Fdny Proems 1st 2016

PROEMS
1st/2016
@fdnypro
Commissioners Brief
PRO
online at fdnypro.org
By Daniel A. Nigro, Fire Commissioner
EDITORIAL BOARD
EMS Pride.
Flanked by the
Chief of EMS,
Commissioner
Nigro unveils the
annual FDNY EMS
Week Campaign
at Headquarters.
DANIEL A. NIGRO
FIRE COMMISSIONER
JAMES E. LEONARD
CHIEF OF DEPARTMENT
ROBERT R. TURNER
FIRST DEPUTY COMMISSIONER
FRANCIS X. GRIBBON
DEPUTY COMMISSIONER
JAMES C. HODGENS
CHIEF OF TRAINING
PAUL CRESCI
CHIEF OF SAFETY
It is with great pleasure that I welcome you to the inaugural edition of FDNY
PROEMSthe Departments 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 success of WNYFWith New York Firefightersa 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 Departments 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 agency 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 Departments 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.
EXECUTIVE OFFICERS
ELIZABETH CASCIO
TO FIRE COMMISSIONER
THOMAS COLEMAN
TO CHIEF OF DEPARTMENT
PRO EMS REVIEW BOARD
JAMES P. BOOTH
CHIEF OF EMS
LILLIAN BONSIGNORE
CHIEF OF EMS ACADEMY
GLENN H. ASAEDA
CHIEF MEDICAL DIRECTOR
STAFF
MARTIN J. BRAUN
DEPUTY CHIEF
JOSEPH D. MALVASIO
DIRECTOR
HUGH LESNER
DIGITAL EDITOR
JANET KIMMERLY
COPY EDITOR
KATY CLEMENTS
PHOTO EDITOR
KRISTIN ENG
VIDEO EDITOR
THOMAS ITTYCHERIA
LAYOUT EDITOR
DIANA KELLY
PRODUCER
FDNY PHOTO UNIT
UNLESS NOTED, PHOTOS ARE
COURTESY FDNY PHOTO UNIT
PROEMS
Features
Published by the
FDNYFoundation
Columns
4 Safety First
Avoiding the Spread of Communicable
Disease Starts with Personal Safety
By First Deputy Medical Dir., Dr. Bradley Kaufman
6 Preparing for Success
The What Ifs-- How Preparing for Ebola
Prepares for All Hazards
By EMT Amanda Schmidt
20
An Inside Look at How Ebola was Stopped
in its Tracks in New York City
24
26
Valet
Doffing/Decontamination
Procedures for Ebola
Building Blocks for

Accomplishing Our
Mission
By Deputy Chief Nicholas Del Re
By Chief Medical Officer, Special

Advisor to the Fire Commissioner for
Health Policy, Dr. David Prezant
8 Step by Step
Donning and Doffing Procedures
Utilized by FDNY Personnel
By Lieutenant Farooq Muhammad
10 EMS Leader
Scene Management at New York Citys
First Confirmed Case of Ebola
By Deputy Chief John Sullivan
12 One on One
Dr. Dario Gonzalez on Being Dispatched to
West Africa During Ebola Outbreak
By Captain Elizabeth Cascio
14 Special Apparatus
FDNYs New Rescue Medic Ambulance
By Assistant Commissioner Mark C. Aronberg
16 Stats
2015 FDNY EMS Division Statistics
Compiled by EMT Harold Wagner
Departments
28
30
Retracing Ebolas
Deadly Path
Tiered Response:
Preparing for Novelty
By Chief Medical Director,

Dr. Glenn H. Asaeda
5 FDNY MSOC
18 Photo Reporter
34 The 10-12
38 About Us
39 In Memoriam
By Assistant Chief Joseph W. Pfeifer
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 Ambulance. The coin is available at fdnyshop.com.
Safety First
Avoiding the Spread of Communicable

Disease Starts with Personal Safety
By First Deputy Medical Director, Doctor Bradley Kaufman
More Online
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Policy
Member Safety. Proper personal protective equipment is utilized at EVD exercise.

he best and safest strategy for treating
T
a patient suspected of having any com-
If symptoms and travel history suggest

EVD, the crew shall maintain a safe distance of at least three feet and request the
appropriate resources to respond, based
on patient stability.
Proper PPE
During the EVD outbreak, if a patient was
coughing, members were advised to have
the patient wear a surgical mask to limit
droplet transmission.
municable disease, but particularly Ebola

Virus Disease (EVD), is:
Assure early identification of the

infected patient.
Assure proper use of personal protective equipment (PPE).
Assure proper cleaning and decontamination.
Patient Identification
In 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 dependent upon the callers 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.
PROEMS
Fit-tested respirators and eye protection

(goggles or face shields), PPE/bunker-style pants and gowns always should
be worn by EMS personnel performing any
aerosol-generating procedures on patients with febrile respiratory illness. This
is a best practice for all communicable
diseases.
Aerosol-generating procedures include
nebulized treatments, intubation, tracheal 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 Nebulizer) or via a disposable, metered-dose
inhaler (MDI) with spacer.
Cleaning and Decontamination
Decontamination of personnel and ambulance 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 common 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
About the Author:

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 Manager with FEMAs 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.
Publishers Note
Registration Open for 2016 FDNY

