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