Charts - Growing Impact of FDNY CFR Runs on Engine Companies

[Lebby]

Lebby this is in your wheelhouse, what do you suggest? I would think it be more productive to implement fly cars (think: strike team) with 2 EMS personnel during high activity hours in targeted areas.

I'm sure there are people much better to make suggestions, but as a whole I don't think the CFR system is in need of much fixing in and of itself. They have proven themselves time after time. My biggest takeaway is the need for more ems call takers screening jobs as they come in, reducing incorrectly categorized assignments.

 

[DaveReinstein]

Saw a video on YouTube about “the busiest engine company in the country”. It was out in Cali, maybe LA, or San Fran. Anyways, it was due to “skid row” being in their first due area, tons of CFR runs.

 

[DaveReinstein]

 

[lfdlt31]

It is important to point out that FDNY CFR only responds on what are reported as serious incidents which only make up a small portions of total EMS assignments in the city. Many departments send companies in even the most minor of EMS assignments tying them up for more serious fires and emergencies.

I should clarify with Lebby’s post and in regard to my post above that our Pumps only respond to Delta and Echo medicals unless specially requested.

 

[Lebby]

I should clarify with Lebby’s post and in regard to my post above that our Pumps only respond to Delta and Echo medicals unless specially requested.

As it should be, some places send them on everything as some sort of virtue signalling making the stats look better.

 

[lfdlt31]

As it should be, some places send them on everything as some sort of virtue signalling making the stats look better.

The problem is lots of callers know the “key-words” to upgrade their call.

 

[grumpy grizzly]

The problem is lots of callers know the “key-words” to upgrade their call.

yes listen to Boston. Engine ## respond to an unknown medical. And when they get there, Engine ## to Fire Alarm person got up and walked away. How do you resolve that and be able to concentrate on the bona fide calls?

 

[entropychaser]

You actually forget the category of "looking for a ride"!

I was trying to be polite. And remember, members cannot accept gratuities for placing previously packed luggage on the ambulance.

 

[Elmerj]

While no approach is fool proof and some of this might already be getting looked at, The following is food for thought:
As Lebby mentioned, an in-depth review of how the call to 911 is processed and call typed is a good place to start.
Are the right questions being asked ? How does the accuracy of the initial call type match up to actual presenting problem and discharge diagnosis ? Are the questions to the 911 caller leading the ARD down a path to the incident being typed as a higher segment for what's actually a low priority ? Are we letting "key" words and phrases from the caller cause this ? Should we be using AI to help with call typing ? Would a very large public awareness campaign serve to educate the public ? Leverage the AVL system to determine if the Engine and the Ambulance are exactly the same ETA from the job then only assign the Ambulance except for some very specific call types.

As one can see lots of questions and few easy (or inexpensive) solutions. All in all the CFR-D program does as intended. It gets trained medical providers to life threatening situations quickly. The program (Firefighters) have positively impacted countless situations that would likely have had negative outcomes without their intervention. Regarding the 5th Firefighter on the Engine I support it. It would help save many lives and help mitigate unchecked fire growth by getting the first line operating sooner. I also support funding a robust EMS system with state of the art training and equipment along with all the required support staff ( think Building Services, Fleet Services Mechanics, Headquarters staff, Radio Mechanics, Dispatchers to name a few) Lets not forget well compensated EMT'S, Paramedics and Officers.

Now if we could only do something about that pesky hospital turn around time to increase availability....