Medical Special Operations Conference
PHOTOS BY EMS ACADEMY
he 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 become 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 Commissioner 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 opportunity 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 communities.
Registerd yet? At FDNY MSOC, network and operate with agencies from around the country.
response from the people and groups who
have attended, said Dr. Douglas Isaacs,
FDNY Deputy Medical Director, Office of
Medical Affairs. The MSOC allows agencies 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 experiences and learn from each other. The MSOC
is the highest quality educational conference 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 Conference organizer. This conference has
become the hottest ticket in the medical
special operations field.
The MSOC gives first responders, physicians 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 prominent 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 years conference will
include the militarys approach to extended patient care management, hemorrhage
control with limited resources and a
firsthand, patient encounter with the Haiti
earthquake. Optional pre-conference workshop topics include a hands-on cadaver
lab, tactical medical care, wilderness medicine 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 register to attend the conference, go to www.
fdnypro.org/msoc. n
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
online at www.fdnypro.org
@fdnypro
Preparing for Success
The What Ifs--How Preparing for Ebola

Prepares for All Hazards
By EMT Amanda Schmidt
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 walkin patient exhibiting symptoms of the Ebola Virus Disease (EVD) and seeking treatment.
Before anything else, preparation is the key
to success.--Alexander Graham Bell,
Inventor
O
n October 23, 2014, local health officials 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 mission and pre-hospital care and transport
functions put the Department and its personnel at the forefront of this potentially
global pandemic crisis.
Planning Ahead
Due 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 Citys
boroughs. Research and planning quickly
led to familiarization drills on EVD. Unfortunately, the what if scenario for New York
City quickly changed to what now, leading
PROEMS
to even more rigorous levels of preparedness.

Exercise Design
It took CTDP members fewer than two
weeks to develop the first full-scale
exercise with an area hospital (Kings
County Medical Center) on the transfer of potential EVD patients by FDNY
personnel. During the exercise, a simulated, 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, conducted by CTDP.
The exercise series used two methods for

maximum effectiveness. The first approach was to conduct tabletop exercises
(TTX) to promote discussions between
hospital and FDNY personnel, which vastly
increased awareness of the respective duties 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 Commander to possess all of the contact information, 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 designated EVD treatment centers. Under the
adage, practice makes perfect, participants worked effectively, using open communication 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
Pre-Planning is Critical to
Ensuring Succesful Operations
The Scenario
Ready for Anything. FDNYs 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.
New Information Tool. FDNY BIT (Bio-Isolation Transfer) Cards allow an FDNY Incident
Commander to possess all of the contact
information at hospitals, including transfer
points and other important information.
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 preparedness, the ability of any department to
respond to a crisis comes down to two
things: Planning and training. While creating 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.
Mission
The primary goal of FDNY EMS always is
to provide the best professional pre-hospital 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, preparedness and diligence. n
Playing it Safe. FDNY units take part

in exercise in full personal protective
equipment (PPE).
About the Author:
More Online
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BIT CARD
EMT Amanda
Schmidt is a 24year veteran of
the FDNY. She is
currently assigned
to the Office of the
Fire Commissioner
as a Liaison. Previous assignments
include the FDNY
Center for Terrorism and Disaster Preparedness (CTDP), where she is still
involved in coordinating and designing
homeland security preparedness exercises, and the EMS Bureau of Training.
Amanda is a certified Master Exercise
Practitioner (MEP) through FEMAs
Emergency Management Institute
(EMI) and a certified DOH Instructor
Coordinator with NYS. She is also a
NYS Regional Faculty member.
@fdnypro
Step by Step
Donning and Doffing Procedures

Utilized by FDNY Personnel
By Lieutenant Farooq Muhammad (in collaboration with the FDNY Ebola Committee)
R
eviewing the proper procedure for donning and doffing
infectious control ensembles

is always a top priority for patient 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.
Donning
First, members should remove
any items from their person
that potentially can tear the
A60 suit.
You should attach your Department-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.
PROEMS
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 adhesive 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 patients 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.
Doffing
Doffing the FDNY-issued infectious control ensemble:
You must have a large, biohazard bag ready. You also will
need a clear bag for contaminated items that are not
disposable for later decontamination. 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 significant 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, HazMat units will respond to the
emergency department to perform valet doffing and decontamination 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 contamination 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 supervising 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 contamination, 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 contamination, proceed with doffing.
Using hand sanitizer, bleach
spray or disinfectant wipes,
disinfect your outer gloves.
Whenever you use hand sanitizer, bleach spray or disinfectant 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 ChemTape from your wrists and
place into the biohazard bag.
On the right side, grasp the
PHOTOS BY EMS ACADEMY
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).
More Online
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Poster
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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. Keeping your hands inside, roll the suit down to
your waist and then down to your ankles.
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
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 touching the outside of the suit while doing this
and do not let these items come into contact with your skin or uniform. Disinfect
the inner gloves again by using hand sanitizer, bleach spray or bleach wipes. Add a
new, fresh pair of gloves over the original
gloves. Now remove your facepiece by following 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.
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
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 decontamination.
About the Author:
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.
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
FDNY Infectious Control Ensemble
Lieutenant Farooq
Muhammad is a 20year veteran of the
FDNY Emergency
Medical Service.
He began his career
as an EMT and
moved up the ranks
to Paramedic and
Lieutenant. Five
years ago, he joined the Departments
internal training and information program called DiamondPlate, representing the EMS Academy. He has received
awards for his role in producing videos
on Intranasal Naloxone and Ebola Preparedness. On the web, he is known
for YouTube music videos highlighting
EMS and Fire professions.
@fdnypro
EMS Leader
Scene Management at New York Citys

