September 9, 2016 | Categories: Profiles
(This article was written exclusively for PRO EMS Magazine, through the FDNY Foundation, the official non-profit organization of the New York City Fire Department.)
Change in any organization is never easy and introducing new members into an already-established “family” can be met with angst on both sides (television series, such as The Brady Bunch, thrive on that concept). Change often is preceded by worries and gossip about what’s going to happen, as well as apprehension about the loss of one’s established culture or identity. Those involved in merging the Fire Department of the City of New York (FDNY) and New York City Emergency Medical Service (NYC EMS), which was part of the New York City Health and Hospitals Corporation (HHC), experienced many of those same issues.
The merger was a massive undertaking. It wasn’t easy and not always smooth sailing, but on March 17, 1996, FDNY and NYC EMS became family. Additionally, the FDNY became the largest pre-hospital care provider in the nation. In fact, by 2015, the Department’s busiest year ever, the FDNY daily averaged approximately 4,000 emergency calls, 3,900 of which were medical emergencies.
Deciding to Merge
“The decision to merge was for efficiency and improving response times,” according to FDNY Commissioner Daniel A. Nigro, who helped spearhead the Fire Department’s merger plan, serving as the Department’s first Chief of EMS. “The Fire Department had a long history of responding to emergencies and many departments around the country had incorporated EMS into their fire departments. Mayor Rudy Giuliani came on in 1994 and the thought was that we could do the same here in New York City and make EMS a part of the Department.”
Deputy Commissioner for Strategic Initiatives and Policy, Edward M. Dolan, wrote the merger plan and worked on its implementation. “New York was the last big city to leverage its Fire protection side to help with the rising number of medical emergencies,” stated Deputy Commissioner Dolan. “We were kind of late to the game because we were the busiest Fire Department in the country in the 1970s and 1980s.”
By the late 1980s, a plan to utilize fire resources for medical calls already was gaining traction. The Fire Department had piloted a number of CPR training programs for Firefighters. However, it was a research study on survival rates of out-of-hospital cardiac arrest patients in New York City that helped quicken the pace and spurred the merger. The Pre-Hospital Arrest Survival Evaluation or PHASE Study, conducted by the Albert Einstein College of Medicine, found that the survival rate for patients in New York City who suffered from cardiac arrests on which resuscitation was attempted was ranked as poor, around 1.4 percent. Comparatively, Chicago was at four percent but, on average, suburban/rural areas were 12.6 percent and mid-size suburban/urban areas were 33 percent. That data came out the first winter (1994) that Mayor Giuliani was in office. It put EMS on the front pages of the tabloids and placed the City’s emergency services in a negative light.
With public scrutiny growing, the Mayor directed the Fire Department to get merger proceedings moving. Within months, FDNY officials were laying the groundwork for the 1996 merger. A Certified First Responder (CFR) Program, which trained Fire personnel to perform basic life-threatening patient care, was launched in July 1994.
“Some of the challenges of facilitating such a large merger were working out the technical and legal pieces of the agreement. Basically, how all the equipment and personnel went from one agency to another was technically difficult, but all doable,” recalled Commissioner Nigro. “It was never thought of as an experiment. From the day the merger took place, this was how the Department was going to unite.”
An in-house, follow-up study a few years after the merger documented how response times and survival rates improved. The Department could cite a tripled (4.2 percent) survival rate for out-of-hospital cardiac arrests when a Fire company responded. Much of that was directly attributable to the success of the CFR program and additional resources, such as more ambulances and EMS stations. “All of those factors contributed to better response times,” remembered Deputy Commissioner Dolan.
“I had been with Health and Hospitals since 1984,” EMS Division Chief Steven Morelli stated. “Even 20 years ago, the FDNY was a tremendous entity that everybody knew, a ‘brand’ that everybody recognized,” continued Chief Morelli. “For us not to merge with the FDNY would’ve really put us at a disadvantage,” he said. “At the time, there was fear about losing our (EMS) identity. I can understand people’s trepidations when it comes to that and for a time, I felt the same way.”
In the early days of the merger, Chief Morelli indicated that there were fears that the Lieutenants, Captains and Chiefs would be replaced by the Fire side and Firefighters would replace EMS on ambulances. “I never saw that as happening because their mission was equally as great and equally as important. I think we’re probably in a better position now than ever before by being one, unified Department,” commented Chief Morelli.
“The workforce on both sides was unsure if they wanted to do this or sure they didn’t want to do it. Not too many thought, ‘This is a great idea,’” said Commissioner Nigro. “On the Fire side, they thought we were going to put ambulances in firehouses and the EMS personnel thought that the plan was to replace them all. To many, this was mistakenly thought to be the ‘secret plan,’ but it never really was discussed here in the Department as a viable plan. There were models elsewhere in the country where they tried to do something like that, but it wasn’t the FDNY’s plan,” according to Commissioner Nigro.