 

[aussiegeorge]

In Sydney Australia the Fire Dept has being trying for over 15 years to get firefighters to respond to medical calls but the firefighters and there union keep saying no not unless we get a 12.5% pay rise to do it.The Ambulance service in the city is getting busier and busier with response times blowing out so the fire service is getting a lot more calls to assist ambulance which is a undercover way of getting the pumps to respond to medical calls.At every union meeting where this issue comes up the firefighters keep voting no unless the pay rise,we signed up to be firefighters not paramedics.The busiest pumper in the city does over 6000 runs a year be mind boggling if they did medical runs as well

 

[Radindex]

Data obtained from Frank Raffa at FDNY.com

In reviewing the annual runs data, it's interesting to examine how the FDNY CFR (Certified First Responder) runs are adding to the FDNY workload. For those not familiar, the FDNY CFR runs are where an engine company is dispatched to a critical call for EMS so that they can arrive on scene faster than EMS to begin initiating aid prior to the arrival of an FDNY civilian staffed EMS BLS or ALS transport unit. The engine company cannot abandon the patient until the ambulance arrives, which can at times, be quite the wait. The FDNY CFR program was initiated in mid 1996, so statistically the first year is incomplete data when examining annual runs. Looking at the charts below, we can clearly see that FDNY engine companies are trending more and more CFR runs each year. From 1997 until 2022, The total number of FDNY CFR runs increased by 118%. Looking at the statistics and chart for the busiest CRF Engine Company, in 1997 the engine company that ran the most CFR runs, responded to 1728 medical runs...by 2022 the engine company that responded to the most CFR runs, ran 3960, and in 2019 the engine company with the most CFR runs responded to 4098, a whopping 137% increase. Some of the units seeing the most fire duty, e.g. E290 and E75 are also among the companies running more than 2000 CFR runs a year. How many times has a first due engine for an actual structural fire been delayed or off the ticket because they were on an EMS run......while an Engine like E75 is surrounded by neighboring Engines in close proximity, E290 has a huge first due response area, and due to geography, has no units coming from the south, meaning that in some cases it is a long run for a second due company like 225 or 257 to get into some of 290's first due areas. Just an observation for discussion. On another note, FDNY Engine 1, by Madison Square Garden, in recent years has placed in the top 10 Engines for total runs. A further look reveals that in 2022, FDNY E1 ran a total of 6027 runs of which 3514 were CFR (EMS) runs. Thats a jaw dropping 58.3% of all their runs are for CFR.

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The biggest reason for the increase is because dispatchers send CFR engine for any type of call.Most of the calls are not critical or even something a CFR engine can treat with the level of training we have.A lot are for intoxicated people or someone who calls saying they just feel sick."Major" injury which I've seen be a blister on the foot.People haven't been getting sicker the EMS dispatchers who send the runs to FD do not properly take the information. I'm sure there's been hundreds of times where first due engine missed a fire due to babysitting someone with a tummy ache because your now legally responsible for patient care when you shouldn't have been there in the first place

 

[CFDMarshal]

In Sydney Australia the Fire Dept has being trying for over 15 years to get firefighters to respond to medical calls but the firefighters and there union keep saying no not unless we get a 12.5% pay rise to do it.The Ambulance service in the city is getting busier and busier with response times blowing out so the fire service is getting a lot more calls to assist ambulance which is a undercover way of getting the pumps to respond to medical calls.At every union meeting where this issue comes up the firefighters keep voting no unless the pay rise,we signed up to be firefighters not paramedics.The busiest pumper in the city does over 6000 runs a year be mind boggling if they did medical runs as well

When station is the busiest? I made a visit a few years back to one that seemed it may be the busiest. old house with four appliances?

 

[grumpy grizzly]

The biggest reason for the increase is because dispatchers send CFR engine for any type of call.Most of the calls are not critical or even something a CFR engine can treat with the level of training we have.A lot are for intoxicated people or someone who calls saying they just feel sick."Major" injury which I've seen be a blister on the foot.People haven't been getting sicker the EMS dispatchers who send the runs to FD do not properly take the information. I'm sure there's been hundreds of times where first due engine missed a fire due to babysitting someone with a tummy ache because your now legally responsible for patient care when you shouldn't have been there in the first place

And the first time the dispatcher does not send a company out for what sounds like a tummy ache and it is more serious than that with fatal consequences the ambulance chasers will be lining up to sue.

