PROEMS

1st/2016 @fdnypro

By Daniel A. Nigro, Fire Commissioner

PROonline at fdnypro.org

It is with great pleasure that I welcome you to the inaugural edition of FDNY PROEMS–the Department’s first ever magazine highlighting the medical training, dedication and preparedness of our Emergency Medical Technicians, Paramedics and EMS Officers.

Published by the FDNY Foundation, FDNY PROEMS will build upon the great suc-cess of WNYF–With New York Firefighters–a quarterly magazine created 75 years ago. WNYF began with the important goal of placing a focus on the training of our Firefighters and was designed to introduce new and efficient training methods to our personnel. WNYF has been an unmitigated success, improving the safety of our members over generations and providing a historical record for many of our Depart-ment’s difficult moments and most impressive operations.

During the last 20 years since the merger of EMS with FDNY, the lifesaving mission of our Department has grown dramatically. Two decades ago, FDNY was transformed from a workforce almost solely dedicated to fighting fires to an agen-cy responsible for providing emergency medical response 24 hours a day to New Yorkers. Today, our members respond to more than 1.6 million medical emergencies per year and we are long overdue for a publication that addresses the outstanding pre-hospital care our EMTs, Paramedics and Firefighters provide our City.

In this issue, we will chronicle in vivid detail the Department’s impressive response to the worldwide Ebola outbreak of 2014. The planning and preparation before Ebola reached our City and the execution of that planning by our members, ensuring the safety of all who responded, are detailed here. This is the kind of critical information that FDNY PROEMS will present in each installment.

Through the articles, photos, videos and podcast in this magazine, you will see challenges our members faced through their eyes. This publication will bring the medical skills and specialized training of FDNY members to a wider audience than ever before. It is our sincere hope that we can educate our readers about our best practices and successes and, in doing so, continue the great tradition started by WNYF decades ago.

Thank you for reading and stay safe.

EDITORIAL BOARD

DANIEL A. NIGROFIRE COMMISSIONER

JAMES E. LEONARDCHIEF OF DEPARTMENT

ROBERT R. TURNERFIRST DEPUTY COMMISSIONER

FRANCIS X. GRIBBONDEPUTY COMMISSIONER

JAMES C. HODGENSCHIEF OF TRAINING

PAUL CRESCICHIEF OF SAFETY

EXECUTIVE OFFICERS

ELIZABETH CASCIOTO FIRE COMMISSIONER

THOMAS COLEMANTO CHIEF OF DEPARTMENT

PRO EMS REVIEW BOARD

JAMES P. BOOTHCHIEF OF EMS

LILLIAN BONSIGNORECHIEF OF EMS ACADEMY

GLENN H. ASAEDACHIEF MEDICAL DIRECTOR

STAFF

MARTIN J. BRAUNDEPUTY CHIEF

JOSEPH D. MALVASIODIRECTOR

HUGH LESNERDIGITAL EDITOR

JANET KIMMERLYCOPY EDITOR

KATY CLEMENTSPHOTO EDITOR

KRISTIN ENGVIDEO EDITOR

THOMAS ITTYCHERIALAYOUT EDITOR

DIANA KELLYPRODUCER

FDNY PHOTO UNITUNLESS NOTED, PHOTOS ARE COURTESY FDNY PHOTO UNIT

Commissioner’s Brief

EMS Pride. Flanked by the Chief of EMS, Commissioner Nigro unveils the annual FDNY EMS Week Campaign at Headquarters.

Columns

4 Safety FirstAvoiding the Spread of CommunicableDisease Starts with Personal SafetyBy First Deputy Medical Dir., Dr. Bradley Kaufman

6 Preparing for SuccessThe What Ifs-- How Preparing for Ebola Prepares for All HazardsBy EMT Amanda Schmidt

8 Step by StepDonning and Doffing Procedures Utilized by FDNY PersonnelBy Lieutenant Farooq Muhammad

10 EMS LeaderScene Management at New York City’s First Confirmed Case of EbolaBy Deputy Chief John Sullivan

12 One on OneDr. Dario Gonzalez on Being Dispatched to West Africa During Ebola OutbreakBy Captain Elizabeth Cascio

14 Special ApparatusFDNY’s New Rescue Medic AmbulanceBy Assistant Commissioner Mark C. Aronberg

16 Stats2015 FDNY EMS Division StatisticsCompiled by EMT Harold Wagner

Departments

5 FDNY MSOC18 Photo Reporter34 The 10-12 38 About Us 39 In Memoriam

PROEMSFeatures

FDNYFoundationPublished by the

An Inside Look at How Ebola was Stopped in its Tracks in New York City

On the Front and Back Covers(Front) Photo by Randy Barron. Donning full personal protective equipment, FDNY members take part in an Ebola preparedness exercise at Bellevue Hospital in Manhattan on November 11, 2014. (Back) Challenge Coin celebrates the merger of FDNY with New York City Emergency Medical Service in 1996. The back of the coin features the back side of the #FDNYEMS20 Ambu-lance. The coin is available at fdnyshop.com.

24

Valet Doffing/Decontamination Procedures for EbolaBy Deputy Chief Nicholas Del Re

26

Building Blocks forAccomplishing Our MissionBy Chief Medical Officer, Special Advisor to the Fire Commissioner for Health Policy, Dr. David Prezant

28

Retracing Ebola’s Deadly PathBy Chief Medical Director, Dr. Glenn H. Asaeda

30

Tiered Response: Preparing for NoveltyBy Assistant Chief Joseph W. Pfeifer

20

4 PROEMS

Safety First

The best and safest strategy for treating a patient suspected of having any com-municable disease, but particularly Ebola Virus Disease (EVD), is:

• Assure early identification of the infected patient.

• Assure proper use of personal pro-tective equipment (PPE).

• Assure proper cleaning and decon-tamination.

Patient IdentificationIn New York City, during the Ebola crisis, FDNY was on high alert for patients possibly having the disease who had (1) fever and/or any of the symptoms considered to be the telltale signs of EVD and (2) traveled recently to one of the West African countries affected by EVD outbreak within 30 days prior to the onset of symptoms.

Of course, it was possible that a patient could have been found to be suffering from symptoms consistent with EVD and recent travel to an index country, but did not get categorized as a fever-travel call type by dispatch for the responding EMTs or Medics. Keep in mind, no matter how conscientious our Assignment Receiving Dispatchers (ARDs), the call type is de-pendent upon the caller’s answers, which are not always accurate. Therefore, all providers were told to make a three-foot assessment of a patient before making physical contact, while simultaneously asking the patient and family questions regarding symptoms and travel history.

If symptoms and travel history suggest EVD, the crew shall maintain a safe dis-tance of at least three feet and request the appropriate resources to respond, based on patient stability. Proper PPEDuring the EVD outbreak, if a patient was coughing, members were advised to have the patient wear a surgical mask to limit droplet transmission.

Fit-tested respirators and eye protection (goggles or face shields), PPE/bun-ker-style pants and gowns always should be worn by EMS personnel performing any aerosol-generating procedures on pa-tients with febrile respiratory illness. This is a best practice for all communicable diseases.

Aerosol-generating procedures include nebulized treatments, intubation, trache-al suctioning and direct laryngoscopy. Administration of nebulized (aerosolized) medications (e.g., Albuterol) may be done only via a nebulizer with a one-way valve (e.g., Aeroeclipse II Breath Actuated Neb-ulizer) or via a disposable, metered-dose inhaler (MDI) with spacer.

Cleaning and DecontaminationDecontamination of personnel and ambu-lance is critical. All disposable materials should be left at the destination hospital whenever possible. All non-disposable equipment used in the treatment of the patient should be cleaned in accordance with normal decontamination procedures.

Infection control procedures should be

undertaken, including aggressive hand washing with soap and water as soon as possible, which is essential in limiting disease transmission. And, as always, responders should wear full PPE when cleaning non-disposable equipment.

In closing, always remember these com-mon sense steps to protect yourself from contamination:

• Keep hands away from face.• Limit surfaces touched (similar to

crime scene operations).• Change gloves when torn or heavily

contaminated.• Perform hand hygiene. n

By First Deputy Medical Director, Doctor Bradley Kaufman

Avoiding the Spread of CommunicableDisease Starts with Personal Safety

Dr. Bradley Kaufman, MD, MPH, FACEP, is the First Deputy Medical Director for the FDNY and the Medical Director for Emergency Medical Dispatch and the EMS Bureau of

Training. He serves as a Medical Man-ager with FEMA’s New York Task Force 1 USAR team. He is board certified in both Emergency Medicine and EMS Medicine, an Associate Professor of Emergency Medicine at the Hofstra Northwell School of Medicine and an Attending Physician at the Northwell LIJ Medical Center.

About the Author:

Member Safety. Proper personal protective equipment is utilized at EVD exercise.

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Policy

5online at www.fdnypro.org @fdnypro

Registration Open for 2016 FDNY Medical Special Operations Conference

The FDNY and the FDNY Foundation are proud to host the fourth annual FDNY Medical Special Operations Conference (MSOC), April 29 to May 1.

The MSOC is the leading conference in medical special operations and has be-come a recognized platform for medical personnel from around the world to train in operating and providing medical care under disastrous conditions.

“We are proud to host this conference each year with the FDNY Foundation, to share our knowledge with members of agencies from across the country and around the world,” said Fire Commission-er Daniel A. Nigro. “We know that we are able to keep the people who live in, work in and travel to New York City safe in all emergencies and it is our hope that this conference serves to help organizations from other cities learn firsthand from our members.”

“The MSOC gives attendees the oppor-tunity to learn from members of the greatest fire department in the world,” said FDNY Chief of Department James E. Leonard. “It provides the opportunity to hear directly from our members, who are on the front lines every day, responding to all types of emergencies. It also gives everyone who participates the ability to train in hands-on skills and attend a wide variety of lectures and workshops, in an effort to better protect their own commu-nities.”

The three-day conference will consist of workshops, lectures, panel discussions, hands-on skills and a vendors’ showcase with some of the latest equipment and technology.

“Now in its fourth year, the conference has always gotten a tremendous positive

response from the people and groups who have attended,” said Dr. Douglas Isaacs, FDNY Deputy Medical Director, Office of Medical Affairs. “The MSOC allows agen-cies and organizations from around the world to come together and to learn not only from the FDNY and other experts in the field, but also to share their experienc-es and learn from each other. The MSOC is the highest quality educational confer-ence for medical personnel to learn the best practices and strategies to care for patients under these increasingly frequent disaster situations.”

“The MSOC continues to give medical operators from all levels of the national and international response framework an opportunity to share and innovate,” said Rescue Paramedic Juan Henriquez, a Con-ference organizer. “This conference has become the hottest ticket in the medical special operations field.”

The MSOC gives first responders, phy-sicians and Paramedics from across the country an opportunity to learn best practices, exchange ideas and learn more about the technology and skills that are

involved with increasing the survivability of patients under the care of the special operations medical community.

Lecturers and instructors include promi-nent members of the U.S. Armed Forces and Urban Search and Rescue teams from around the country, as well as leaders within the FDNY.

Highlights of this year’s conference will include the military’s approach to extend-ed patient care management, hemorrhage control with limited resources and a firsthand, patient encounter with the Haiti earthquake. Optional pre-conference work-shop topics include a hands-on cadaver lab, tactical medical care, wilderness med-icine and search canine veterinary care and will conclude with a visit to the World Trade Center site.

Continuing Education Credit (CEU) will be made available to Paramedics, nurses, physicians assistants and physicians. For more information about MSOC or to reg-ister to attend the conference, go to www.fdnypro.org/msoc. n

Publisher’s Note

Registerd yet? At FDNY MSOC, network and operate with agencies from around the country.

PHOTOS BY EM

S ACADEMY

6 PROEMS

Preparing for Success

Before anything else, preparation is the key to success.--Alexander Graham Bell,Inventor On October 23, 2014, local health offi-cials identified the first case of Ebola in New York City. A physician working for Doctors Without Borders had returned from Guinea, where he had been treating Ebola patients five days earlier. All eyes then turned to New York, more specifically toward the FDNY, whose life safety mis-sion and pre-hospital care and transport functions put the Department and its per-sonnel at the forefront of this potentially global pandemic crisis.

Planning AheadDue to the foresight of its leaders, the FDNY Center for Terrorism and Disaster Preparedness (CTDP) already had begun preparations for Ebola Virus Disease (EVD) cases in all five of New York City’s boroughs. Research and planning quickly led to familiarization drills on EVD. Unfor-tunately, the what if scenario for New York City quickly changed to what now, leading

to even more rigorous levels of prepared-ness.

Exercise DesignIt took CTDP members fewer than two weeks to develop the first full-scale exercise with an area hospital (Kings County Medical Center) on the trans-fer of potential EVD patients by FDNY personnel. During the exercise, a simu-lated, self-presenting, “walk-in” patient in stable condition sought care via the hospital emergency department. FDNY Haz-Tac EMS, a highly trained specialty unit, equipped with specialized gear and TyChem-F suits, would transport the EVD patient to a pre-determined hospital. In this scenario, the patient would be transferred to an EVD treatment center at Bellevue Hospital (where an actual EVD patient was being treated at that time). The Kings County Medical Center drill was the first of what would become more than 20 exercises, meetings and familiarization walk-throughs in less than a year, conduct-ed by CTDP.

The exercise series used two methods for maximum effectiveness. The first ap-proach was to conduct tabletop exercises (TTX) to promote discussions between hospital and FDNY personnel, which vastly increased awareness of the respective du-ties and mission alignment. The tabletop exercises also led to a new FDNY product, now called a BIT (Bio-Isolation Transfer) Card, allowing a FDNY Incident Command-er to possess all of the contact informa-tion, including transfer points, in addition to a checklist that both the hospital staff and responders could use as a guideline. In the second phase, full-scale exercises (FSE) primarily were carried out at desig-nated EVD treatment centers. Under the adage, practice makes perfect, partici-pants worked effectively, using open com-munication with their receiving hospital partners. These exercises focused on the BIT Card, donning and doffing PPE and the patient handoff.