“As much as we wanted to fully integrate the two areas, there are certain things that (both sides) do differently. We tried changing the dispatch pattern early on, to mimic the way Fire apparatus respond and tailor the ambulance response to that same system, but that didn’t work,” continued Commissioner Nigro. The ambulances respond out of their area and go to hospitals; they have a different daily routine than our engines and trucks.
“Operationally, we were concerned about the merger,” added Chief Morelli. “Many EMS members wondered, ‘Are they going to change dispatch’? ‘Are they going to change our responsibilities’? ‘Are they going to change how we’re doing things’”?
“The beginning was rough,” EMS Division 5 Commander, Chief Roberto Colon, recalled. “We didn’t want to merge with the Fire Department and the Fire Department didn’t want to get EMS, but it was a big learning curve for both sides of the job. The positive aspect was that we were absorbed into a bigger service and received more recognition.”
One of the first positives for EMS members was that they now were outfitted with uniforms from the Department, explained Chief Colon. “Prior to that merger year, each EMS member had to purchase his/her own uniform, so there were different shades of green and white. As soon as we merged, the Department gave us uniforms, so now we all started to look the same–EMTs, Paramedics and Officers. Everybody had the same uniform, so that was a plus to get everybody to look the professional part.”
After 32 years in this business, 20 years in the Department, Chief Morelli revealed he’s held onto his green work jacket from his early days with the Health and Hospitals Corporation. “We never want that identity to go away, but we have to move forward as one Department.”
EMS also started receiving equipment during the next few months after the merger. “We got better, newer ambulances. With the HHC, we’d have ambulances that were breaking down and on the road for 12 to 15 years, but under the FDNY, we were receiving newer vehicles more often,” Chief Morelli elaborated.
“For me, one of the earliest positives of the merger was the additional training. We received more instruction, including joint training with Firefighters and training to do the job at hand,” explained Chief Colon, who became a member of EMS Haz-Tac in 2004. With Health and Hospitals, there was a track EMS could follow to get nursing degrees, but the training members received once under the FDNY was better suited to helping EMS members in the variety of circumstances they might encounter in the City.
Deputy Assistant Chief Lillian Bonsignore was an EMT in the Bronx before the merger. In early 1997, she became an instructor at the EMS Academy in Fort Totten, Queens, where she instructed Firefighters in the CFR Program.
“You could feel that there was just a greater amount of attention placed on your development, since we became part of the FDNY,” Chief Bonsignore commented. “The Fire Department is very proud of their training. The feeling in the Fire Department is that everything begins and ends with training,” she added.
“The personnel who ran the CFR training with Fire and EMS together did a great job early on,” recalled Commissioner Nigro. “That really showed us that this could work.” Even though many people didn’t want to be at the CFR training, at end of the day, they graduated and accepted it. “That was to the credit of the folks who worked very hard at our CFR Academy and proved to us that we could keep moving forward and get the merger done. Many of them, such as Executive Officer, Captain Elizabeth Cascio, helped make the merger easier,” said Commissioner Nigro.
At first, it was very difficult teaching Firefighters, many of whom had no interest in medicine. They truly came to FDNY just to fight fires, stated Chief Bonsignore. “We worked very hard to try to teach them how to conduct patient care. As the years went on, it got a little easier, as many started realizing that this information not only was good for the public, but good for fellow Firefighters and even their families at home. We actually had a Fire Captain who collapsed from a heart attack. A Probie from a truck company performed CPR on him until EMS Medics defibrillated and brought him back to life,” remembered Chief Bonsignore, who said this Captain became a spokesperson at the Firefighter CFR trainings.
“Now, we’re 20 years into this and Firefighters and EMS together are a very well-oiled machine when it comes to delivery of patient care on the scene,” Chief Bonsignore continued.
The FDNY now runs two world-class academies. “The Fire Academy and EMS Academy work together perfectly. Although we’re in two different locations, you wouldn’t know it,” explained Chief Bonsignore. “The things that we do as far as the leadership goes affects both Academies and we do it collectively. I’m in constant contact with Deputy Assistant Chief Andrew DiPadova, Chief of the Fire Academy, and the decisions that are made for training include us both,” added Chief Bonsignore.
“For example, the active shooter drill that we’re practicing is really something to see,” she said. “We’ve developed Task Force Teams that are integrated. You have Firefighters, EMTs, Paramedics and Officers working really well together. It’s kind of like a pit crew of pros, where everyone has a role, everyone knows what that role is and, together, they’re unstoppable. It’s really nice to see how they depend on each other, especially coming from a place 20 years ago when you couldn’t get them in the same classroom.”