First Confirmed Case of Ebola
By Deputy Chief John Sullivan
I523,
n October 2014, while operating as car
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 other notifications, which included FDNY.
Upon my arrival, I immediately made contact 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 probability 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 without 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 located 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
10
PROEMS
Transfer Point. With a police escort, FDNY units arrive at Bellevue Hospital in Manhattan.
promised to keep him updated.
The EMS Officers were keeping me apprised 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 assisting 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
patients 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, members 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 patient. 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 apartment buzzers, also with no response. We
had tried for 10 minutes without gaining
entry. I pushed multiple apartment buzzers, 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 proceeded up to the patients apartment, 12
minutes after our initial attempts to gain
entry.
This assignment
yielded a positive
outcome due to the
professional
conduct exhibited
by all members, in
particular, exceptional communications among all
involved.
Debrief. Chief Sullivan speaks with

FDNY members involved in the
assignment after successful
operations are completed.
Lieutenant Caballero continued to ensure

the transport ambulance was fully prepared 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. Asaeda, 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 requested 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 available 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 patients 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 Outcome
This assignment yielded a positive outcome 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 Challenges
Several challenges cropped up on this response 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 operating 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 patients apartment.
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. Additionally, the patients privacy has to be protected. 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 entertained 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 expose Officers and members to the public
for scrutiny and questions regarding the
patient.
Note
On suspected Ebola cases, Haz-Tac members 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 consequences that might arise.
Members who are accepted into the HazTac 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
About the Author:
Deputy Chief
Sullivan currently
is assigned to EMS
Division 2. Appointed in 1986, he
served 10 years in
Manhattan before
being promoted
to Lieutenant and
then Captain. He
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 Johns
University.
@fdnypro
11
One on One
Dr. Dario Gonzalez on Being Dispatched to

West Africa During Ebola Outbreak
By Captain Elizabeth Cascio
On the
Front
Lines
Itherecently
had the honor of conducting
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 employee, 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-related 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-
12
PROEMS
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, Dont
you want to think about it? I said, No,
lets go.
Q: How many patients did you treat and
what was the experience like?
You lose count after a while. I went to Anniston, (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 whats 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
dont 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 its 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 2/2 hours
now.
Youre protected and you go in. And the
idea is, you go in and the first time, you
dont do anything, you dont touch anything, 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
PHOTOS BY CENTERS FOR DISEASE CONTROL AND PREVENTION
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actually assist with providing care. That
really is putting in IV lines, giving fluids,
doing assessments, seeing if somebody
is still alive, seeing whats 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 didnt 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 remember 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. Shes 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, its reallyits quite
frightening. And if anybody tells you, Oh, I
can do that. Its no big deal. The response
is, You dont know what youre 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 dont
get sick for the next couple of days. Its
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 couldnt 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 Im
much more appreciative of what goes on,
Im much more sensitive to what goes on
in the world. One of the big things is, we
worry about trivial stuff that doesnt mean
a whole lot. We sit here and worry about
things and we say, this is important. No
its not. n
Deadly Toll. Dr. Dario Gonzalez (seen far left)

worked inside African medical tents and saw
firsthand the devastation wrought on thousands of people.
About the Author:

Captain Elizabeth
Cascio is a 32-year
veteran of Emergency Medical
Service, including
20 years with FDNY.
She serves as Executive Officer to the
Fire Commissioner
the first woman
and EMS Officer to do so in Department history. She began her career as
an EMT in Brooklyn, later serving as
a 911 Medical Dispatcher and as program coordinator for the EMS Cadet
Program. In 1994, she helped develop
and implement the FDNY CFR training program, teaching Firefighters to
respond to medical emergencies. She
is an editorial advisor for PROEMS.
@fdnypro
13
Special Apparatus
FDNYs New Rescue Medic Ambulance

By Assistant Commissioner Mark C. Aronberg
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 services 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 moments 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
14
PROEMS
ambulances, we enlisted the help of numerous 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 Diamond for their tireless work and dedication 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 afforded 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 accommodate all of the special equipment
necessary to operate safely and effectively 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 disentanglement, Paramedics are medically
stabilizing and packaging the patient.
The new Rescue Medic ambulances, as
well as our new standard ambulances, are
Additional Specs
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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.
equipped with the Stealth Power idle-reduction systems. These smart systems
provide mobile electric power to run the
trucks electrical equipment, including air
conditioning and heat, power windows,
radios, data terminal and lights, without
running the engine. This allows the vehicle to be turned off while at the hospital,
at a cross street location or anywhere else
engine idling usually is required to run the
vehicles emergency equipment. This results in a significant fuel and maintenance
savings for the FDNY, as well as reducing
harmful emissions, diesel particulate matter 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 Yorks
stated goals for greenhouse gas emissions reduction.
Both our current ambulances and the Rescue 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
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.
At 27 feet long, FDNYs new Rescue Medic ambulance features a

conventional-style, extended International 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 minimum horsepower rating of 300
HP @ 2600 RPM and a minimum
torque rating of 660 ft.-lbs. @
1600 RPM.
Rescue Medic body is approximately 14 feet long, approximately 7 feet wide and approximately 9 feet tall. The interior
space of the patient compartment
is 11 feet long, 5 feet wide and 6
feet, 1 inch, tall.
The Rescue Medic ambulance has
provisions to carry four 60-minute
SCBA bottles.
About the Author:

Mark Aronberg
began his nearly
34-year City career
as an EMT/Paramedic in 1982 with
NYC EMS. As he
progressed through
the ranks in FDNY,
he held a variety of
positions in Fleet
Services and Technical Services. He
was instrumental in developing the Incident Management Teams equipment
cache and served as Cache Manager
for several years. He returned to Fleet
Services as Assistant Commissioner
in 2012. Hes an Officer in his hometown volunteer fire department.
@fdnypro
15
Stats
2015 FDNY EMS Statistics
FDNY EMS statistics were verified by FDNY

EMS Operations on 03/31/2016.
Compiled By EMT Harold Wagner

TOP 25 AMBULANCES
TOP 25 C. CAR
SPECIAL UNITS
Responses
Responses
Responses
RANK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
RUNS
RANK
UNIT
RUNS
2,814
2,792
2,778
2,758
2,691
2,684
2,678
2,671
2,653
2,570
2,559
2,558
2,545
2,483
2,417
2,414
2,413
2,413
2,381
2,371
2,370
2,363
2,351
2,350
2,333
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
C51
C54
C26
C53
C17
C19
C03
C43
C46
C16
C45
C55
C14
C18
C07
C04
C40
C08
C15
C38
C11
C58
C49
C20
C13
4,724
4,508
4,482
4,359
4,271
4,269
4,216
4,191
4,151
4,131
4,054
3,995
3,971
3,899
3,821
3,811
3,753
3,595
3,572
3,549
3,502
3,432
3,307
3,300
3,259
UNIT
16D2
11F3
16C2
07C3
12B3
12A3
08D2
07D2
07E3
11A3
14C3
12A2
16A3
16B3
07C2
06D3
07C1
14B2
07B3
16C3
06D2
12B2
08A3
06A3
08D3
Key to Abbreviations
Ambulance 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 Ambulance resource
16
PROEMS
*Six-wheel drive all-terrain

vehicle utilized for beach operations and special events.
Last digit is the shift (1-midnight, 2-day, 3-evening)
All specialty resource
definitions= LS, ME, MV, MR,
are followed by the Division
number:
1= Manhattan
2= Bronx
3= Brooklyn
4= Queens
5= Staten Island
UNIT
HT1
HT2
MR3
MV4
MR1
ME4
HTB
MV1
MV2
LS4
MR2
MV5
ME3
LS1
LS3
ME5
LS2
HT3
LS5
MV3
MR4
SPOTLIGHT ON CARDIAC ARRESTS
RUNS
1,175
957
310
253
227
162
148
135
134
129
115
101
87
68
61
48
40
22
14
13
2
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 Person Medical Provider: 1,730
13.99%
mass casualty incidents
(MCIs) to coordinate the
activities of all resources
to optimize patient outcome, 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, technical
rescue incidents), any incident that is substantially
more significant than an
ordinary occurrence because of its seriousness,
peculiarities, sensationalism, magnitude, differences or newsworthiness.
C
Conditions 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, HT
such as cardiac arrests and
Haz-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 assignment, the Haz-Tac Officer
may operate as a Haz-Tac
or Rescue Medical Technician to initiate care or
assist a Haz-Tac/Rescue
member.
HT Officer units are designated as follows:
HT1= City North (Manhat-
tan and the Bronx)

HT2= City South (Brooklyn, Queens
and Staten Island)
HT3= Supplemental Contingency
unit
HTB= Haz-Tac Captain operating
in field
LS
(LSU) Logistical Support Unit-- a
specially configured equipment
vehicle used to transport and provide 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 necessary. 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 perform one or more of the following
functions: provide needed equipment 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 borough. The METU, when properly
staffed, can provide transportation
for up to 24 non-ambulatory patients. 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.
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MR
(MRTU) Mobile Respiratory Treatment 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 simultaneously. 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
@fdnypro
17
Photo Reporter
18
PROEMS
PHOTO BY CAPTAIN ELIZABETH CASCIO
2 Documenting
What We Do...
Compiled by Paramedic Kyra Neeley
In every issue of FDNY PROEMS, our
Photo Reporter offers a unique perspective 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 Midtown 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 OShaughnessy
(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 competition 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 buildings, killing eight people and injuring at least
70 others. Here, FDNY EMS Haz-Tac Battalion
Lieutenant Thomas Schulz oversees the Medical 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 Manhattan. 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.
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
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 Womens Benevolent Association.
@fdnypro
19
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 previous 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 exposed 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 Respirator (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 didnt further expose his fiance 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. NYCs 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, Paramedic 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
20
PROEMS
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 wasnt 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 Medical Director of the Office of Medical Affairs (OMA). We previously 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 supposed 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 youre fine, but
Im sure youre a little bit uneasy, as anyone would be. Not for
nothing, but youve 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 were faced with, but
the Department is really great with our training and I trust it 100
percent.
Preparing for Ebola
Although the FDNY was tracking Ebola in West Africa since
spring of 2014, by early summer, officials started initial preparations of what to do if/when it came to New York City. After an
incident in Dallas in September 2014, Commissioner Daniel A.
More Online
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@fdnypro
21
Huge Undertaking. It took roughly three months to train the entire EMS workforce and each training session took approximately four hours.
Leonard. Theyd 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 ultimate 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 familiar with it, explained Deputy Chief Paul Miano. It wouldnt be
learning to use the equipment; it would be familiarizing ourselves
again and understanding that it can be used for this type of situation, not just the situation for which we were training.
The PPE suits normally are used for chemical protection and hazardous 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 biological 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. Were going to be using this equipment again,
but were 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
22
PROEMS
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 equipment we were purchasing didnt 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 ones 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
theyd 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
solution to decon people. Its clear, so you cant see it, but someone 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.
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.
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 Department on November 1, 2014, after NYCs inaugural Ebola patient
was being cared for at the hospital, he was briefed on the situation 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 werent 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 members of New York State called and asked us to share the training,
video and our PowerPoint with them, which we did willingly,
because we didnt know where this virus was going, noted Chief
Ahee.
A lot of ingenuity was exhibited by different members of the Department. One simple change was that we were using a bleach
We had to get the staff up to speed and recruit additional