Aside from the exercises, discussions were made with non-EVD treatment center

Establishing a Plan. FDNY held a full-scale exercise at Kings County Medical Center in Brooklyn to drill on a what if scenario that involved a “walk-in” patient exhibiting symptoms of the Ebola Virus Disease (EVD) and seeking treatment.

By EMT Amanda Schmidt

The What Ifs--How Preparing for Ebola Prepares for All Hazards

7online at www.fdnypro.org @fdnypro

hospitals, including the many lessons learned regarding the care of an EVD patient in critical condition. Under these conditions, EMS units would provide transport to the closest 911 receiving hospital, representing an entirely new problem set.

When it comes to real-world prepared-ness, the ability of any department to respond to a crisis comes down to two things: Planning and training. While cre-ating the familiarization drills to practice our response to an EVD patient, we came to recognize that the previous decade spent on developing and conducting exercises and familiarization drills for responding to CBRN events had primed us to be adept at responding to the EVD crisis.

MissionThe primary goal of FDNY EMS always is to provide the best professional pre-hos-pital care to the citizens and visitors of New York City. During the period of EVD-heightened awareness, people were afraid. While the FDNY may not be able to completely allay that fear, the Department carried out its mission at the highest level of safety through education, prepared-ness and diligence. n

Center for Terrorism and Disaster Pre-paredness (CTDP), where she is still involved in coordinating and designing homeland security preparedness exer-cises, and the EMS Bureau of Training. Amanda is a certified Master Exercise Practitioner (MEP) through FEMA’s Emergency Management Institute (EMI) and a certified DOH Instructor Coordinator with NYS. She is also a NYS Regional Faculty member.

About the Author:EMT Amanda Schmidt is a 24-year veteran of the FDNY. She is currently assigned to the Office of the Fire Commissioner as a Liaison. Previ-ous assignments include the FDNY

Pre-Planning is Critical to Ensuring Succesful Operations

New Information Tool. FDNY BIT (Bio-Isola-tion Transfer) Cards allow an FDNY Incident Commander to possess all of the contact information at hospitals, including transfer points and other important information.

Ready for Anything. FDNY’s Exercise Design Team prepares to oversee the simulation of the removal of a patient with Ebola symptoms from one medical facility to another. FDNY Chief Medical Officer and Special Advisor on Health Policy, Dr. David Prezant, observed the drill.

The Scenario

Playing it Safe. FDNY units take part in exercise in full personal protective equipment (PPE).

More Online DownloadBIT CARD

8 PROEMS

Step by Step

By Lieutenant Farooq Muhammad (in collaboration with the FDNY Ebola Committee)

Donning and Doffing Procedures Utilized by FDNY Personnel

Reviewing the proper proce-dure for donning and doffing infectious control ensembles is always a top priority for pa-tient care providers. But, as the Department prepared for the potential spread of the Ebola Virus Disease (EVD), the need to ensure health and safety of members could be felt more acutely. The EMS Academy re-released long-standing procedures and reinforced the following protocol.

DonningFirst, members should remove any items from their person that potentially can tear the A60 suit.

You should attach your Depart-ment-issued hand sanitizer to the radio strap for later use during the doffing procedure. Inspect your footwear for debris that potentially can tear the suit. Each member should open and inspect his/her own A60 suit for any breaches to the garment, such as tears or open seams. Now, find a clean surface to sit on that will not cause the suit to rip or tear. If necessary, place a clean sheet or blanket down on top of the surface where you plan to sit.

Slip your feet into the suit and pull up to the waist. Don the rubber boot covers. Tape is not required for sealing the rubber boots and should not be used here (note: unlike TyChem-F

suit, which should be taped).

Don your first pair of nitrile gloves. These will be your inner gloves. Don your MSA millennium APR or your SCBA facepiece. Place your arms into the suit and place the hood over the top of your head.

The edge of the hood should be placed into the groove of the APR or SCBA facepiece in order to protect your skin from contamination. Zip up the A60 suit and don a second pair of nitrile gloves. These will be your outer gloves. Ensure that these outer gloves go over the sleeves of the suit.

Using Chem-Tape®, seal the outer glove cuff to the sleeve of the suit. Make sure there is a tab at the end of the tape to facilitate easy doffing. Ensure that the tape is not too tight. Repeat this procedure on the opposite side. Using the ad-hesive strip on the zipper flap, seal the flap over the zipper of the suit. Now, carefully don the shroud by pulling it over the hood and the facepiece as shown here. The edge of the shroud also should be placed into the groove of the facepiece in order to protect you from exposure to the pa-tient’s bodily fluids. Doing this eliminates the need for taping the shroud to the facepiece.

Attach your P100 canister to the MSA APR or SCBA facepiece.

DoffingDoffing the FDNY-issued infec-tious control ensemble:

You must have a large, biohaz-ard bag ready. You also will need a clear bag for con-taminated items that are not disposable for later decontam-ination. Remove the CO meter, dosimeter and radio from the case and place in the clear bag. Place the radio case and strap into the red bag. Inspect the A60 suit. If there is signifi-cant contamination, a Haz-Mat unit will respond to assist you with the doffing procedure.

In the event non-Haz-Tac members transport a high-risk, suspected Ebola patient, Haz-Mat units will respond to the emergency department to per-form valet doffing and decon-tamination of the ambulance, plus other equipment. The request for Haz-Mat units to respond will be determined by the EMS Officer on the scene. If there is minimal contamina-tion or no visible bodily fluids, a Conditions Officer will assist you with the doffing procedure.

The Conditions Officer should wear his or her bunker-style ppe and gloves when super-vising this process and should stand at least three feet from the member who is doffing.

Find a surface where you can sit that will not tear the suit. If there is minimal contami-nation, wipe off with a bleach wipe and proceed with doffing. Once again, the Conditions Officer should supervise this entire process. If there is no visible bodily fluid contami-nation, proceed with doffing. Using hand sanitizer, bleach spray or disinfectant wipes, disinfect your outer gloves. Whenever you use hand sani-tizer, bleach spray or disinfec-tant wipes, you should allow to air dry. Remove the outer shroud, while being mindful of the P100 canister.

When removing the shroud, you should put your gloved hand over the front of the facepiece and grab the shroud from the back with the other hand, pulling it forward and guiding it off the facepiece. Place the shroud into the biohazard bag. Now, disinfect your outer gloves, again using hand sanitizer, bleach spray or disinfectant wipes. Open the seal over the front of the zipper.

Unzip the suit carefully so as not to contaminate the skin, clothing or inside of the suit. Remove the hood by grabbing it from the top of your head and pulling it toward the back. Carefully remove the Chem-Tape® from your wrists and place into the biohazard bag. On the right side, grasp the

PHOTOS BY EM

S ACADEMY

9online at www.fdnypro.org @fdnypro

years ago, he joined the Department’s internal training and information pro-gram called DiamondPlate, represent-ing the EMS Academy. He has received awards for his role in producing videos on Intranasal Naloxone and Ebola Pre-paredness. On the web, he is known for YouTube music videos highlighting EMS and Fire professions.

About the Author:Lieutenant Farooq Muhammad is a 20- year veteran of the FDNY Emergency Medical Service. He began his career as an EMT and moved up the ranks to Paramedic and Lieutenant. Five

fingertips of the outer glove in order to loosen the glove. Repeat this process with the left glove.

Grab the sleeve and outer glove together and pull your arm out of the suit. Avoid touching the outside of the suit with your inner gloved hand by keeping it over your chest. Now slide this hand into the left side of the suit and roll it down to the wrist. Grab the outer glove and the suit at the wrist and pull your left arm free. Disinfect the inner gloves by using hand sanitizer, bleach spray or bleach wipes. Avoid touching the outside of the suit. Your inner gloves should still be on. Keep-ing your hands inside, roll the suit down to your waist and then down to your ankles.

Avoid touching the outside of the suit. Now sit down and remove your feet from the suit. You must do this from the inside of the suit in order to avoid contamination. The yellow boots and the A60 suit come off together. Remove one foot from the suit and turn away from the contaminated

area. Remove the second foot from the suit and turn away from the contaminated area. Carefully pick up the suit, yellow boots and outer gloves together and place them into the biohazard bag. Avoid touch-ing the outside of the suit while doing this and do not let these items come into con-tact with your skin or uniform. Disinfect the inner gloves again by using hand san-itizer, bleach spray or bleach wipes. Add a new, fresh pair of gloves over the original gloves. Now remove your facepiece by fol-lowing these steps: Keep your eyes closed in order to avoid contamination. Grasp the facepiece from the front. Pull it forward, away from your face and over your head. Remove and dispose of the P100 canister into the biohazard bag.

When Haz-Mat is on-scene, they will handle decontamination of the facepiece. When they are not on-scene, place the facepiece into the clear bag with the other non-disposable items for later decontam-ination.

Follow Department policy and guidelines for decontaminating these items. Remove your outer gloves and place them into the biohazard bag. Disinfect the inner gloves once again by using hand sanitizer, bleach spray or bleach wipes. Wipe your shoes with bleach wipes.

Place all used bleach wipes into the biohazard bag. Dispose of the used hand sanitizer bottle, bleach spray bottle and bleach wipes container into the biohazard bag. Remove the inner gloves and place into the biohazard bag. Put on a fresh pair of gloves and seal the red bag by tying it or using tape. Place this bag into another biohazard bag, seal it off once again and dispose of it appropriately in a red bag container. Remove your last pair of gloves and place them into a biohazard bag. The Conditions Officer now will provide you with hand sanitizer to once again disinfect your hands. It is very important that you wash your hands and face with soap and water as soon as possible. n

More Online Watch Video

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PosterFDNY Infectious Control Ensemble

• 1 Kimberly-Clark® A60 Suit• 1 shroud (hood)• 2 pieces of Chem-Tape® • 1 pair of rubber boot covers• Several pairs of gloves• 1 P100 canister

10 PROEMS

EMS Leader

By Deputy Chief John Sullivan

Scene Management at New York City’s First Confirmed Case of Ebola

In October 2014, while operating as car 523, I was assigned to a multi-dwelling residence in Upper Manhattan, along with a Haz-Tac BLS, an ALS, one Conditions Officer and a Haz-Tac Officer. On arrival, I received a phone call from FDNY EMS Operations personnel, stating that the patient was a doctor who recently had returned from West Africa, where he had been treating Ebola patients with the group, Doctors Without Borders. The doctor had informed his superiors that he was starting to exhibit symptoms of the disease. Doctors Without Borders then notified the New York State Department of Health, whose officials then made oth-er notifications, which included FDNY.

Upon my arrival, I immediately made con-tact with Haz-Tac Lieutenant Jonathan Negron and EMS Lieutenant Giovanni Caballero, assigned to Conditions Car 13. Both 10 Henry and 14 Zebra had arrived and we disseminated the information we had received. Both Officers then began the task of suiting up the members who were going to enter the apartment and prepared the ambulance for transport of the patient.

Then-Chief of EMS, Abdo Nahmod, called and informed me that the patient had initiated the call. The Chief wanted to ensure that the members were in the proper personal protective equipment (PPE). Based on experience with several previous calls of suspected Ebola cases, I realized that this case had a high proba-bility of a real Ebola patient. FDNY Chief Medical Director, Dr. Glenn H. Asaeda, called to tell me that Bellevue Hospital would be the transport destination and the hospital staff were getting set up.

I notified the crews and the Officers of the hospital selection and we reviewed procedures and created a plan to safely remove the patient from the building with-out compromising any civilians or public safety personnel. When NYPD arrived, I advised them that we required the street and sidewalk to be closed. The NYPD officers quickly began to tape off the sidewalk and call in additional resources to assist in securing the scene.

I reviewed the CAD assignment for the phone number for the patient. When I lo-cated it, I called the patient so that I could have direct communication with him. I informed him that we were downstairs, a crew was getting suited up and Bellevue Hospital was the designated receiving hospital. The patient understood the precautions that were being taken and I

promised to keep him updated.

The EMS Officers were keeping me ap-prised on their preparations for crew entry and patient contact. Dr. Asaeda and I had several more telephone conversations regarding the plans and progress we were making. Lieutenant Negron, while assist-ing the crew in getting suited up and the ambulance prepared for transport, was also in communication with the FDNY Haz-Mat Battalion Chief Edward Bergamini regarding our progress. Chief Bergamini was directing the preparation of the decon area for our arrival at Bellevue.

I had a brief meeting with the on-scene NYPD Commander to bring him up to date. He had cleared an area across Broadway to keep the press at a distance and in one area. I focused on coordination with the hospital, Decon Task Force and FDNY EMS Communications, as well as the Fire Department Operations Center (FDOC), because cooperation was paramount to ensuring that the operation proceeded smoothly and effectively.

When I was informed that the members were suited up and prepared for entry, I called the patient to inform him we were going to come up to his apartment. He indicated the correct buzzer to ring when we arrived at the first-floor lobby, so he could buzz us in. I updated FDOC that we were in the process of making entry to the patient’s apartment. However, this became a new challenge. The two large, glass entry doors were locked and a key was

obviously required for entry. At first, mem-bers attempted to force open the door, but this was unsuccessful.

While attempting entry, Dr. Asaeda requested a progress report. While I was explaining our dilemma, both EMS Officers had managed to force open this door, which had come off its hinges. Dr. Asaeda then advised that we should not ask the patient to throw keys out the window since he did not want any of us to touch any personal items belonging to the pa-tient. As we made our way to the second entry door, the patient advised me which buzzer to push. I did so several times with no response. I informed the patient that I had rung his buzzer several times and he stated it was not ringing. Since the key option was out of play, we now faced our second dilemma--not being able to gain entry to the common hallway.

I resorted to pushing several other apart-ment buzzers, also with no response. We had tried for 10 minutes without gaining entry. I pushed multiple apartment buzz-ers, again with no success. Finally, the elevator door opened and a female exited toward the lobby doors, only to stop in her tracks at the site of five EMS members standing there, two of whom were in full protective ensemble. After a minute of discussion through the closed door, the female opened the door and made a quick exit out of the building. The crew pro-ceeded up to the patient’s apartment, 12 minutes after our initial attempts to gain entry.

Transfer Point. With a police escort, FDNY units arrive at Bellevue Hospital in Manhattan.