“Now we know what each other’s rules and roles are,” observed Chief Colon. “In the past, some Firefighters didn’t know what a Rescue Medic was and what a Rescue Medic could do. Now, with this joint training, they know what the Rescue Medics do, what EMTs can do, what Paramedics can do and so on and so forth. That all comes from training.” The same can be said with EMTS and Paramedics who now are equipped with a better understanding of what the Fire service is doing, he added.
EMS training involved going to firehouses where they’re doing drills with Firefighters, such as teaching them how to make a tourniquet and apply it, explained Chief Colon. “It helps out tremendously when you know a friendly face at the scene and those relationships make it that much easier to get the job done.”
Where We Are Now
The Fire and EMS branches never have been more closely aligned than they are right now. One particular example of this was the non-fire, mass-casualty incident of the Metro-North passenger train derailment on December 1, 2013, where four people died and 63 were injured. More than 150 people were aboard the train and hundreds of first responders arrived on the scene quickly. The New York City-bound train departed Poughkeepsie at 0554 hours and lost control as it went around a curve in the Bronx, with several cars derailed and one train car flipped, coming to rest on the riverbank, just inches from the water where the Harlem River meets the Hudson River.
“There were a lot of moving parts, it was a very large scene and not easy to compartmentalize, especially due to the topography of the area,” recalled Deputy Chief John (Jay) Jonas, Incident Commander at the scene. The Firefighters evaluated hazards and experienced a hazardous materials leak at the end of the tracks, but other than that, this was a medical operation, continued Chief Jonas.
“The scene at the train tracks was chaotic to say the least,” remembered Chief Colon. “I had to stake claim to one area and decided everybody should come to me.” He put on a white helmet so everyone would know that he was the Medical Branch Director at the incident.
“We established a Command Post where all agencies could assemble on an overhead trestle that provided an overview of the incident without clogging up the scene,” stated Chief Jonas. “From this point, everyone could see where the ambulances were coming and going; they could view triages; they could observe what I was doing; and recognize the haz-mat and water situations,” he said.
The Rescue Companies made sure they got everyone out of the train cars and identified fatalities. “Since there was no fire and the train was stable, this became a medical operation. Chief Jonas assisted me by assigning Firefighters to carry people from the train tracks to the street, where we had a doctor waiting. The doctor determined which patients should go to the hospital first, second and so forth,” Chief Colon related.
The Firefighters helped triage the patients before they got to the ambulances, added Chief Jonas, who estimated they were getting patients out to the ambulances within about 30 minutes.
“I started assigning people to go to work and then Chief Jonas and I started formulating a plan about how we were going to run this operation and coordinate the resources. Because we worked together at other incidents and knew each other, it made the operation a lot easier. We had a few things going in our favor—the streets were relatively empty because it was a Sunday morning and so there were fewer people on the train as well,” stated Chief Colon. “It was a cooperative effort among everybody on the job, which contributed to the success.”
As new Firefighters and EMTs join the FDNY, they build relationships and work together from the beginning.
“The job has provided me with a lot of great friends and excellent opportunities, probably more so than if we were still with Health and Hospitals,” Chief Morelli remarked. “It’s more welcoming than it’s ever been before. The example I set before others is important to me. I learned the importance of responsibility and obligation through the FDNY.”
“September 11th was a pivotal point in our history,” said Chief Bonsignore. “For the first time, many FDNY EMS members felt they were the Fire Department. It was a real turning point for our future. It was just as hurtful for us to see all of these people with whom we worked perish, knowing it could have been any one of us. I think that’s when everybody accepted the merger and said, ‘We’re married.’ We had rebuilding to do because it was a big blow for the Department, but we were on the path to something that was going to end up being a completely integrated system.”
“Commissioner Nigro has summed up the Fire Department’s mission as, ‘We’re the agency that you call when you need help’ and that rings very true on the medical side because it doesn’t really matter if the help gets there on an engine or BLS or ALS ambulance,” explained Deputy Commissioner Dolan. “You need to save the victim’s life. The Fire Department is extraordinarily committed to that mission and is really, really good at it, as you’d expect it to be. It’s great to see and it’s just a never-ending challenge to try and keep making a great system even better,” he added.
“I think we’ve recognized that we operate together very well at the scenes of emergencies. For example, we have Rescue Medics now and we answered the Ebola calls with Firefighters performing the de-contamination of the EMTs who were doing the transports. They all work together, but have distinct roles. I think that’s where our 16,000-member workforce does a great job,” Commissioner Nigro summarized. “Whether it’s civilian employees of the Department or our EMTs, Medics or Firefighters, everybody has a job to do and the synergy of all the people working together make FDNY that much stronger.”
“Now, as we move forward, we’re trying to further integrate EMS leadership into the Department. We’re looking for opportunities to put our talented EMS people into positions where we can best utilize them to help the Department fulfill its lifesaving mission to protect life and property, a mission that has remained unchanged since 1865,” Commissioner Nigro concluded.
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