instructors because we couldnt 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 patients 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 telephone 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 monitored compliance in the [dispatch system] very closely, he said.
The first time you introduce something new to the algorithm,
theres 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 patients 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
@fdnypro
23
Valet Doffing/Decontamination
Procedures for Ebola
By Deputy Chief Nicholas Del Re
In the summer of 2014, there wasnt 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 recommendations 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 Department 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.
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.
providers and wore their own PPE suits, said Assistant Chief Stephen Raynis, then the Chief of Training. The firefighting workforce
of the FDNY did awareness training through videos released
internally on the Departments intranet website DiamondPlate to
recognize the symptoms of an Ebola patient, even if the patient
they were dealing with didnt 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 theyre
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 Fever/Travel call and theyd have to wear PPE and other protective
equipment. They were trained to put on a mask and gloves and
24
PROEMS
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Policy Brief
an N95 TB respirator, the gloves and a gown when dealing with

a Fever/Travel patient. This equipment is part of an isolation kit
thats on their rigs, but is not as sophisticated as the PPE suits
the EMS Haz-Tac used, explained Chief Raynis.
Making Sure Units Were Available
There were select Haz-Tac units designated and strategically
deployed off-line or on standby, waiting for that F/T call type. Because 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
Leading New York Citys first successful Ebola operation showed the country that the FDNY is ready
and able to handle any situation its members face.
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 [ambulances] back in the 911 system and if we had a Fever/Travel call, wed
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 circumstances. 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 someone 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 Paramedics treating the patient. We determined early on that you
couldnt take care of a patient, take the suit off, get in the ambulance and drive it and put the suit back on and get the patient out
of the ambulance, stated Chief Miano. Theres too much chance
of getting contaminated while doffing the equipment. Wed
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
wed 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 Case
The FDNY calls the On Line Medical Control Center (OLMC) as
their source of telemetry. Based in Queens, its 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 orders, information about additional medication or treatment thats
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, theyre knocked out of the box of making 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 coming 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 were 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 couldnt 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 Citys first successful Ebola operation
showed the country that the FDNY is ready and able to handle 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 Fitton. While this equipment wasnt 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 Departments service, stated Chief Miano. I think my
peers in other parts of the country should look around at
whats 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 doesnt take long for something to get
from one part of the world to the next. Be proactive in your
Department by being reactive to whats going on across the
country. When patient zero came, we already had something 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 adjustments, 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
@fdnypro
25
Building Blocks for

Accomplishing Our Mission
By Chief Medical Officer, Special Advisor to the Fire Commissioner for Health Policy, Dr. David Prezant
Isuccessfully
n August 2014, months before FDNY
transported its first Ebo-
la patient, it was my responsibility as

FDNYs 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 patient with Ebola Virus Disease (EVD) from
a pre-hospital environment to a hospitals
emergency department or bio-containment unit. At the time, guidance information 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 preparedness. 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), integrate the best EMS and Fire had to
offer and retrain accordingly.
Coordinate with other partners,
including the New York City Department 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-making and technical representatives from
Fire and EMS Operations, Haz-Tac EMS,
Haz-Mat Fire, Communications, Physicians 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-
26
PROEMS
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
Departments Bureaus and units.
ly with an epidemic-like surge of patients.
Based on the task forces collective
experience, we knew that the far greater
likelihood was that single or several patients 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 forces 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/HazMat 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-supervised doffing and a special call to HazMat 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 follow-up. We organized tabletops and drills
with FDNY, DOH and receiving hospitals
to assess and improve all facets of the response. Members of the task force were
present and reported back with assessments, 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 continue to maintain our preparedness for this
and all hazards.
The task force was recognized by the Fire
Commissioner and the Chief of Department with an award for excellence. The
award institutionalizes the task force
approach as a model for future use by
FDNY and other departments. n
About the Contributors
(In order of appearance in article)
Haz-Tac Paramedic Winsley Julien

joined FDNY in
1999 as a Paramedic. He became
Haz-Tac certified
in 2005. He has
served for 16 years
at Station 14 in the
Mott Haven section
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 Citys first
Ebola patient. He holds an AAS degree
in Applied Science from Manhattan
Community College.
Dr. Glenn H. Asaeda, MD, FAAEM,