11online at www.fdnypro.org @fdnypro

Lieutenant Caballero continued to ensure the transport ambulance was fully pre-pared to accept the patient by removing as much equipment and personnel gear to the second ambulance, leaving only essential patient care equipment in the patient compartment. All three Officers then met for some additional logistical planning. The crew was in the apartment preparing the patient and a travel route to Bellevue was being finalized. Lieutenant Negron updated Chief Bergamini of our progress and estimated time of arrival (ETA); I updated FDOC, as well as Dr. Asae-da, who was in communication with the staff at Bellevue.

All three EMS Officers agreed a police escort to Bellevue was our best option. I approached the NYPD Commander and re-quested his assistance with an escort. He quickly assembled several police vehicles for the escort. The chosen route was the East Side and down the FDR Drive. The crew had communicated that the patient was ready for transport. We again entered the lobby to ensure the elevator was avail-able and there was a clear, unobstructed path to the ambulance. Within several minutes of exiting the building, the patient was placed in the ambulance and on his way with a police escort to Bellevue.Upon the patient’s arrival at Bellevue, the hospital staff was waiting with a hospital stretcher and the FDNY Haz-Mat decon team was in place and prepared to perform decon procedures on the crew. The patient was transferred to a hospital stretcher under the guidance of Bellevue staff and taken to the isolation room. The crew was decontaminated and evaluated for any effects of being in the protective ensemble for a prolonged period of time.Later that evening, FDNY members who operated on the scene were informed that the patient indeed, tested positive for Ebola.

Positive OutcomeThis assignment yielded a positive out-come due to the professional conduct exhibited by all members, in particular, exceptional communications among all involved. Considering Ebola was new to New York City, our units were thoroughly and properly prepared, ready to conduct patient care, while maintaining their own safety. Communications went well as we continued to keep the Office of Medical Affairs (OMA), FDOC and Chief Bergamini informed of our progress.

The safe removal and transport of the patient to Bellevue were critical to the success of this operation.

Some ChallengesSeveral challenges cropped up on this re-sponse that can occur in similar situations at other assignments.

1) Both the ALS and BLS units were half Haz-Tac crews, which necessitates the response of two Haz-Tac units, rather than one conventional BLS unit (normal operat-ing procedure).

2) The inability to gain entry into the building because the outer lobby doors were locked with no key holder available and then being unable to access the inner lobby because the doorbell system was not working caused a 12-minute delay in getting in and up to the patient’s apart-ment.

3) Interacting with the neighbors of the surrounding buildings has to be handled delicately and discreetly, while operating so as not to alarm the residents. Addition-ally, the patient’s privacy has to be protect-ed. Some of the questions we faced were: What is going on? What does he have? Why is no one telling us anything? None of these questions should be enter-tained by Officers or members operating on-scene. Have NYPD deal with crowd control and security.

4) Officers and members are directed not to entertain any press inquiries and refer all questions to the FDNY Office of Public Information.

5) Officers and members should clear the scene of the incident as quickly as possible after the patient has left the area. Lingering on-scene only will serve to ex-pose Officers and members to the public for scrutiny and questions regarding the patient.

NoteOn suspected Ebola cases, Haz-Tac mem-bers operate in TyChem-F suits and wear the AV-3000 facepiece, along with the Powered Air Purifying Respirator (PAPR). These assignments have, at times, required Haz-Tac members to operate in the suits for a minimum of two hours or longer, due to continuity of patient care. Members constantly are monitored for the duration of the assignment for signs of fatigue or other health-related conse-quences that might arise.

Members who are accepted into the Haz-Tac program are placed in the suits during training and perform physical activity for two hours to acclimate them to what they possibly will endure while treating and transporting patients. n

was assigned to Bronx Stations 20 and 26 as Commanding Officer until being promoted to his current rank. Served 12 years in the Navy as a flight crewman on the P-3 Orion. Studied Business Management at Saint John’s University.

About the Author:Deputy Chief Sullivan currently is assigned to EMS Division 2. Ap-pointed in 1986, he served 10 years in Manhattan before being promoted to Lieutenant and then Captain. He

Debrief. Chief Sullivan speaks with FDNY members involved in the assignment after successful operations are completed.

This assignment yielded a positive outcome due to the professional conduct exhibited by all members, in particular, excep-tional communica-tions among all involved.

12 PROEMS

One on One

By Captain Elizabeth Cascio

Dr. Dario Gonzalez on Being Dispatched to West Africa During Ebola Outbreak

I recently had the honor of conducting the first One on One interview for our new FDNY PRO Podcast with a colleague of mine. As our Office of Medical Affairs (OMA) physician, long-time FDNY employ-ee, Dr. Dario Gonzalez, is responsible for medical protocols, training, field response and quality assurance reviews. He is also the FDNY representative for the Federal Emergency Management Agency (FEMA) and Urban Search and Rescue (USAR) assignments and activities.

At the height of the Ebola outbreak, Dr. Gonzalez volunteered to go to Liberia. For nearly three months, he provided direct patient care to Ebola victims and assisted with administrative duties for Ebola-re-lated activities in West Africa. He offered his services, knowing full well that many healthcare providers had become infected with Ebola during patient care and that in-

fection resulted in death or critical illness.The following is a brief portion of our discussion about his deployment to West Africa during the Ebola Virus Disease (EVD) outbreak.

Q: What compelled you to make the trip to Liberia, knowing you would be in potential danger?

The decision was made on a contact call from AmeriCares that said, “Would you be interested in going? Your name was given to us.” And I said, “Sure.” They said, “Don’t you want to think about it”? I said, “No, let’s go.”

Q: How many patients did you treat and what was the experience like? You lose count after a while. I went to An-niston, (Alabama), to do training with CDC. Then I went to Liberia to train with the

Department of Defense (DOD) and World Health Organization (WHO). And then I went to a place called Bong, to actually do what’s called “hot training,” where you work with patients with Ebola. You wear a mask to cover your eyes and then you wear an N-95 mask on your mouth, so we don’t wear APRs. Remember, this is in temperatures that are about 95 degrees and about 92-93 percent humidity. It rains pretty much every night and so it’s very, very hot. And so you start off being able to wear this thing probably about 15-20 minutes. I can go up to about 2/2½ hours now.

You’re protected and you go in. And the idea is, you go in and the first time, you don’t do anything, you don’t touch any-thing, you just go into a clean area, then a contaminated area and watch the nurses and the doctors take care of the patients. Then, when you make a second visit, you

On the Front Lines

13online at www.fdnypro.org @fdnypro

and EMS Officer to do so in Depart-ment history. She began her career as an EMT in Brooklyn, later serving as a 911 Medical Dispatcher and as pro-gram coordinator for the EMS Cadet Program. In 1994, she helped develop and implement the FDNY CFR train-ing program, teaching Firefighters to respond to medical emergencies. She is an editorial advisor for PROEMS.

About the Author:Captain Elizabeth Cascio is a 32-year veteran of Emer-gency Medical Service, including 20 years with FDNY. She serves as Exec-utive Officer to the Fire Commissioner – the first woman

actually assist with providing care. That really is putting in IV lines, giving fluids, doing assessments, seeing if somebody is still alive, seeing what’s happening with the patient, talking to the patients. Then you get your own patients and you try and manage their fluids, antibiotics, assess them, are they getting sicker or are they improving. And some people became encephalopathic. They were confused, disoriented. Those were really the ones who were going to die.

Q: What was the most challenging part of treating the patients?

I guess the worst part was dealing with the kids. It was very interesting because the parents who are Ebola negative would go in with their kids. But the problem was that the kids who were Ebola negative, had to go with the parents because their family basically was thrown out of the villages and there was nobody to care for them. There were no services available. So they would go in there and we would hope that they didn’t become Ebola positive. You would see families that came in that lost 15 people in their family and these were the only two who were left. I remem-ber one group. We had a three-year-old come in with her older sister, who was six or seven, and her mother. Her father, grandmother and other relatives already had died. The other brother had died. And they were alone. So they came there. And then the sister died. Then the mother died. And then the three-year-old survived. After 27 days, which is quite a long time, she finally became negative. The question became: What do you do with her? Where does she go? No one wants her. She’s an Ebola patient.

Q: Did you ever feel like your life was in danger?

I can tell you this. The first time you touch an Ebola patient, it’s really…it’s quite frightening. And if anybody tells you, “Oh, I can do that. It’s no big deal.” The response

is, “You don’t know what you’re talking about.” This could be potentially fatal if the way they tell us how to do it is wrong. So we really do get scared. And you sort of say, “Well, alright.” And you go from there. I did have one breach in my PPE, which was not very encouraging. It was very frightening. So you had to really scrub and clean. I had an exposure on my hand. You just imagine the virus going through you. So you just watch and see that you don’t get sick for the next couple of days. It’s really assessing, evaluating, working with nurses, working with PAs, working with the Africans who actually would go in there. And all the Africans we had there, every one of them had lost somebody to Ebola. It was really amazing because they were willing to go in there to take care of those patients whom they considered their brothers and sisters.

Q: How long were you in Liberia?

I was gone for three months and then I tacked on three weeks of quarantine. I self-quarantined in Brussels because, mainly, we had tried to come back to the U.S. We couldn’t get back. And I just went to a SRO--single room occupancy--and stayed there for 22 days to make sure that I was okay.

Q: How did this experience change you?

I tend to appreciate family a little bit better, friends a little bit more. I think I’m much more appreciative of what goes on, I’m much more sensitive to what goes on in the world. One of the big things is, we worry about trivial stuff that doesn’t mean a whole lot. We sit here and worry about things and we say, “this is important.” No it’s not. n

Deadly Toll. Dr. Dario Gonzalez (seen far left) worked inside African medical tents and saw firsthand the devastation wrought on thou-sands of people.

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14 PROEMS

Special Apparatus

By Assistant Commissioner Mark C. Aronberg

FDNY’s New Rescue Medic Ambulance

The citizens of New York City know that when they call 911, the best-trained, most diligent medical professionals will arrive at their door. It is due to the attentiveness and organization of the Bureau of Fleet Services that these trained professionals have the ability to reach those callers in a timely and effective manner.

Fleet Services takes great pride in its ability to customize vehicles to match the needs of its members in their daily ser-vices to New York City. We are aware that our direct consumers are the members of the Department who ensure the safety of the citizens of New York on a daily basis. It is our responsibility to guarantee that these members, such as the specially trained Paramedics or the Rescue Medic Units, have the equipment properly stored and ready for use at a moment’s notice when out in the field.

Therefore, before the purchase of this specialized unit, highly experienced and well-trained personnel are consulted and engaged in the design process. When designing and building the Rescue Medic

ambulances, we enlisted the help of nu-merous individuals from the field, as well as support areas. Special thanks go out to Deputy Chief Paul Miano, Lieutenant Don Hudson (retired), Paramedic Don Faeth and Fleet Executive Director Andy Dia-mond for their tireless work and dedica-tion to getting it right.

Rescue Paramedics, assigned to this special apparatus, are highly trained for situations such as building collapse, confined space rescue, high-angle rescue, trench rescue and crush medicine. Prior to the purchase of the new Rescue Medic ambulances, they operated in the 2008 Haz-Tac ambulances, which initially were designed for our Hazardous-Materials EMS units. Although these vehicles af-forded the crews enhanced storage, there was not nearly enough space to store all of their additional equipment. The new Rescue Medic ambulances are able to ac-commodate all of the special equipment necessary to operate safely and effective-ly in any of these situations. Some of that specialty equipment they carry includes:

• Confined space helmets

• Portable ventilators• Rappelling harnesses• Sternal IO systems• Rescue skeds• Intra-compartment pressure monitors• Halfback infusion pumps• Tactical tourniquets• MP2 patient medical monitors• Optical laryngoscopes• Tracheostomy Kits• Medical backpacks• Multi-gas meters• Sam splints• IV warmer/cooler• (I-Stat) blood/chemistry analysis Paramedics on these units work hand in hand with the FDNY Special Operations Command (SOC) in order to successfully perform operations without any injury to the members of the Department or further injury to the patient. While the SOC and Fire members are providing scene safety and performing the rescue and the dis-entanglement, Paramedics are medically stabilizing and packaging the patient.

The new Rescue Medic ambulances, as well as our new standard ambulances, are

15online at www.fdnypro.org @fdnypro

Services and Technical Services. He was instrumental in developing the In-cident Management Team’s equipment cache and served as Cache Manager for several years. He returned to Fleet Services as Assistant Commissioner in 2012. He’s an Officer in his home-town volunteer fire department.

About the Author:Mark Aronberg began his nearly 34-year City career as an EMT/Para-medic in 1982 with NYC EMS. As he progressed through the ranks in FDNY, he held a variety of positions in Fleet

Additional Specs

• At 27 feet long, FDNY’s new Res-cue Medic ambulance features a conventional-style, “extended” In-ternational Terrastar cab/chassis.

• The gross vehicle weight rating is 19,500 lbs.

• Payload capacity is approximately 1,800 lbs.

• Engine is diesel-powered, eight-cylinder, certified for use with #1 and #2 ultra-low sulfur diesel fuel, as well as biodiesel blends. The engine has a mini-mum horsepower rating of 300 HP @ 2600 RPM and a minimum torque rating of 660 ft.-lbs. @ 1600 RPM.

• Rescue Medic body is approxi-mately 14½ feet long, approxi-mately 7½ feet wide and approx-imately 9 feet tall. The interior space of the patient compartment is 11 feet long, 5½ feet wide and 6 feet, 1 inch, tall.

• The Rescue Medic ambulance has provisions to carry four 60-minute SCBA bottles.

equipped with the Stealth Power idle-re-duction systems. These smart systems provide mobile electric power to run the truck’s electrical equipment, including air conditioning and heat, power windows, radios, data terminal and lights, without running the engine. This allows the vehi-cle to be turned off while at the hospital, at a cross street location or anywhere else engine idling usually is required to run the vehicle’s emergency equipment. This re-sults in a significant fuel and maintenance savings for the FDNY, as well as reducing harmful emissions, diesel particulate mat-ter and noise pollution. Consequently, the crew, patients and general public are not exposed to dangerous vehicle emissions while near the ambulance. This system aligns FDNY with the City of New York’s stated goals for greenhouse gas emis-sions reduction.

