[Elmerj]

Not sure as for the MCI60 but upon the transmission of the MCI66 they should atleast be getting the BLS, ALS, Rescue & the chiefs

You would likely have significant amounts of EMS units already responding to or operating at the scene just based on the initial patient load. As the alarm level escalated you would in theory get the next the EMS equivalent if you continued to generate patients. If you weren’t generating additional patients then you might keep the EMS commitment to let’s say a 3 alarm equivalent.

Having been faced with a similar situation I can tell you that I asked for everything in the response matrix and more. Reason being is I was already hammered with the initial onslaught of critically injured patients and have to consider the type and size and occupancy of the fire building as well as time of day and the sheer volume of people who responded who will most certainly not go unscathed.

So would I get exactly what the Matrix said ? No , I would always ask for and get what I needed based on the incident needs both actual and potential. Matrix is just a starting point. Lastly, I understand it’s not a bottomless pit of resources and I was lucky enough to be in an environment where the Dispatchers found what I asked for and sent it. I was never told no. It might take a minute but never no.

Now I did occasionally have to justify myself after the incident ? Yes, and sometimes I might get a lecture but I stood by what I did because let’s face it, I did what I did no getting around it. Did I always get it right ? No. But I focused on the Incident at hand. The very large occupied MD on fire, the people who were inside and those who responded to help them.

 

[F117AN]

You would likely have significant amounts of EMS units already responding to or operating at the scene just based on the initial patient load. As the alarm level escalated you would in theory get the next the EMS equivalent if you continued to generate patients. If you weren’t generating additional patients then you might keep the EMS commitment to let’s say a 3 alarm equivalent.

Having been faced with a similar situation I can tell you that I asked for everything in the response matrix and more. Reason being is I was already hammered with the initial onslaught of critically injured patients and have to consider the type and size and occupancy of the fire building as well as time of day and the sheer volume of people who responded who will most certainly not go unscathed.

So would I get exactly what the Matrix said ? No , I would always ask for and get what I needed based on the incident needs both actual and potential. Matrix is just a starting point. Lastly, I understand it’s not a bottomless pit of resources and I was lucky enough to be in an environment where the Dispatchers found what I asked for and sent it. I was never told no. It might take a minute but never no.

Now I did occasionally have to justify myself after the incident ? Yes, and sometimes I might get a lecture but I stood by what I did because let’s face it, I did what I did no getting around it. Did I always get it right ? No. But I focused on the Incident at hand. The very large occupied MD on fire, the people who were inside and those who responded to help them.

Just to clarify on that, would you get everything on the matrix for all 3 MCI categories as the base, then make decisions based on what you can see and what you’re being told by your crews?

 

[Elmerj]

That’s correct. Get everything responding and adjust accordingly.