DABEMS, is the
Chief Medical Director with the FDNY.
Board certified in
Emergency Medicine and EMS, he
has been an EMS
field provider since
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 provided on-site medical oversight during
the tragic September 11th terrorist
attacks.
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 promoted to Captain
in 1997, Deputy Chief in 2006 and Division Chief in 2008, serving in all five
boroughs. In 2011, he was appointed
Chief of Medical Dispatch. In January 2015, Chief Fitton was appointed
Assistant Chief of EMS. Chief Fitton
holds a Bachelors degree in Emergency Management and Community
Affairs from Empire State College of
the State University of New York.
Chief James E.
Leonard is the current and 35th Chief
of Department. He
was appointed in
2014. His career
with the Department began as a
Firefighter with Engine 310 in Brooklyn 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 Institute (FOMI) at Columbia University.
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 commands. Throughout
his career, Chief
Ahee has served in a number of key
positions, including the role of Commanding OfficerStation 45, Deputy
Chief in Division 2 and the Deputy
Chief of EMS Training. Currently assigned to Recruitment and Diversity.
Deputy Chief Paul

Miano, is a 16-year
veteran of the
FDNY Emergency
Medical Service.
He serves as the
Chief of the HazTac Battalion. He
began his career as
an EMT in Brooklyn,
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 Pintchik Medal and The Leon Lowenstein
Award.
(Sidebar page 24)
(Sidebar page 26)
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 Management Institute
(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 related to Chemical Protective Clothing
Standards.
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
FDNYs World Trade Center Medical
Program. Dr. Prezant was in charge of
coordinating FDNYs overall preparedness and response to patients with
potential Ebola Virus Disease.
Assistant Chief
Stephen Raynis is a
35-year veteran of
the FDNY. He is the
Chief of Fire Dispatch Operations
in the Bureau of
Communications.
He is a graduate
of the Masters
Program from the Center for Homeland Defense and Security at the
Naval Postgraduate School and FDNY
Officers Management Institute (FOMI)
from Columbia University Graduate
School of Business.
@fdnypro
27
Mysterious Origins. The Ebola outbreak

began in the nation of Guinea in 2013,
spreading quickly to other West African
countries.
Retracing Ebolas Deadly Path

By Chief Medical Director, Doctor Glenn H. Asaeda
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 mysterious 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 described 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. Humans are infected by bats either through
indirect contact with their saliva from half-
28
PROEMS
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 infected victims may begin to bleed both internally and externally. The disease death
rate is anywhere from 25 to 90 percent of
those infected. Currently, a vaccine is being 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 international public health crisis.
Ebola Cases in the United States
On 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 Nebraska, becoming the first case of Ebola in
the United States. He was treated successfully and released after a three-week
stay in the hospital.
In late September 2014, a person coming
from Liberia became the first U.S. diagnosed 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 effectiveness of personal protective equipment
(PPE).
Into New York City
On 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 successfully and released from the hospital
about three weeks later.
The initial efforts to block the diseases
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
PHOTO BY DEPARTMENT OF DEFENSE
Ebola Scare
Tabloid Coverage. Local press coverage

detailed Ebolas path to New York City.
Tent Facilities. Makeshift hospitals served many Ebola patients in the hardest hit nations. Strict rules were enforced for operating inside to avoid further
spread of the disease.
Case Count
As of this writing, the following information 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)
On August 8, 2014, the World

Health Organization (WHO)
declared the epidemic to be an
international public health crisis.
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 Ebola-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 End
As previously mentioned, all of the Departments preparations paid off on October
23, 2014, as FDNY members responded to
the Citys first Ebola patient. Our units assessed, treated, transported and delivered
this first Ebola patient to Bellevue Hospital.
The handoff to hospital infectious disease
personnel went smoothly, as did FDNYs
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. FDNYs
plans were robust enough to respond not
just to Ebola patients, but to any patient
infected with a future potential communicable disease that may present in the Departments response area. The outstanding
teamwork of all units within the FDNY facilitated 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
Liberia:
Sierra Leone:
Guinea:
Nigeria:
Mali:
United States:
Senegal:
Spain:
United Kingdom:
Italy:
28,603
14,124
3,804
20
8
4
1
1
1
1
About the Author:

Glenn H. Asaeda, MD, FAAEM,
DABEMS, is the
Chief Medical Director with the FDNY.
Board certified in
Emergency Medicine and EMS, he
has been an EMS
field provider since
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 provided on-site medical oversight during
the tragic September 11th terrorist
attacks.
@fdnypro
29
Tiered Response: Preparing for Novelty

By Assistant Chief Joseph W. Pfeifer
F
irst responders are expected to have
emergency response plans in place and
Figure 1. Typical hazardous

material incident illustrates how a multi-tiered
response works.
periodically test these plans through exercises to ensure that the procedures work.
But after years of preparedness, what happens when they are faced with an event
that goes beyond specific plans? Are first
responders prepared for novelty? On October 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 professionals 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 doctors residence and
used personal protective equipment (PPE),
originally purchased for chemical terrorism 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 system-wide response contained a potentially
fatal epidemic and proper decontamination procedures ensured the safety of all
emergency responders.
Tiered Response Model
Such 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 response 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 organization 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, biological, 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 identification, chemical protective equipment and
decontamination. These two tiers are fol-
30
PROEMS
Note: Haz-Tac
ambulances are
staffed by EMT or
Paramedic Haz-Mat
Technicians.
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 HazMat Unit I and the Haz-Mat Battalion.
The Tiered Response Model increases
FDNYs capability and capacity to deliver
timely services by integrating each tier
into a response matrix. For routine hazardous 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 incident 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 performed in the face of novelty. The incident
demanded four operational elements.