Both our current ambulances and the Res-cue Medic ambulances are manufactured by Wheeled Coach Industries in Florida. Extraordinary assistance was provided by the engineers and staff at Wheeled Coach Industries during the design/build of these units.

Currently, there are eight new Rescue Medic ambulances in service City-wide, with an additional four units to be added to the fleet during the next several months. n

On the Streets of NYC. Rescue Paramedics, assigned to this special apparatus, are highly trained for situations such as building collapse, confined space rescue, high-angle rescue, trench rescue and crush medicine.

Fleet Services takes great pride in its ability to customize vehicles to match the needs of its members in their daily services to New York City.

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16 PROEMS

Stats

Compiled By EMT Harold Wagner

2015 FDNY EMS Statistics

12345678910111213141516171819202122232425

C51C54C26C53C17C19C03C43C46C16C45C55C14C18C07C04C40C08C15C38C11C58C49C20C13

4,7244,5084,4824,3594,2714,2694,2164,1914,1514,1314,0543,9953,9713,8993,8213,8113,7533,5953,5723,5493,5023,4323,3073,3003,259

ResponsesRANK UNIT RUNS

TOP 25 C. CAR SPECIAL UNITS

HT1HT2MR3MV4MR1ME4HTBMV1MV2LS4MR2MV5ME3LS1LS3ME5LS2HT3LS5MV3MR4

1,17595731025322716214813513412911510187686148402214132

ResponsesUNIT RUNS

mass casualty incidents (MCIs) to coordinate the activities of all resources to optimize patient out-come, refusal of medical aid against medical advice, member injuries, precinct assignments, Medevacs, special events, mutual-aid responses, disaster exercises/drills, major incidents warranting investigation, significant ongoing inter-agency operations (e.g., warrant executions, technicalrescue incidents), any in-cident that is substantially more significant than an ordinary occurrence be-cause of its seriousness, peculiarities, sensational-ism, magnitude, differenc-es or newsworthiness.

HTHaz-Tac Officer Unit pro-

vides direct leadership to the EMTs and Paramedics assigned to Haz-Tac and Rescue units on the scene of assignments involving hazardous materials and technical rescue. Haz-Tac Officers provide technical knowledge and resources to the Medical Branch Director. They respond to a wide variety of mass casualty incidents and are used as subject matter experts for the Medical Branch Director. At the scene of a haz-mat or technical rescue assign-ment, the Haz-Tac Officer may operate as a Haz-Tac or Rescue Medical Tech-nician to initiate care or assist a Haz-Tac/Rescue member.

HT Officer units are desig-nated as follows:HT1= City North (Manhat-

FDNY EMS statistics were verified by FDNY EMS Operations on 03/31/2016.

12345678910111213141516171819202122232425

16D211F316C207C312B312A308D207D207E311A314C312A216A316B307C206D307C114B207B316C306D212B208A306A308D3

2,8142,7922,7782,7582,6912,6842,6782,6712,6532,5702,5592,5582,5452,4832,4172,4142,4132,4132,3812,3712,3702,3632,3512,3502,333

ResponsesRANK UNIT RUNS

TOP 25 AMBULANCES SPOTLIGHT ON CARDIAC ARRESTS

Total Cardiac Arrest Runs: 12,365

CPR started by Lay Person: 671 5.43%

CPR started by Lay Person Family Member: 527 4.26%

CPR started by Lay Per-son Medical Provider: 1,730 13.99%

Key to AbbreviationsAmbulance abbreviations are two digits, followed by one letter, followed by one digit. Example: 99A1. The first two digits represent Battalion number. The letter identifies type of resource:• R= Rescue ALS• H= Haz-Tac BLS• Z= Haz-Tac ALS• P= Gator* BLS resource• Q= Gator* BLS resource• A thru O (excluding H)= BLS Ambulance unit• S thru Y= ALS Am-bulance resource

*Six-wheel drive all-terrain vehicle utilized for beach op-erations and special events.

Last digit is the shift (1-mid-night, 2-day, 3-evening)

All specialty resource definitions= LS, ME, MV, MR, are followed by the Division number:1= Manhattan2= Bronx3= Brooklyn4= Queens5= Staten Island

CConditions Car is staffed by an EMS Officer of the rank of Lieutenant or Captain operating as a Field Officer. The unit ID is designated as C for conditions, followed by two digits, indicating the Battalion. They concentrate on directing members on operational “conditions,” defining expectations and reviewing the members’ performance. The Conditions Car will respond to incidents, such as cardiac arrests and

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tan and the Bronx)HT2= City South (Brooklyn, Queens and Staten Island)HT3= Supplemental Contingency unitHTB= Haz-Tac Captain operating in field

LS(LSU) Logistical Support Unit-- a specially configured equipment vehicle used to transport and pro-vide medical equipment at mass casualty incidents and large-scale operations. The LSU is identified with two letters, followed by the digit that represents the borough. The LSU can be used to restock EMS vehicles (e.g., MERV, METU, MRTU or ambulances), if neces-sary. There is one LSU located in each borough. The LSU will respond to incidents in accordance with the Bureau of EMS Response to mass casualty incidents matrix or as directed. Within the Incident Command structure, the LSU generally will be assigned to the Logistics Sector, where it will per-form one or more of the following functions: provide needed equip-ment to support EMS operations, as conditions warrant, and provide power, light and/or shelter (e.g., tent, Command Post canopy).

ME(METU) Mobile Evacuation Transportation Unit--The largest emergency vehicle in the FDNY Bureau of EMS fleet. The METU is identified with two letters, followed by the digit that represents the bor-ough. The METU, when properly staffed, can provide transportation for up to 24 non-ambulatory pa-tients. The METU also can be used to transport various combinations of seated and supine patients. When combination transport is required, up to four seated patients can be substituted for three supine patients, for up to 32 seated patients; has the ability to provide safe transport for up to 10 stable, wheelchair-bound patients. The METU also can be utilized to facilitate the transportation of a bariatric patient with a specially modified bariatric stretcher and ramp winch combination.

MR(MRTU) Mobile Respiratory Treat-ment Unit-a specially configured patient care vehicle, which when properly staffed, can provide oxygen therapy for up to 30 seated patients. The MRTU is identified with two letters, followed by the digit that represents the borough.

MV(MERV) Major Emergency Response Vehicle-- a specially configured patient care vehicle, which when properly staffed, can provide care and transportation for numerous patients simultaneous-ly. The MERV is identified with two letters, followed by the digit that represents the borough. MERVs are stocked with specialized equipment and additional supplies that can augment operations at an MCI. n

18 PROEMS

Photo Reporter

1PHOTO BY CAPTAIN ELIZABETH CASCIO

19online at www.fdnypro.org @fdnypro

Compiled by Paramedic Kyra Neeley

In every issue of FDNY PROEMS, our Photo Reporter offers a unique perspec-tive of the busiest EMS system in the world. While always taking patient privacy into consideration, you will get access to never-before-seen or rare images of FDNY EMS units in action.

Photo 1. Partial collapse of a building in Mid-town Manhattan in October of 2015 resulted in one fatality, as well as another patient who was critically injured. Patient is treated here by FDNY Station 4 Rescue Medics Joseph Hudak (seen left) and Niall O’Shaughnessy (seen right), from Zero One Rescue.

Photo 2. This is one of the FDNY pre-EMS Week regional competitions. EMTs competing to represent their borough in a City-wide com-petition at the end of EMS Week in May work through complex, multi-faceted patient care scenarios. (Foreground: FDNY EMT Scott Rest from EMS Station 45, Maspeth, Queens.)

Photo 3. A gas explosion occurred on the morning of March 12, 2014, in East Harlem. The explosion leveled two apartment build-ings, killing eight people and injuring at least 70 others. Here, FDNY EMS Haz-Tac Battalion Lieutenant Thomas Schulz oversees the Med-ical Branch during extended search through the rubble.

Photo 4. On March 26, 2015, a gas explosion occurred in a building located at 121 Second Avenue on the Lower East Side of Manhat-tan. Here, FDNY Chief of Rescue Operations Stephen Geraghty confers with FDNY EMS Haz-Tac Battalion Lieutenant Nicholas Aiello on-scene during ongoing search and rescue operations.

the first EMT & Paramedic Probie class to enter the Fire Academy, culminating in a photography exhibit at the NYC Fire Museum. Kyra is a member of the Ceremonial Unit, Photo Unit, Incident Management Team and secretary of the FDNY Women’s Benevolent Asso-ciation.

About the Author:Rescue Medic Kyra Neeley joined FDNY in 2006 as an EMT in Manhattan. She holds an M.Ed from Brooklyn College and serves as a Fire Commissioner Liaison. In 2013, she documented

DocumentingWhat We Do...2

3

4

20 PROEMS

An Inside Look at How Ebola was Stopped in its Tracks in New York City

When Haz-Tac EMS Paramedic Winsley Julien first got the call on October 23, 2014, that a patient in Hamilton Heights very likely had Ebola, the 15-year EMS veteran said he started to get a little nervous. “I took a deep breath, but then I knew we had the suits, so I would be okay,” he said. Paramedic Julien had been on previ-ous runs where it was thought the patient might have Ebola, but actually was afflicted with something else. This initial New York City case of Ebola was a doctor who had been in Guinea treating patients through Doctors Without Borders and called 911, stating that he had a fever of 100.3 degrees and recently had been ex-posed to the virus in Africa.

“My heart was racing, but then I donned my personal protective equipment--a TyChem-F suit and Powered Air Purifying Respi-rator (PAPR), relied on my training and knew I was protected,” Paramedic Julien remembered. “The patient was very nice to us once we arrived at his apartment and wanted to make sure he didn’t further expose his fiancée and neighbors.” Paramedic Julien and his partner took the patient down the steps of the apartment building in a stair-chair and into the ambulance, while ensuring that everyone stayed back. Everything in the ambulance already was sealed by this point, so he secured the patient on the stretcher and administered supplemental oxygen. “We just tried to keep him isolated and make sure we kept everything enclosed so nothing was exposed,” he explained. NYC’s first Ebola patient arrived at Bellevue Hospital Center properly isolated and was handed off to medical personnel there.

Once at the hospital, using a bleach and water solution, Para-medic Julien and his partner deconned with the aid of Haz-Mat Firefighters. Then, they did an assisted doff of the suit. The FDNY uses a unique valet doffing process to ensure member safety. Doffing a PPE suit after being exposed to a hazardous biological element, such as Ebola, is a high-risk process that requires a structured procedure, followed by elimination of the suits and cleaning the area with bleach. “After doffing, my adrenaline was

pumping when the Fire Department (Bureau of Health Services)doctor told us we needed to take our temperature twice a day for two weeks,” Paramedic Julien stated. Since there wasn’t a breach in the PPE suits of Paramedic Julien and his partner and they followed protocol exactly, they went back in service immediately and finished their shift, while the ambulance used for transport was taken to be cleaned.

“The process went very smoothly and it worked out just as well as we could have planned,” said Dr. Glenn H. Asaeda, Chief Med-ical Director of the Office of Medical Affairs (OMA). “We previ-ously did transfer drills from Kings County Hospital to Bellevue Hospital Center. We took it further and identified where we would decon. We ran through every step as if it were real. That made it seamless when the actual case came through. All members knew where they were supposed to be and what they were sup-posed to do.”

At the hospital, Dr. Asaeda told Paramedic Julien and his partner, “Of all cases, it appears credible that this patient is going to test positive. There was no breach in your PPE, so you’re fine, but I’m sure you’re a little bit uneasy, as anyone would be. Not for nothing, but you’ve taken care of the first New York City case of Ebola!”

“I trusted my training and trusted my suit. When it comes down to it, your training is the most important thing that gives you confidence,” said Paramedic Julien. “In the haz-mat area, it takes a lot of guts to handle any of the situations we’re faced with, but the Department is really great with our training and I trust it 100 percent.”

Preparing for EbolaAlthough the FDNY was tracking Ebola in West Africa since spring of 2014, by early summer, officials started initial prepa-rations of what to do if/when it came to New York City. After an incident in Dallas in September 2014, Commissioner Daniel A.

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22 PROEMS

Leonard. They’d have the full travel history within 30 minutes and most of the time, it ruled out that this person was an Ebola candidate. “It was a great partnership with DHS in order to get travel history that quickly. They gave us travel dates and times of patients who were classified as a Fever/Travel case. Once we [had confirmed there was a chance of Ebola], we took the ulti-mate caution for our people,” Chief Leonard emphasized.

Training with Equipment“After we watched the Dallas Ebola case unfold on the news and saw what they were wearing, we realized we already have this equipment and the EMS Haz-Tac Battalion already was famil-iar with it,” explained Deputy Chief Paul Miano. “It wouldn’t be learning to use the equipment; it would be familiarizing ourselves again and understanding that it can be used for this type of situ-ation, not just the situation for which we were training.”

The PPE suits normally are used for chemical protection and haz-ardous materials, so it was a relatively easy transition. But, now, there was a different mask, the addition of a double-glove and use of the booties. “We got approvals from the companies that manufacture the equipment, saying that it can be used for biolog-ical protection. It meets all the standards and the ratings and our Haz-Tac members already train twice a year on this equipment for 16 hours each time,” noted Chief Miano. Training was a matter of “Come on down. We’re going to be using this equipment again, but we’re using it for biological incidents this time,” Chief Miano remarked. “While we already had enough PPE suits, the FDNY did purchase more because they were unsure just how widespread

Ebola could become and the suits must be thrown out after opened. The canister we started using is called a CAP-1 filter, but it was overkill for our needs, so we switched to the smaller, P-100 filter and bought a lot of those,” explained Chief Miano.

“We got our equipment as needed, but then there were some rejections during that time when we realized some of the equip-ment we were purchasing didn’t meet our needs. Some of the gloves, booties and hats we purchased were permeable to the Ebola virus and had to go back,” said Chief Ahee. The CDC put out parameters of the equipment the Department should have to protect their members from Ebola, but the FDNY ordered even higher quality than what the CDC recommended.