 

[dan]

So not to let the facts get in the way of kitchen table folklore and experts....The FDNY CFR program is based on the NYPD 911 Operators coding of the initial complaint. As soon as the NYPD 911 operator enters the 53 or 54 code with the subcode it generates the CFR response Directly from NYPD CAD to FDNY Fire CAD and EMS CAD ..hence the reason for the "first responder" program. The Engine company is on the road or should be before the FDNY EMS dispatcher even speaks to the caller. If there are no changes based on the FDNY EMS call triage..... the run stays as is...The dispatcher can upgrade or downgrade based on the computerized triage system. IE the 10-91 EMS downgrade or reassigned for an upgrade. Like it or not, the FDNY is now an all hazards emergency response agency that goes to fires less often then many of their urban counterparts.

 

[Skyler Fire]

You actually forget the category of "looking for a ride"!

Just last night Mount Sinai pulled up in-front of me and lady walks up to ambulance…. EMT says “hey Caroline how you doing? You want to go to the hospital again? She responds yeah I have nowhere to go tonight”

 

[Lebby]

So not to let the facts get in the way of kitchen table folklore and experts....The FDNY CFR program is based on the NYPD 911 Operators coding of the initial complaint. As soon as the NYPD 911 operator enters the 53 or 54 code with the subcode it generates the CFR response Directly from NYPD CAD to FDNY Fire CAD and EMS CAD ..hence the reason for the "first responder" program. The Engine company is on the road or should be before the FDNY EMS dispatcher even speaks to the caller. If there are no changes based on the FDNY EMS call triage..... the run stays as is...The dispatcher can upgrade or downgrade based on the computerized triage system. IE the 10-91 EMS downgrade or reassigned for an upgrade. Like it or not, the FDNY is now an all hazards emergency response agency that goes to fires less often then many of their urban counterparts.

What are 53 and 54 codes? How can they assign a CFR until the assignment has a segment determined?

 

[LaurenSkye]

In Cincinnati, where I live, they're a bit different from the norm. A fire engine or ladder truck responds on all medical emergencies and does a majority of the on-scene care, even if an ambulance is coming from the same station. For some minor issues that may not require transport, an ambulance may not be assigned right away and may be requested by the company on scene (if transport is necessary). All engines and ladder trucks are staffed by at least one paramedic at all times. Up until about 10-12 years ago, only the Engines had paramedics, while the ladder trucks had EMTs and if a paramedic was needed and the closest station only had an EMT ladder truck available the ladder truck would be dispatched as well as the closest paramedic engine. In many suburbs, an ambulance is assigned to every medical run (except for lift assists and sometimes no-contact medical alarms). An engine or ladder truck may be assigned to more serious emergencies (usually cardiac or respiratory issues).

 

[Elmerj]

Should be reasonably accurate:

10-53 Vehicle Accident [D-Dispute, H-Hit by Auto, I-Injury, P-Property only, Q-Other, X-Person Pinned]
10-54 Ambulance Case [B-Burn, C-Cardiac, D4-Drowning/Water Rescue, E-EDP, H-Heavy Bleeder,
I-Minor Injury, L-Severed Limb, R-Rescue, S-Serious, U-Unconscious, Q-Other]

 

[Lebby]

Should be reasonably accurate:

10-53 Vehicle Accident [D-Dispute, H-Hit by Auto, I-Injury, P-Property only, Q-Other, X-Person Pinned]
10-54 Ambulance Case [B-Burn, C-Cardiac, D4-Drowning/Water Rescue, E-EDP, H-Heavy Bleeder,
I-Minor Injury, L-Severed Limb, R-Rescue, S-Serious, U-Unconscious, Q-Other]

CFR only responds on some segments 1,2 and 3. So no drugs, unknowns, injuries, sicks, edps, stabs, shots, etc. I'm not doubting what you're saying but perhaps one of our FADs on here could clarify the process.

 

[Elmerj]

FAD input would be great, I was just posting the 10-53 and 10-54 PD codes with the sub codes for context. The sub code in the form of the letters following the numerical code appears to drive the some of the CFR-D response.