CommandBio-incident operations
were under the strict supervision of
an Incident Commander and a HazMat Operations Chief, assisted by an
EMS Officer.
Pre-Hospital CareEMS 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 TransferThe patient was
handed off by EMS personnel in
protective gear to hospital personnel,

who had the proper personal protective equipment.
DecontaminationHaz-Mat Technicians in CPC were used to properly
decontaminate responders and
equipment at the end of the incident
to ensure no cross contamination.
The Departments Tiered Response managed 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 returning from an Ebola-infected country with
a fever was treated as a possible Ebola patient. FDNY, as the lead pre-hospital emergency 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 capacity for bio-responses could spread the
disease with national consequences.
Reconfiguring Tiered Response
With 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, FDNYs Tiered Response was
leveraged and, simultaneously, reconfigured to manage the risk of an Ebola outbreak in one of the worlds most densely
populated cities.
With the stakes

so high, crisis
managers had
to think
systematically
about the
complexity of
preparedness.
@fdnypro
31
Figure 2. The structure of a

pyramid allows for seamless adaptation among
first responders, hospitals
and government agencies.
responders and hospital staff to work

together to provide patient care and avoid
spreading the disease. The systematic reshaping 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. Dont get contaminated.
3. Clean up when you are done.
New levels for preparedness emerged
from collective interactions as a bottom-up process of self-organization and
the emergence of a Tiered Response
Pyramid.
The Technician and Specialist tiers, made

up of units from the Departments 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 preparedness. Reconfiguring involved discovering how a different part of the Department 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 experience enhanced the disease monitoring.
The Center for Terrorism and Disaster Preparedness was used to design joint tabletop and full-scale exercises for FDNY and
the hospital. The Departments Tech Services 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 Triangle by rearranging the building blocks of
tiered response with new elements in the
Mission Specific Tier.
32
PROEMS
Reshaping Tiered Response

Understanding the urgent need to avoid
a pandemic, FDNYs preparedness efforts
were extended to hospitals and coordinated 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 required 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 Pyramid 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 systematically about what can be done (capability), 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
Preparedness is the process of adapting

to perpetual novelty by reconfiguring and
reshaping the building blocks of tiered response 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 Organization (WHO) declared the end to the
deadliest Ebola outbreak on record, which
killed more than 11,300 and infected more
than 28,500. FDNYs 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 preparedness. n
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 Counterterrorism and Emergency Preparedness. He holds
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.
EMS PRIDE
FDNY is Celebrating the Merger of

FDNY and NYC EMS! Join Us!
Get Your Official

FDNY Gear!
Online!
fdnyshop.com
Worn with Pride!

FDNY EMT
Michelle
Campbell
In Store!
FDNY Fire Zone
51st Street
Between 5th & 6th Avenues
New York City
Proceeds support the FDNY Foundation To Better Protect New York