The Haz-Tac teams were trained on how to don and doff the suits, whether they should wear the boots over or under the suit and, depending on one’s assignment, the way one doffs would differ. “In this situation, the Haz-Tac team was going to cut and peel the suit and this was going to be an assisted doff. Although we already were trained in that, we had to identify this was the way we were going to do it,” said Chief Miano. “We also needed to educate our workers about the disease so they’d feel comfortable operating around it since they already were comfortable wearing the equipment,” he continued. “It was about building confidence that this suit had the right protections to keep our workers safe,” Chief Miano remarked.

The Firefighters were part of the decon process for the EMS

Huge Undertaking. It took roughly three months to train the entire EMS workforce and each training session took approximately four hours.

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Nigro formed the EVD Task Force to prepare for all contingencies and the Department started holding meetings up to five times a week with a very diverse group. The meetings included EMS Operations, Fire Operations, Haz-Tac operations, Fire Special Operations Command, the Chief Medical Officer, Chief Medical Director and technology. “Nearly every entity had a representative in these meetings,” explained Michael Fitton, Assistant Chief, EMS Operations. “We all came together in the Fire Department to devise a coordinated, cohesive plan, not only to protect the public, but also our members,” he said.

Even though James E. Leonard officially became Chief of Depart-ment on November 1, 2014, after NYC’s inaugural Ebola patient was being cared for at the hospital, he was briefed on the situ-ation in the weeks leading up to his onboard date. According to Chief Leonard, “The most important thing was that every bureau of the Department was leveraged for this.”

After 9/11, the FDNY decided to tier the haz-mat response to chemical/biological and any hazard, so the Department had elements in place to deal with certain incidents, even though they weren’t Ebola-specific. “People did a lot of research for us and some things we already had captured,” said Deputy Assistant Chief Roger Ahee, then assigned to EMS Bureau of Training. “We had past lessons and people on staff who had knowledge of the virus already, including the doctors and Office of Medical Affairs staff,” stated Chief Ahee. “They were well-prepped, so they were able to put together the video and PowerPoint presentations for training relatively quickly.

“We were so successful with our training model that many mem-bers of New York State called and asked us to share the training, video and our PowerPoint with them, which we did willingly, because we didn’t know where this virus was going,” noted Chief Ahee.

A lot of ingenuity was exhibited by different members of the De-partment. “One simple change was that we were using a bleach

solution to decon people. It’s clear, so you can’t see it, but some-one suggested putting a dye in the bleach so you can see that the dye is hitting where it needs to be hitting while deconning our people,” remarked Chief Leonard. Training the Workforce to Identify Ebola“The training portion of this was a huge undertaking. We never had done anything like this before. It was spur of the moment; we were reacting, based on information we received from the Centers for Disease Control (CDC) and, sometimes, their planning changed hourly,” stated Chief Ahee.

It took roughly three months to train the entire EMS workforce and each training session took approximately four hours. The Department trained all EMTs and Paramedics regarding what to do when faced with an Ebola patient, just in case there was a true outbreak. Everyone would have the same four-hour training, so they were prepared if it became an “all hands on deck” situation.

“We had to get the staff up to speed and recruit additional instructors because we couldn’t do everything with the in-house faculty we had,” said Chief Ahee. “There was additional staff in from the field and we brought them up to Headquarters and trained them,” he mentioned. “Then we did ‘the road show’ and took to the field to train the members near where they worked to make it more convenient. We had double and triple sessions in all five boroughs, including weekends. The training staff was working from 7 a.m. to 11 p.m. In a very short period of time, everyone came through. We got everything done in a very short time frame.”

Finding the “Ebola Needle in the NYC Haystack”The FDNY wanted to catch the “front end” of Ebola, those pa-tients who potentially could have Ebola, were exposed to Ebola or already sick with Ebola as part of our Emergency Medical Dispatch, said Dr. Asaeda. To determine the “potential Ebola patient,” we decided to implement the Fever/Travel (F/T) call since the CDC recommendations said Ebola patients likely would have a fever. “It was relatively easy to implement the F/T call type since we already had fever rash and fever cough call types in place after the World Trade Center attacks. It was a matter of adding the question about whether they visited Sierra Leone, Guinea or Liberia and getting the Department of Health involved,” Dr. Asaeda noted.

“When we first were put on notice about Ebola, we had our assignment receiving dispatchers discern people who might be high index,” stated Chief Fitton. The Department created a tele-phone triage algorithm that would whittle its way down to anyone who reported he/she was suffering from a fever and if he/she had traveled to West Africa within the past 30 days. “We moni-tored compliance in the [dispatch system] very closely,” he said. “The first time you introduce something new to the algorithm, there’s a break-in period where people are still catching on and a big part of that fell on the Officers who worked at Emergency Medical Dispatch. In the beginning, anyone who had a call with a fever would alert an Officer so the Officer could come, assist and oversee the call. We did that until we got our feet beneath us and the call became more routine,” Chief Fitton explained.

“Once we got a patient’s name and identified it as a F/T call, Fire Marshals would work with the Department of Homeland Security (DHS) Border Patrol and run their travel history,” remarked Chief

Ingenuity on Display. FDNY members use a bleach solution to decon, which includes a dye in it so units can see where the cleaning solution, which is typically clear, is hitting and where it still needs to be applied.

24 PROEMS

providers and wore their own PPE suits, said Assistant Chief Ste-phen Raynis, then the Chief of Training. The firefighting workforce of the FDNY did awareness training through videos released internally on the Department’s intranet website DiamondPlate to recognize the symptoms of an Ebola patient, even if the patient they were dealing with didn’t come in as a Fever/Travel call type. “They were trained for that and to recognize when the run came in, we set up our CAD system to classify a patient they’re responding to as a Fever/Travel patient. If they traveled to any of those West African countries, the dispatcher would enter it into the CAD system and the Firefighters would know that it was a Fe-ver/Travel call and they’d have to wear PPE and other protective equipment. They were trained to put on a mask and gloves and

an N95 ‘TB’ respirator, the gloves and a gown when dealing with a Fever/Travel patient. This equipment is part of an isolation kit that’s on their rigs, but is not as sophisticated as the PPE suits the EMS Haz-Tac used,” explained Chief Raynis.

Making Sure Units Were AvailableThere were select Haz-Tac units designated and strategically deployed off-line or on standby, waiting for that F/T call type. “Be-cause it was such a high-profile situation and there was a great deal of concern by the Fire Department and the City as a whole, we made sure these Haz-Tac units were available. They were put on a separate frequency on our City-wide frequency and utilized for Fever/Travel calls,” remembered Chief Fitton. “We backfilled

Valet Doffing. FDNY Haz-Mat units were instructed to wash down...to cut and peel suits off FDNY Haz-Tac teams in an assisted doff. After numerous exercises and training sessions, the Department identified the best approach for the type of suits that were donned.

Valet Doffing/Decontamination Procedures for Ebola

In the summer of 2014, there wasn’t much information available in the United States regarding the proper doffing and equipment decontamination procedures for handling patients potentially infected with the Ebola Virus Disease (EVD). Subsequent to the cross contamination and exposure of a registered nurse who treated a confirmed EVD patient in Dallas during September of 2014, the Centers for Disease Control (CDC) put forth recommen-dations on Ebola decontamination for both emergency personnel and equipment.

FDNY Haz-Mat Operations carefully reviewed these newly issued CDC recommendations. Working closely with the FDNY Office of Medical Affairs, Haz-Mat Operations modified the existing doffing/decontamination procedures that members already were trained on and familiar with to include additional procedures from the newly released CDC recommendations. This created a new EVD doffing/decontamination procedure that ensured that the health and safety of FDNY personnel were the utmost priorities.

After many hours of practicing, modifying and training, the De-partment released a new operational procedure to its members. This unique FDNY doffing and decontamination procedure has been successfully utilized during many suspected cases of EVD, as well as during the first confirmed case of EVD in New York City.

By Deputy Chief Nicholas Del Re

More Online DownloadPolicy Brief

25online at www.fdnypro.org @fdnypro

those Haz-Tac ambulances with other ambulances on overtime or straight time so we had the same coverage in the field,” he said. “As we moved on and were able to evaluate the number and frequency of these Fever/Travel call types, we put the [ambulanc-es] back in the 911 system and if we had a Fever/Travel call, we’d send an ambulance, a Haz-Tac ambulance and a Haz-Tac Officer as well.” The Haz-Tac Officer assigned to the situation would call a physician out of telemetry and further evaluate the circum-stances. “Unless a patient was in dire need, the direction was to stand back and wait for the properly outfitted individual who could operate safely in that environment should there be some-one who posed a high index of suspicion,” Chief Fitton remarked. The FDNY transported 13 patients while fully dressed in PPE, but only one case proved positive for Ebola.

There were two Haz-Tac units on the scene, but only two Para-medics treating the patient. “We determined early on that you couldn’t take care of a patient, take the suit off, get in the ambu-lance and drive it and put the suit back on and get the patient out of the ambulance,” stated Chief Miano. There’s too much chance of getting contaminated while doffing the equipment. “We’d have two ambulances respond to the call, one being a Haz-Tac unit or two being half Haz-Tac units to make a Haz-Tac unit and we’d have ‘clean members’ and ‘dirty members.’ ‘Dirty members’ treated the patient; ‘clean members’ never came in contact with the patient; they drove the vehicles,” he continued.

Using Telemetry with the Ebola CaseThe FDNY calls the On Line Medical Control Center (OLMC) as their source of “telemetry.” Based in Queens, it’s a 24/7 center where at least one physician is on duty at any time so that EMTs and Paramedics can call when they need additional medical or-ders, information about additional medication or treatment that’s beyond their protocol.

“Telemetry was part of our planning for Ebola and we put OLMC into the mix; mainly as the contact person for the Department of Health physician,” noted Dr. Asaeda. Since the field personnel are in encapsulated suits, they’re knocked out of the box of mak-ing simple phone calls, so there was always a Haz-Tac Officer responding to the scene in every one of the Fever/Travel calls. That supervisor would be the contact for OLMC, who would be in contact with the Department of Health and there would be a discussion between the two physicians regarding the hospital to which the patient should go. Then, the DOH physician would contact the transport facility to let them know a patient is com-ing and later, the FDNY OLMC physician contacted the hospital to let them know when the crews were ready to leave the scene. This allowed the hospital staff to get ready, but prevented them from having to be dressed in their PPE for too long while waiting for the patient to arrive. “We figured the DOH would get their plan

ready, then we told them when we’re just about to leave. That gave them about 25 to 30 minutes to get the suits on, meet our crew and facilitate a handoff,” explained Dr. Asaeda.

“Member safety was our number one priority,” said Chief Leonard. “We couldn’t expose our people, nor did we want to expose any civilians unnecessarily. We knew we had to be right in what we were doing. Our mission for success had to be 100 percent.”

Lessons Learned/Reinforced• Leading New York City’s first successful Ebola operation

showed the country that the FDNY is ready and able to han-dle any situation its members face.

• “The way we reframed and retooled this Department after 9/11 allowed us to seamlessly adapt to situations such as Ebola,” explained Chief Leonard. “The strength of the FDNY is always its people. We have tremendous people. I say that my goal as the Chief of Department is to have the ‘Best trained, best equipped, best led,’ Department and in this situation, we gave them the best training, the most up-to-date equipment and they were led by the best Chiefs and Officers we had. It was a success not only for the Department, but also the City of New York.”

• “The primary reason our Haz-Tac individuals have these TyChem-F suits and Powered Air Purifying Respirators is to work in a hazardous-material environment,” noted Chief Fit-ton. “While this equipment wasn’t necessarily designed for a biological or contagious disease situation, we used those resources for other circumstances and applied them to the situation that was presented to us.”

• “You need to be reactive to incidents taking place around the country and know that any situation can arise and affect your Department’s service,” stated Chief Miano. “I think my peers in other parts of the country should look around at what’s going on in other parts of the country and say, ‘If this came here tomorrow, am I prepared’? If not, figure out how you can be. It doesn’t take long for something to get from one part of the world to the next. Be proactive in your Department by being reactive to what’s going on across the country. When ‘patient zero’ came, we already had some-thing in place; we were prepared. In the future, if something else comes to New York City, we are prepared because we have a structure that allows us the latitude to make adjust-ments, but still have this protocol in place to start from,” Chief Miano elaborated.

• “In this time of need, the smartest of the smart people all got together, everyone put aside egos and we got the job done because we recognized the importance of the safety of our members,” remarked Chief Ahee. “Everyone came together, everyone participated. The team effort truly worked well for us.” n

Leading New York City’s first successful Ebola op-eration showed the country that the FDNY is ready and able to handle any situation its members face.

26 PROEMS

Building Blocks for Accomplishing Our MissionBy Chief Medical Officer, Special Advisor to the Fire Commissioner for Health Policy, Dr. David Prezant

ly with an epidemic-like surge of patients.

Based on the task force’s collective experience, we knew that the far greater likelihood was that single or several pa-tients would present long before a surge response might be needed.

Through meetings, demonstrations, tabletops and drills, we agreed that while the building blocks for success were in place, we lacked the information and confidence that our PPE and protocols were adequate to keep us safe from this new threat.

Therefore, the task force’s immediate solution was to use Haz-Tac/Haz-Mat units already trained to operate in PPE with full skin coverage and respiratory protection to respond to the EVD patient. Understanding that if patient numbers climbed, surge capacity for Haz-Tac/Haz-Mat units would become unmanageable, that was addressed with a mid-term plan (equipping and training approximately 1,300 FDNY EMS members within two months and another 2,000 two months later to work in full PPE with Officer-su-pervised doffing and a special call to Haz-Mat if body fluid contamination occurred) and a long-term plan (do the same for all

Firefighter Certified First Responders, if needed).

The best plans are useless without fol-low-up. We organized tabletops and drills with FDNY, DOH and receiving hospitals to assess and improve all facets of the re-sponse. Members of the task force were present and reported back with assess-ments, corrective actions and follow-up after implementation.

The greatest measure of success is that through these efforts, the workforce trust was maintained, with record numbers of members requesting to join Haz-Tac and Haz-Mat units. And, today, with the threat of EVD no longer immediate, drills contin-ue to maintain our preparedness for this and all hazards.

The task force was recognized by the Fire Commissioner and the Chief of Depart-ment with an award for excellence. The award institutionalizes the task force approach as a model for future use by FDNY and other departments. n

In August 2014, months before FDNY successfully transported its first Ebo-la patient, it was my responsibility as FDNY’s Chief Medical Officer and Special Advisor to the Fire Commissioner on Health Policy, to provide the Department with advice on what was needed to safely respond to, stabilize and transport a pa-tient with Ebola Virus Disease (EVD) from a pre-hospital environment to a hospital’s emergency department or bio-contain-ment unit. At the time, guidance informa-tion was sparse and changing rapidly. As the disease spread, time was short and any day we faced the possibility of having to treat an Ebola patient. The facts, known and unknown, were presented to Fire Commissioner Daniel A. Nigro and he determined that a task force was necessary to bring all Bureaus of the Department together with a clear objective– “provide exceptional patient care, while keeping our members safe.”

I was appointed Chair of the EVD Task Force and charged with leading the effort to assess our current level of prepared-ness. The task force was designed to assess and accomplish the following action items:

• Tailor rapidly evolving medical and scientific knowledge in a way that works in our pre-hospital setting.

• Redesign protocols and personal protective equipment (PPE), inte-grate the best EMS and Fire had to offer and retrain accordingly.

• Coordinate with other partners, including the New York City Depart-ment of Health (DOH), receiving hospitals and other agencies at the local, state and federal levels.

• Institute a continuous improvement process to reassess, redesign and retrain.

Using an Incident Command structure, the task force consisted of decision-mak-ing and technical representatives from Fire and EMS Operations, Haz-Tac EMS, Haz-Mat Fire, Communications, Physi-cians from the Office of Medical Affairs and the Bureau of Health Services, Logistics, Safety Command, Training Academy and others, as needed. Labor and management were kept informed.

The clock was ticking. The fear was that with New York City being an international travel hub, we would be faced immediate-

At the table. Led by Dr. David Prezant (pictured at the head of the table, left), the FDNY EVD Task Force consisted of decision-making and technical representatives from many of the Department’s Bureaus and units.

27online at www.fdnypro.org @fdnypro

About the Contributors(In order of appearance in article)

of the South Bronx. He was honored by the Department in 2015 with the Tracy Allen-Lee Medal for his role in transporting New York City’s first Ebola patient. He holds an AAS degree in Applied Science from Manhattan Community College.

Haz-Tac Paramed-ic Winsley Julien joined FDNY in 1999 as a Para-medic. He became Haz-Tac certified in 2005. He has served for 16 years at Station 14 in the Mott Haven section

1983 and with FDNY since 1998. He is the Associate Medical Director for the NYTF-1 USAR team with deployments to Haiti, the Dominican Republic and upstate New York. He also provid-ed on-site medical oversight during the tragic September 11th terrorist attacks.

Dr. Glenn H. Asae-da, MD, FAAEM, DABEMS, is the Chief Medical Direc-tor with the FDNY. Board certified in Emergency Medi-cine and EMS, he has been an EMS field provider since

in 1997, Deputy Chief in 2006 and Di-vision Chief in 2008, serving in all five boroughs. In 2011, he was appointed Chief of Medical Dispatch. In Janu-ary 2015, Chief Fitton was appointed Assistant Chief of EMS. Chief Fitton holds a Bachelor’s degree in Emer-gency Management and Community Affairs from Empire State College of the State University of New York.

Assistant Chief Michael Fitton was appointed as an EMT in 1984 and assigned to EMS Communications where he processed and dispatched 911 calls. He was pro-moted to Captain

lyn in 1979. Most recently, he was the Brooklyn Borough Commander and, before that, the Division 8 Division Commander. He holds both AA and BA degrees from St. Francis College, as well as a Masters degree from John Jay College/CUNY. He is a graduate of the FDNY Officers Management Insti-tute (FOMI) at Columbia University.

Chief James E. Leonard is the cur-rent and 35th Chief of Department. He was appointed in 2014. His career with the Depart-ment began as a Firefighter with En-gine 310 in Brook-

Ahee has served in a number of key positions, including the role of Com-manding Officer–Station 45, Deputy Chief in Division 2 and the Deputy Chief of EMS Training. Currently as-signed to Recruitment and Diversity.

Deputy Assistant Chief Roger Ahee began his career in EMS in 1987. He went on to become a Paramedic in 1990, working at several field com-mands. Throughout his career, Chief

later serving as a Haz-Tac and Rescue Paramedic. Chief Miano has deployed with the FDNY SOC Task Force and was a member of USAR NYTF-1. In 2015, he was awarded the Jack Pin-tchik Medal and The Leon Lowenstein Award.

Deputy Chief Paul Miano, is a 16-year veteran of the FDNY Emergency Medical Service. He serves as the Chief of the Haz-Tac Battalion. He began his career as an EMT in Brooklyn,

Program from the Center for Home-land Defense and Security at the Naval Postgraduate School and FDNY Officers Management Institute (FOMI) from Columbia University Graduate School of Business.

Assistant Chief Stephen Raynis is a 35-year veteran of the FDNY. He is the Chief of Fire Dis-patch Operations in the Bureau of Communications. He is a graduate of the Masters

(FOMI), the Executive Leaders Training Program from the Naval Postgraduate School and the Combating Terrorism Leadership Program at West Point Military Academy. He is a member of numerous committees, including NFPA 1992/1994 Technical Committee re-lated to Chemical Protective Clothing Standards.

Deputy Chief Nicholas Del Re has served the FDNY since 1985. He is the Chief in Charge of Haz-Mat Operations. He is a graduate of the FDNY Officers Man-agement Institute

FDNY’s World Trade Center Medical Program. Dr. Prezant was in charge of coordinating FDNY’s overall prepared-ness and response to patients with potential Ebola Virus Disease.

Dr. David Prezant is the Chief Medical Officer for the FDNY, Office of Medical Affairs, and the Special Advisor to the Fire Commissioner for Health Policy. He is Co-Director of

(Sidebar page 24) (Sidebar page 26)

28 PROEMS

Retracing Ebola’s Deadly Path

The 2014/2015 Ebola epidemic, which is thought to have started in Guinea in March of 2014, affected several West African countries and infected more than 28,500 people, with nearly 11,500 of those dying, to date. This Ebola epidemic (the 26th outbreak in history) has been the largest and worst. According to the World Health Organization (WHO), a “mysteri-ous” disease began spreading in a small village in Guinea in December of 2013, but was not identified as Ebola until March of 2014. Soon after, several other West African countries also were affected (Liberia, Sierra Leone, Nigeria, Mali and Senegal), as well as the United States, the United Kingdom, Italy and Spain. (All of the non-African countries were due to infection from primary infected patients in West Africa.)

On the Banks of Ebola River Ebola Virus Disease (EVD) first was de-scribed in 1976 in outbreaks occurring in South Sudan and the Democratic Republic of Congo, near the Ebola River; hence, its name. Also known as Ebola Hemorrhagic Fever, the Ebola virus sickens humans and other primates, with the fruit bat thought to be the natural reservoir for Ebola. Hu-mans are infected by bats either through indirect contact with their saliva from half-

eaten fruits or directly from the bat.

Signs and symptoms typically begin between two days and three weeks after contracting the virus, human to human, through direct contact with body fluids of those infected patients. Viral symptoms and signs can include a fever, sore throat, muscle pain and headaches, followed by vomiting, diarrhea and rash. Some infect-ed victims may begin to bleed both inter-nally and externally. The disease death rate is anywhere from 25 to 90 percent of those infected. Currently, a vaccine is be-ing developed but, otherwise, treatment is supportive therapy, trying to prevent fluid losses and low blood pressure.

Across the Atlantic Ocean As the FDNY monitored the spread of Ebola in Africa, preparations were made in case the disease spread to the United States. As a hub for international travel, New York certainly was a city at risk. FDNY officials were not concerned about Ebola starting here in the U.S., but rather spread of the virus from those infected reaching our borders. On August 8, 2014, WHO declared the epidemic to be an inter-national public health crisis.

Ebola Cases in the United StatesOn September 5, 2014, an American phy-

sician, who was treating Ebola patients in Liberia and was infected with the virus, was flown to a bio-containment unit in Ne-braska, becoming the first case of Ebola in the United States. He was treated suc-cessfully and released after a three-week stay in the hospital. In late September 2014, a person coming from Liberia became the first U.S. diag-nosed case of Ebola. Staying in Dallas, Texas, he succumbed to the disease fewer than two weeks later. This patient infected two nurses during his admission in the hospital, causing alarm about the effec-tiveness of personal protective equipment (PPE).

Into New York CityOn October 23, 2014, a physician returning from treating Ebola patients in Guinea was transported by FDNY HazTac ambulance to Bellevue Hospital and diagnosed with Ebola Virus Disease, becoming the first case in New York City. He was treated suc-cessfully and released from the hospital about three weeks later.

The initial efforts to block the disease’s spread, as part of an FDNY EMS response, were to try to determine which of the 4,000 plus calls per day to the 911 system for an ambulance request was a potential

By Chief Medical Director, Doctor Glenn H. Asaeda

“Mysterious” Origins. The Ebola outbreak began in the nation of Guinea in 2013, spreading quickly to other West African countries.

29online at www.fdnypro.org @fdnypro

patient who might be infected with Ebola. At the Emergency Medical Dispatch (EMD) level, the plan was implemented to ask any caller who was complaining of a fever if he/she had travelled to any of the Ebo-la-suspect countries in the past 30 days. This was the beginning of the Fever/Travel (FT) call type, which allowed any of our EMTs or Paramedics to use extra caution when assessing these patients.

The implementation of the FT call type was rather simple since after the WTC attacks on 9/11, FDNY EMD was able to initiate a Fever/Rash (FR) and Fever/Cough call type in anticipation of a possible smallpox and anthrax attack or subsequent SARS infection.

Dead EndAs previously mentioned, all of the Depart-ment’s preparations paid off on October 23, 2014, as FDNY members responded to

the City’s first Ebola patient. Our units as-sessed, treated, transported and delivered this first Ebola patient to Bellevue Hospital. The handoff to hospital infectious disease personnel went smoothly, as did FDNY’s decontamination process by Haz-Mat 1. All procedures went according to plan and none of the patient care providers allowed Ebola to spread any further.

Subsequently, FDNY responded to dozens of other potential F/T calls. Luckily, none ultimately tested positive for Ebola. FDNY’s plans were robust enough to respond not just to Ebola patients, but to any patient infected with a future potential communi-cable disease that may present in the De-partment’s response area. The outstanding teamwork of all units within the FDNY facil-itated the development of this extensive and all-encompassing protocol, helping to ensure that the path of any future outbreak also can become a dead end. n

1983 and with FDNY since 1998. He is the Associate Medical Director for the NYTF-1 USAR team with deployments to Haiti, the Dominican Republic and upstate New York. He also provid-ed on-site medical oversight during the tragic September 11th terrorist attacks.

About the Author:Glenn H. Asae-da, MD, FAAEM, DABEMS, is the Chief Medical Direc-tor with the FDNY. Board certified in Emergency Medi-cine and EMS, he has been an EMS field provider since

On August 8, 2014, the World Health Organization (WHO)

declared the epidemic to be an international public health crisis.

Ebola “Scare”

Tabloid Coverage. Local press coverage detailed Ebola’s path to New York City.

Case Count

As of this writing, the following infor-mation was provided by the Centers for Disease Control, in conjunction with the World Health Organization, last updated on March 3, 2016.

Ebola Outbreak Case Count(Suspected, Probable and Confirmed)

Liberia: 28,603Sierra Leone: 14,124Guinea: 3,804Nigeria: 20Mali: 8United States: 4Senegal: 1Spain: 1United Kingdom: 1Italy: 1

Tent Facilities. Makeshift hospitals served many Ebola patients in the hard-est hit nations. Strict rules were enforced for operating inside to avoid further spread of the disease.

PHOTO BY DEPARTMENT OF DEFENSE

30 PROEMS

First responders are expected to have emergency response plans in place and periodically test these plans through exer-cises to ensure that the procedures work. But after years of preparedness, what hap-pens when they are faced with an event that goes beyond specific plans? Are first responders prepared for novelty? On Oc-tober 23, 2014, New York City was hit with such a novel event when a doctor, working with Doctors Without Borders, returned from Guinea with signs and symptoms of the Ebola Virus Disease (EVD). Suddenly, first responders and health care profes-sionals were challenged to adapt to a new threat environment with possibly deadly and widespread consequences.

During this crisis, FDNY dispatched a Haz-Mat Chief, Haz-Tac ambulances and Haz-Mat Tech Units as part of a tiered response to the doctor’s residence and used personal protective equipment (PPE), originally purchased for chemical terror-ism as bio protection, to transport the patient by ambulance to Bellevue Hospital. The patient then was handed off to the hospital staff in bio protective gear and, within a short period of time, was receiving treatment that saved his life. This sys-tem-wide response contained a potentially fatal epidemic and proper decontamina-tion procedures ensured the safety of all emergency responders.

Tiered Response ModelSuch a state of preparedness did not happen by chance. For well more than a decade, FDNY has been developing a new approach to hazardous material response. Instead of having just one highly trained Haz-Mat unit, the Department created a Tiered Response Model that divides response duties into layered groupings, with each subsequent layer containing resources trained incrementally to a higher response capability. Thus, a tiered re-sponse model graphically is depicted as a triangle. With each tier as a set of building blocks, many more people are trained with basic-level skills and provide support for those with technical skills, allowing the or-ganization to boost overall response. The vertical axis of the triangle represents an increase in capability, while the horizontal axis indicates greater capacity.

A typical hazardous material incident illustrates how a multi-tiered response works (see Figure #1). The entire FDNY has been trained to the Operational Level for hazardous material (chemical, biolog-ical, radiological and nuclear) events and members are likely to arrive first to initiate lifesaving efforts. This is enhanced with a Mission Specific Tier of selected units receiving special training in agent identifi-cation, chemical protective equipment and decontamination. These two tiers are fol-

Tiered Response: Preparing for NoveltyBy Assistant Chief Joseph W. Pfeifer

lowed by the Technician Tier of Haz-Mat Tech II Units for mitigation and Haz-Tac ambulances for medical care and patient transport. This response then is elevated to the highly trained Specialists in Haz-Mat Unit I and the Haz-Mat Battalion.

The Tiered Response Model increases FDNY’s capability and capacity to deliver timely services by integrating each tier into a response matrix. For routine hazard-ous material incidents, the tiered response has a proven track record, which is cited as a best practice by the Department of Homeland Security (DHS) for effective in-cident mitigation and life safety. But tiered response was developed for more than just the predictable; it also was created for the unexpected and unprecedented events.

The Ebola case demonstrated how well the Haz-Mat Tiered Response Model per-formed in the face of novelty. The incident demanded four operational elements.

• Command—Bio-incident operations were under the strict supervision of an Incident Commander and a Haz-Mat Operations Chief, assisted by an EMS Officer.

• Pre-Hospital Care—EMS ambulance personnel (Haz-Tac) were deployed in donned chemical protective clothing (CPC) before making contact with the patient and stayed in CPC during patient care and transportation to the hospital.

• Patient Transfer—The patient was handed off by EMS personnel in

protective gear to hospital personnel, who had the proper personal protec-tive equipment.

• Decontamination—Haz-Mat Techni-cians in CPC were used to properly decontaminate responders and equipment at the end of the incident to ensure no cross contamination.

The Department’s Tiered Response man-aged the unique operational demands of this one Ebola case by adapting chemical preparedness to an urgent bio-response. But New York City as an international hub for people around the world still was at risk for other Ebola cases. In the hope of containing this disease, anyone return-ing from an Ebola-infected country with a fever was treated as a possible Ebola pa-tient. FDNY, as the lead pre-hospital emer-gency care provider, could not just wait for the next case, but instead prepared the Department and hospitals for potentially many more Ebola patients. Any failure to meet this challenge to create surge ca-pacity for bio-responses could spread the disease with national consequences.

Reconfiguring Tiered ResponseWith the stakes so high, crisis managers had to think systematically about the complexity of preparedness. The whole response system had to be considered, from EMS’ initial contact with fever-travel patients to working with the hospital staff. To do this, FDNY’s Tiered Response was leveraged and, simultaneously, reconfig-ured to manage the risk of an Ebola out-break in one of the world’s most densely populated cities.

Figure 1. Typical hazardous material incident illus-trates how a multi-tiered response works.

Note: Haz-Tac ambulances are staffed by EMT or Paramedic Haz-Mat Technicians.

31online at www.fdnypro.org @fdnypro

With the stakes so high, crisis managers had to think systematically about the complexity of preparedness.

32 PROEMS

Masters Degrees from the Harvard Kennedy School, Naval Postgraduate School and Immaculate Conception. He is a Senior Fellow at the Combating Terrorism Center at West Point and the Ash Center for Democratic Governance and Innovation at Harvard University. He writes frequently and is published in various books and journals.

About the Author:Assistant Chief Joseph W. Pfeifer is a 34-year veteran of the FDNY (with 27 years certified as an EMT) and the Chief of Counterter-rorism and Emer-gency Prepared-ness. He holds

The Technician and Specialist tiers, made up of units from the Department’s EMS Bureau and Special Operations Command, easily adapted to this biological event and played a pivotal role in preparedness and response. But as we examined possible expanding demands, tiered response had to be reconfigured for a new level of pre-paredness. Reconfiguring involved discov-ering how a different part of the Depart-ment could contribute to preparedness and then add these skills to the Mission Specific Tier to enhance response.

FDNY Emergency Medical Doctors from the Office of Medical Affairs were added to ensure patient care, as were doctors from the Bureau of Health Services, to monitor the health of first responders. Dr. Dario Gonzalez, an FDNY Emergency Medical Doctor, even traveled to Western Africa to care for patients. Such experi-ence enhanced the disease monitoring. The Center for Terrorism and Disaster Pre-paredness was used to design joint table-top and full-scale exercises for FDNY and the hospital. The Department’s Tech Ser-vices ordered thousands of sets of PPE and medical supplies. Extensive training in donning and doffing PPE was provided by the Bureau of Training. Crisis managers reconfigured the Tiered Response Trian-gle by rearranging the building blocks of tiered response with new elements in the Mission Specific Tier.

Reshaping Tiered Response Understanding the urgent need to avoid a pandemic, FDNY’s preparedness efforts were extended to hospitals and coordi-nated with City and State Departments of Health and the Center for Disease Control. Extreme events, such as the Ebola outbreak, are about inter-agency collaboration and coordination, which re-quired reshaping the graphic of the Tiered Response Triangle to a Tiered Response Pyramid. (See Figure #2.) The structure of the pyramid allowed seamless adaptation among first responders, hospitals and government agencies.

Moving toward a Tiered Response Pyra-mid encouraged organizations to consider not only their own core competencies, but also the proficiencies of other agencies. By using the Tiered Response Pyramid, crisis managers can better visualize the system-wide response and anticipate incident management requirements. When done as part of preparedness analysis, it drives crisis managers to think more sys-tematically about what can be done (capa-bility), how much can be done (capacity) and when it can be done (delivery).

Fire Commissioner Daniel A. Nigro, aware of this overarching need for coordination, appointed Dr. David Prezant as the Ebola Czar to work with senior leaders across the Department and other agencies to develop response protocols, acquire protective equipment and prepare first

responders and hospital staff to work together to provide patient care and avoid spreading the disease. The systematic re-shaping of response was developed from agency-centric brainstorming sessions and inter-agency meetings, tabletops and full-scale exercises. It was through experiential learning and a feedback loop of what works that first responder and hospital staff were able to create a system to manage the Ebola crisis with three simple principles:

1. Provide patient care. 2. Don’t get contaminated.3. Clean up when you are done.

New levels for preparedness emerged from collective interactions as a bot-tom-up process of self-organization and the emergence of a Tiered Response Pyramid.

Preparedness is the process of adapting to perpetual novelty by reconfiguring and reshaping the building blocks of tiered re-sponse into a pyramid form for interacting with multiple agencies. Public awareness of how novel crises are managed is critical for maintaining confidence in government. By containing the Ebola Virus Disease to one patient and preparing a health care system to manage additional patients, FDNY provided confidence in government, which reduced national anxiety about Ebola becoming an epidemic event that could kill thousands in the United States. On January 14, 2016, the World Health Or-ganization (WHO) declared the end to the deadliest Ebola outbreak on record, which killed more than 11,300 and infected more than 28,500. FDNY’s ability to adapt its tiered response system to the threat of Ebola contributed to the mitigation of the disease and is the new model for pre-paredness. n

Figure 2. The structure of a pyramid allows for seam-less adaptation among first responders, hospitals and government agencies.

33online at www.fdnypro.org @fdnypro

FDNY is Celebrating the Merger of FDNY and NYC EMS! Join Us!

Get Your Official FDNY Gear!Online!fdnyshop.com

In Store!FDNY Fire Zone51st StreetBetween 5th & 6th AvenuesNew York CityProceeds support the FDNY Foundation To Better Protect New York

EMS PRIDE

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34 PROEMS

Division 1 Retirements/Terminal LeaveDivision 1–EMT Martin Fernandez (RCC), appointed 09/12/1988. Station 16–Lt. Pamela Hehn, appointed 08/13/1984. Station 16–Lt. Eartha Sedeniussen, appoint-ed 07/01/1991. Station 16– December. Captain Cuevas and EMTs from Station 16 met with the children of P.S. 197 (Pre-K) for a show and tell and to speak about EMS and what to do in an emergency. Captain Cuevas noted that events like this one showcase Station 16’s relationship with the com-munity.

Division 2To commemorate Cancer Awareness Month in October, EMT Diana Baez of FDNY EMS Div. 2 led the way in getting our Stations involved in raising awareness…Big applause to the members of FDNY EMS Division 2 (Div. 2, 03, 14, 15, 17, 18, 19, 20, 26, 27, 55) as they helped raise more than $2,000 for cancer awareness! In addition, we proudly wore our “EMS for a CURE” T-shirts and participated in the Bronx American Cancer Society Walk on October 18, 2015. FDNY EMS Division 2...MAKING STRIDES FOR A CURE! Kudos to Lt. Barbara Aziz-Lopez (EMS Station 14). For the past 10 years, Lt. Aziz-Lopez has taken the lead on toy drives, ensuring smiles for all residents of the Arbor Inn Homeless

Women’s/Children’s Shelter, located in Brooklyn. Her dedi-cation has ensured that for the past 10 years, every child and mother located at the shelter receives a Christmas gift. She has been honored for her work in the past by private supporters of the shelter and I believe we, as the FDNY, should applaud her for her dedication. This year, the members of FDNY EMS Division 2 raised more than $1,400 for the Arbor Inn Homeless Women’s/Chil-dren’s Shelter. They took the money raised and shopped for toys and gift cards and played the role of Santa. They participated in the distribution of gifts and their generosity ensured a gift for every child and mother located at the shelter.

Divison 32015 saw a new Division Commander–Steven Morelli –and several new Officers: Captains Chuck Morgan, Will Merrins, Lisa Freitag and Staci Grguric. Station 59 opened for business under the leadership of Captain Vincent Walla. We saw the retirement of the following members: EMTs Kevin Light-sey, Gary Hackett, Joseph Cassisi and Lilieth Watts; EMT-Ps Peter Hamilton, Michael Motley and George Trail; Lts. Carlos Ariza, Mario Bastidas and Joanne Miller; and Deputy Chief Antho-ny DeGennaro. Station 32 hosted a Make-a-Wish event, with children visiting the

facility. Gifts were provided, refreshments served and the community involved. It now will be an annual event, with the station taking the lead on the planning. Station 57 has a new mascot, Killer the Cat. He currently has more than 5600 followers on Instagram. Each Station has been direct-ed to assign a member to the PROEMS project.

Division 4We would all like to wish EMT Johnathon Leavy best of luck in his new position as Chief Bonsignore’s Aide at the FDNY EMS Academy. 2016 has started off with a bang here at Station 50. Lots of new faces (some back again), a few goodbyes and a whole lot of accomplish-ments! So as we prepare for our move into our new home on Goethals, let’s take a few minutes to celebrate our already very eventful start to the year! Welcome to all of our new Lts.: John Raftery, John Eyzaguirre and welcome back to Michael Dennehy! Congratulations are in order for our newly minted Rescue Lt. Donna Tiberi! We also have quite a few new EMTs and Paramed-ics to say hello to from our ptop program, medic basic and new transfers! Welcome, Paramedics Lennon Paras-ram, Omran Khan, Ashriel Frasier, Amanda Uster, Steven Myhand, Anthony Pal-mato, Rocco Panetta, John Piccone, Megan Pfeiffer, Dachary Farnum and Vijay

Rampersad and EMTs Chris-topher Reilly and Gregory A! We also said goodbye to a few members of our family. Lt. Lorena Concepcion now is coordinating City-wide units from FDOC; Matthew Liu and James Von Der Linn are shaping the minds of our new EMTs at the Academy; and Paramedic Roberto Abril signed off one last time and entered retirement after 26 years of dedicated service. Thank you all for your contri-butions to Station 50! On the personal side of things, three of our members are looking foward to very big events. EMT Kevin Cramblitt recently became engaged and EMTs Richard Forrester and Robert Skarda are both expecting little ones to come into their lives this month! Good luck, gentlemen! Greetings from Station 45! We have had a great start to 2016. Two of our members have success-fully completed MedicBasic, Andre Gallego and Malcom Jenkins. Congrat-ulations and good luck for the next stage of your career. Bushara Mahmud moved to RCC...The blizzard and bad weather brought out the best in our members. They pulled together, worked hard and carried on, despite brutal conditions and they looked great doing it! We seldom receive the credit we deserve for the awesome job we do on a daily basis, but some-times, we need to congrat-ulate ourselves and take note. One such time was the

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Celebrating 20 Years! FDNY life safety mascot Siren and the FDNY EMS 20 Am-bulance appear in Flushing Meadows Park in front of the iconic Unisphere. The ambu-lance debuted March 16, 2016, to help commemorate the 20th anniversary of the merger be-tween FDNY and NYC EMS.

35online at www.fdnypro.org @fdnypro

When Mayor Bill de Blasio and Fire Commissioner Daniel A. Nigro announced in early 2016 that the year prior had seen a 17 percent decline in fire deaths, the second lowest year ever in New York City history, the FDNY Foundation gladly joined in marking the Department’s success at keeping New Yorkers safe.

The Foundation has a long history of funding critical educational programs that help the FDNY save lives. In 2015, as the Department celebrated its 150th An-niversary, the Foundation funded more than 200 Firehouse/EMS Station Open Houses around the City, which helped the FDNY reach more than 25,000 people with its messages of fire and life safety. FDNY members distributed thousands of combination smoke/carbon monoxide alarms and information about careers available with the FDNY. They also handed out educational materials, including fire safety coloring books, fire helmets for children and commemorative items with messages promoting the 150th Anniversary of the Department and mes-sages of fire and life safety.

Beyond those open houses, Commissioner Nigro said the Department’s commu-nity outreach, fire safety education and free CPR classes in 2015 reached more than 740,000 New Yorkers–a 26 percent increase over 2014–at nearly 3,900 different events held throughout the City during the year.

At these community-based presentations, in addition to instructing people about safety in the home, Firefighters and EMS personnel distributed more than 20,000 smoke and carbon monoxide alarms and 94,000 batteries for use in smoke/CO alarms. Through the Foundation-funded CPR Program, the FDNY de-livered CPR training to more than 17,000 New Yorkers in 2015, including 4,000 high school students.

These critical programs teach New Yorkers how to stay safe, how to respond in the event of an emergency and how to prevent fires in their homes. They are all programs funded by the FDNY Foundation in an effort to help the FDNY fulfill its mission to protect life and property.

As the Department looks to the future, the Foundation stands at its side, ready to continue to support its most important programs. These include the FDNY Officers Management Institute (FOMI), which offers continued training for high-ranking Officers in management principles and leadership strategies, and Get Alarmed NYC, which has brought together the FDNY with the Red Cross, the Mayor’s Office, the City Council and the Foundation to offer the largest smoke alarm giveaway and installation program in the country. These programs–and others like them–are saving lives and the Foundation is proud to continue to fund training, equipment and the educational needs of the FDNY to help New York’s Bravest continue to address the complexities of response in this great City.

newsworthy moment where two of our crews–46Z2, Mike Greco and Vanessa Tenorio and 6482, Sal Salvatoreand John Lamonica–along with Station 46’s crew of 4682 Michael Rojas and Eric Feng, rescued and resusci-tated the premature infant born in the toilet. Although the news and public failed to see us, we were there and we know the truth. Station 46 thanks everyone who worked numerous hours for the big snowstrom we had at the end of January. Station 46 welcomes Captain Michael Earley, who is now the new Commanding Officer of Station 46. We wish Captain Jeannette Otero good luck on her new assignment in the Bronx. Station 46 would also like to welcome our new Lieutenant, Christopher Specht. Congratulations to Station 46’s new Paramed-ics: Andres Coll Martinez and Gonzalo DeJesus. Station 46 congratulates Paramedic Trevor Coleman on his 10-year anniversary with the Department. Also, congratulations to Paramed-ic Christopher Gonzales on his five-year anniversary with the Department. Congratula-tions to all the members who passed their medic screen-ing and could be in the next Medic class.We send our condolences to Station 46’s EMT Nancy Leger on the death of her son. Station 46 says good luck and happy retirement to EMT Kenneth Rau, who retired February 26th, 2016, after 27 years with the Department. The Officers, EMTs and Paramed-ics of FDNY EMS Station 47 (the fighting 47) announce the retirement of one of their own. EMT Jeffrey Levine, shield #2902, has hung up his coat and scope for greener grass! He made it official on the 28th day of February in the year 2016, 27 years in the making, 26 years of that time spent serving the sunny community of the Rockaways. Jeff has a wife, Ester, two sons, Anthony and David, and daughter, Jessica, who are very proud of him. We are very proud to have worked with such a fine coworker, partner, mentor, friend. He will be missed! Congratulations to Pedro Dos Santos, Brian Morrissey and Paul Rufrano for successfully completing

FDNY Foundation

What a Year!

36 PROEMS

Paramedic Basic class 21 and 22. EMS Battalion S4 is honored to be the only EMS Battalion within the FDNY EMS to operate five Advanced Life Support units, because of the redeployment of SOY from our sister sta-tion EMS Battalion SO. There are currently nine Paramedic interns placed on the units being mentored for their Paramedic internship under the guidance of seasoned Paramedics. We also have six basic life support interns who are being mentored by seasoned Emergency Medi-cal Technicians. EMS BS4 is privileged to have one of the two Paramedic Rescue Units operate out of our Battalion for the borough of Queens. The members of Battalion S4 showed their commitment to the City of New York by maintaining a high level of performance during the sec-ond biggest snowstorm in the history of New York City. EMS BS4 offers congratula-tions to Paramedic Coty and her husband on the birth of a daughter in January 2016. The EMTs, Paramedics and Supervisors of EMS BS4 take great pride in caring for the

citizens in their service area. All of the Supervisors have more than 22 years of experience and truly take a “hands-on” approach in nurturing new EMTS and Paramedics. In addition, Battalion S4 Supervisors have the understanding that they are helping to build the next generation of emergen-cy care providers and that eventually, the torch will be passed on to them. Division 5Capt. Richard Bracken: one-year anniversary as EMS Captain on 3/23/16; Lt. Esmerelda Pepper-Gonzalez: 10-year anniversary as EMS Lieutenant on 1/23/16; andLt. Matt Jachyra: one-year anniversary as EMS Lieu-tenant on 1/26/16. Baby announcements: Paramedic Kymberleigh Marshall gave birth to a beautiful baby girl, Reya Marie; Paramedic Daniel Ornstein is the proud father of beautiful baby girl, Gemma Josephine; and EMT Chris Smith is the proud father of beautiful baby girl, Gabriella Marie. Lt. Linda Carlson: 25-year EMS anni-versary on 3/4/16.

EMT Michael Van Pelt, a team player on the EMS Hockey League, won the Championship against NYPD in the Hot Shots Ice Hockey League. Baby Announce-ments: Paramedic Arthur Bronshteyn is the proud fa-ther of baby girl, Avigail, andLt. Luis Devino is the proud father of baby boy, Vincent.Station 43 wants to extend their thoughts and prayers to Salvatore Turturici, a mem-ber of FDNY EMS, who is battling 9-11-related cancer.Members completing 10 years of service in 2016:Paramedic Mary D’Angelo, #4707, 5/18/2016;EMT Christopher Daley, #1705, 3/13/2016.Members completing 10 years in title as EMS Officers in 2016: Captain Robert Rousso, #9880, 01/06/2016. Members who retired after 25+ years of service in 2015/2016:Lts. Ralph Mustillo,Lori Mazzeo and Mark Samuels. Paramedic Wilbert Acosta in 2015 marked the 10-year anniversary of the combined house of EMS Station 23 and Engine 168 on the South Shore of

Staten Island. Station 40 just received new gear racks at their Station (old firehouse turned EMS station). Every-one is ecstatic!

EMS AcademyCongratulations to Deputy Chief Cesar Escobar! After 21 years with the Department, Chief Escobar was assigned to the Bureau of Training in 2008 as a Lieutenant before being promoted to Captain in 2011. Chief Escobar accept-ed the promotion to Deputy Chief on December 7, 2015. We, at the Bureau of Training, wish him the best of luck. Congratulations to Captain Hugo Sosa! After 24 years with the Department, Captain Sosa was promoted on Sep-tember 28, 2015. We, at the Bureau of Training, wish him the best of luck. Congratula-tions to Lt. Barbara Aziz-Lo-pez! After 19 years of service to the Department, nine of which were as an Instructor at the Bureau of Training, Lt. Aziz-Lopez accepted her pro-motion on 5/22/2015. We, at the Bureau of Training, wish her the best of luck. Con-gratulations to Lt. William Bedoya! Lt. Bedoya has been

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37online at www.fdnypro.org @fdnypro

with the Department for nine years. Lt. Bedoya became a BLS Instructor in 2010 and then upgraded to an ALS In-structor in 2014. Lt. Bedoya accepted his promotion on 12/9/2015. We, at the Bureau of Training, wish him the best of luck. Congratulations to EMT Shauna Egan, who welcomed a beautiful baby boy into the world. EMT Egan and her husband welcomed Eoin Egan on 7/22/15. Baby Eoin joins his family, which includes his big brother, Charles. EMT Egan has been with the Department for seven years and has been an Instructor at the Bureau of Training for three years. We, at the Bureau of Training, wish the Egan family all the best!

Office of Medical AffairsCongratulations to Paramed-ic Sean Randazzo, #4927, who was accepted to Stony Brook University School of Medicine. Paramedic Randa-zzo currently is assigned to the Office of Medical Affairs/Telemetry and just complet-ed five years of service with the Department. We wish him success with his future educational endeavors.

EMS OperationsCongratulations to EMT/P Nicole Nehwadowich. She

booked her first cruise to the Caribbean for summer 2016. EMT Cosmo Jackson re-ceived an award for work he did in the Bureau of Training for EVOC Training. EMT Wil Brauner sent his daughter to Israel for the first time. Lt. Arlene Simmons branched out to a new job area (EMS Operations) and is learning another set of skills for her EMS career, aspiring to learn even more. While off-duty, Lt. Juliette Arroyo saved a woman from choking. Mery Bento’s son passed part of his Boards for becoming a doctor. Cathy McCrorie’s son got engaged and the other son gained entry into the FDNY Training Academy.Congrats to Capt. Evan Suchecki on the arrival of his new baby girl. Chief Booth appreciates and ac-knowledges the great team working for him. Chief Janice Olszewski appreciates her recent promotion to Depu-ty Assistant Chief and for being one of the honorees at the FDNY Women’s History Month Awards ceremony.

Haz-TacLt. Barrett Hirsch promoted to Captain (occurred on Sep-tember 28, 2015). Capt. Paul Miano promoted to Deputy Chief (occurred on December 6, 2015; see pic page 36, #7).

Capt. Patrick Flynn named Commanding Officer of the Haz-Tac Battalion (February 21, 2016). Retirement of Lt. Bill Melaragno (February 2016). A retirement party was held and some attend-ees include Division Com-mander Roberto Colon, Lt. Ann Mullooly (ret.), Captain John Ryan (ret.), Lt. Kirk Delnick (ret.), Lt. Bill Melarag-no and Deputy Chief Joseph Apuzzo (ret.). Party held at The Thirsty Koala, Astoria, Queens, thanks to owner Kathy Fuchs, retired EMS Deputy Chief. Retirement of EMT Jeffery Church (De-cember 2015). New Rescue Paramedic ambulances hit the street, March 2016!

Emergency Medical DispatchChief Napoli and Chief Aur-richio would like to congrat-ulate Chief Werner on her appointment to Emergency Medical Dispatch. And, best wishes to Chief Swords in his new position. Also, congratulations to the entire EMD staff for the inception and implementation of the Decision Dispatcher and City-wide training programs.We’d also like to welcome Lts. Joshua Benjamin and Christopher Orlik, as well as the graduates of the Probationary EMT 16-01 to the EMS Communications

family.10-12 Info compiled by:

Division 1: Paramedic William MeringoloDivision 2: Chief Joseph PatakyDivision 3: EMT Joseph BrandstetterDivision 4: EMT Beth TichmanDivision 5: Paramedic Krista O’DeaEMS Academy: Capt. Jack QuigleyEmergency Medical Dispatch: EMT Milagros RamirezHaz-Tac: Lt. Tracey MulqueenOffice of Medical Affairs: Chief Gerard SantiagoEMS Operations: Paramedic Nicole Nehwado-wich

#1As part of the FDNY’s 150th Anniversary celebration, the Department hosted a series of summer community events at Firehouses and EMS Stations in all five boroughs. All members of the community were invited to join the FDNY for games, food, live music and family fun right in their neighborhoods. Here, Bronx EMTs and Paramedics, including now-Lieutenant Joy Canter, give a demo of emergency care and best practices to neighborhood children and their families.

#2FDNY Chief of EMS James Booth gives a high five to his new mascot, EMT Siren, at one of the FDNY’s 150th Anniversary celebration events.

#3FDNY Commissioner Daniel A. Nigro meets new EMS mascot, EMT Siren, for the first time. Awwwww!

#4Led by Instructors from the FDNY CPR Training Unit, community mem-bers take part in the Be 911 CPR Program–a free, 30-minute class on compressions-only CPR–at one of the FDNY’s 150th Anniversary celebration events.

#5Check out this great hat at fdnyshop.com!

#62015 FDNY 2nd Chance BrunchFDNY Fire Alarm Dispatcher (FAD) Sherri Johnson-Campbell was on-duty dispatching FDNY units in Brooklyn when she began to have a seizure on August 8, 2014. Fellow FDNY members responded imme-diately to assist Johnson-Campbell, but within moments, she had stopped breathing and slipped into cardiac arrest. CPR was initiated and an external defibrillator was applied. After a shock, return of spon-taneous circulation was achieved. Here, FAD Sherri Johnson-Campbell embraces one of the EMS Lieutenants who rendered aid to her on that fateful day. Today, she is back at work, helping FDNY units reach those in need and enjoying her second chance at life.

#7Haz-Tac Battalion poses for a photo with Commissioner Daniel A. Nigro and Chief of Department James E. Leonard after the promotion of Deputy Chief Paul Miano. Congrats!

#8As part of the FDNY’s 150th Anniversary celebration, EMTs and Para-medics give a demo of emergency care to patients inside a training version of an upturned car, while FDNY EMS Captain Hugo Sosa provides informative commentary to neighborhood children and their families.

#9Station 40 receives new gear racks to properly store turnout gear and associated equipment.

38 PROEMS

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In Memoriam

This first edition is dedicated to the FDNY EMS members who have made the Supreme Sacrifice, proudly serving New York City...

Paramedic Deborah Reeve EMS Station 20Morris Park Station3/15/2006

Lieutenant Brian Ellicott Bureau of CommunicationsEMS Dispatch 11/26/2007

Paramedic Clyde F. SealeyBureau of Health Services Headquarters 4/12/2009

Paramedic Carene A. Brown Bureau of TrainingEMS Academy 12/22/2009

EMT Freddie Rosario EMS Station 4 Lower East Side Station6/15/2010

Deputy Assistant Chief John S. McFarland EMS OperationsHeadquarters2/6/2012

EMT Anthony J. Ficara EMS Station 43Gravesend Station 6/15/2012

EMT Joseph V. Schiumo EMS Station 20Morris Park Station12/9/2012

Paramedic Ruben I. Berrios EMS Station 20Morris Park Station12/10/2012

Lieutenant Douglas Mulholland EMS Station 35Williamsburg Station 5/28/2013

Paramedic Rudolph T. Havelka Bureau of TrainingEMS Academy 7/9/2013

EMT Francis A. Charles EMS Station 58 Canarsie Station8/27/2013

Paramedic John W. Wyatt, Jr. EMS Station 22Willowbrook Station 9/24/2013

EMT Luis de Peña EMS Station 13 Washington Heights Station11/7/2013

Lieutenant Michael F. Cavanagh EMS Station 16Harlem Station12/2/2013

Captain William C. Olsen EMS Station 23 Rossville Station6/1/2014

Lieutenant Thomas Giammarino EMS Station 31Cumberland Station 10/7/2014

EMT Christopher J. Prescott Station 39Pennsylvania Station6/17/94

EMT Tracy Allen-Lee Station 10Yorkville Station9/24/97

Lieutenant Barbara PoppoStation 39Pennsylvania Station1/21/01

Paramedic Carlos LilloStation 49Astoria Station9/11/01

Lieutenant Ricardo QuinnStation 57Bedford-Stuyvesant Station9/11/01

EMT Andre R. Lahens Station 39Pennsylvania Station4/25/02

Lieutenant Brendan D. PearsonStation 23Rossville Station4/23/05

...and to all those who have died of World Trade Center-related illnesses since bravely and selflessly contributing to the rescue and recovery efforts.

#FDNYEMS20