@fdnypro
33
The 10-12
Celebrating 20 Years!
FDNY life safety mascot Siren

and the FDNY EMS 20 Ambulance appear in Flushing
Meadows Park in front of the
iconic Unisphere. The ambulance debuted March 16, 2016,
to help commemorate the 20th
anniversary of the merger between FDNY and NYC EMS.
Division 1
Retirements/Terminal Leave
Division 1EMT Martin
Fernandez (RCC), appointed
09/12/1988. Station 16Lt.
Pamela Hehn, appointed
08/13/1984. Station 16Lt.
Eartha Sedeniussen, appointed 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 16s
relationship with the community.
Division 2
To commemorate Cancer
Awareness Month in October,
EMT Diana Baez of FDNY
EMS Div. 2 led the way in
getting our Stations involved
in raising awarenessBig
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
34
PROEMS
Womens/Childrens Shelter,
located in Brooklyn. Her dedication 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 Womens/Childrens 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 3
2015 saw a new Division
CommanderSteven 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 Lightsey, 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 Anthony 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 directed to assign a member to the
PROEMS project.
Division 4
We would all like to wish
EMT Johnathon Leavy best
of luck in his new position
as Chief Bonsignores 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 accomplishments! So as we prepare
for our move into our new
home on Goethals, lets 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 Paramedics to say hello to from our
ptop program, medic basic
and new transfers! Welcome,
Paramedics Lennon Parasram, Omran Khan, Ashriel
Frasier, Amanda Uster,
Steven Myhand, Anthony Palmato, Rocco Panetta, John
Piccone, Megan Pfeiffer,
Dachary Farnum and Vijay
Rampersad and EMTs Christopher 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 contributions 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 successfully completed Medic
Basic, Andre Gallego and
Malcom Jenkins. Congratulations 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 sometimes, we need to congratulate ourselves and take
note. One such time was the
FDNY Foundation
newsworthy moment where
two of our crews46Z2, Mike
Greco and Vanessa Tenorio
and 6482, Sal Salvatore
and John Lamonicaalong
with Station 46s crew of
4682 Michael Rojas and Eric
Feng, rescued and resuscitated 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 46s new Paramedics: Andres Coll Martinez
and Gonzalo DeJesus.
Station 46 congratulates
Paramedic Trevor Coleman
on his 10-year anniversary
with the Department. Also,
congratulations to Paramedic Christopher Gonzales on
his five-year anniversary with
the Department. Congratulations to all the members who
passed their medic screening and could be in the next
Medic class.We send our
condolences to Station 46s
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 Paramedics 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
What a Year!
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 Departments 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 Anniversary, 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 messages of fire and life safety.
Beyond those open houses, Commissioner Nigro said the Departments community outreach, fire safety education and free CPR classes in 2015 reached more
than 740,000 New Yorkersa 26 percent increase over 2014at 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 delivered 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
Mayors Office, the City Council and the Foundation to offer the largest smoke
alarm giveaway and installation program in the country. These programsand
others like themare saving lives and the Foundation is proud to continue to
fund training, equipment and the educational needs of the FDNY to help New
Yorks Bravest continue to address the complexities of response in this great
City.
@fdnypro
35
The 10-12
3
6
5
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 station 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 Medical 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 second biggest snowstorm in
the history of New York City.
EMS BS4 offers congratulations 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
36
PROEMS
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 emergency care providers and that
eventually, the torch will be
passed on to them.
Division 5
Capt. 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; and
Lt. Matt Jachyra: one-year
anniversary as EMS Lieutenant 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 anniversary 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 Announcements: Paramedic Arthur
Bronshteyn is the proud father of baby girl, Avigail, and
Lt. Luis Devino is the proud
father of baby boy, Vincent.
Station 43 wants to extend
their thoughts and prayers to
Salvatore Turturici, a member of FDNY EMS, who is
battling 9-11-related cancer.
Members completing 10
years of service in 2016:
Paramedic Mary DAngelo,
#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). Everyone is ecstatic!
EMS Academy
Congratulations 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 accepted 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 September 28, 2015. We, at the
Bureau of Training, wish him
the best of luck. Congratulations to Lt. Barbara Aziz-Lopez! 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 promotion on 5/22/2015. We, at
the Bureau of Training, wish
her the best of luck. Congratulations to Lt. William
Bedoya! Lt. Bedoya has been
#1
As part of the FDNYs 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.
#2
FDNY Chief of EMS James Booth gives a high five to his new mascot,
EMT Siren, at one of the FDNYs 150th Anniversary celebration events.
#3
FDNY Commissioner Daniel A. Nigro meets new EMS mascot, EMT
Siren, for the first time. Awwwww!
#4
Led by Instructors from the FDNY CPR Training Unit, community members take part in the Be 911 CPR Programa free, 30-minute class
on compressions-only CPRat one of the FDNYs 150th Anniversary
celebration events.
#5
Check out this great hat at fdnyshop.com!
with the Department for nine

years. Lt. Bedoya became a
BLS Instructor in 2010 and
then upgraded to an ALS Instructor 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 Affairs
Congratulations to Paramedic Sean Randazzo, #4927,
who was accepted to Stony
Brook University School of
Medicine. Paramedic Randazzo currently is assigned to
the Office of Medical Affairs/
Telemetry and just completed five years of service with
the Department. We wish
him success with his future
educational endeavors.
EMS Operations
Congratulations to EMT/P
Nicole Nehwadowich. She
booked her first cruise to the

Caribbean for summer 2016.
EMT Cosmo Jackson received 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
Bentos son passed part of
his Boards for becoming a
doctor. Cathy McCrories 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 acknowledges the great team
working for him. Chief Janice
Olszewski appreciates her
recent promotion to Deputy Assistant Chief and for
being one of the honorees at
the FDNY Womens History
Month Awards ceremony.
Haz-Tac
Lt. Barrett Hirsch promoted
to Captain (occurred on September 28, 2015). Capt. Paul
Miano promoted to Deputy
Chief (occurred on December
6, 2015; see pic page 36, #7).
#6
2015 FDNY 2nd Chance Brunch
FDNY 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 immediately 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 spontaneous 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.
#7
Haz-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!
#8
As part of the FDNYs 150th Anniversary celebration, EMTs and Paramedics 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.
#9
Station 40 receives new gear racks to properly store turnout gear and
associated equipment.
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 attendees include Division Commander Roberto Colon, Lt.
Ann Mullooly (ret.), Captain
John Ryan (ret.), Lt. Kirk
Delnick (ret.), Lt. Bill Melaragno 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 (December 2015). New Rescue
Paramedic ambulances hit
the street, March 2016!
Emergency Medical Dispatch
Chief Napoli and Chief Aurrichio would like to congratulate 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.
Wed 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 Meringolo
Division 2:
Chief Joseph Pataky
Division 3:
EMT Joseph Brandstetter
Division 4:
EMT Beth Tichman
Division 5:
Paramedic Krista ODea
EMS Academy:
Capt. Jack Quigley
Emergency Medical Dispatch:
EMT Milagros Ramirez
Haz-Tac:
Lt. Tracey Mulqueen
Office of Medical Affairs:
Chief Gerard Santiago
EMS Operations:
Paramedic Nicole Nehwadowich
@fdnypro
37
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CHRIS CARRERA
SALVATORE J. CASSANO*
JOSEPH P. COPPOTELLI
MATTHEW J. DILIBERTO
HEIDI HOTZLER
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38
PROEMS
WWW.FDNYFOUNDATION.ORG
In Memoriam
This first edition is dedicated to the FDNY EMS
members who have made the Supreme Sacrifice,
proudly serving New York City...
EMT Christopher J. Prescott
Station 39
Pennsylvania Station
6/17/94
Lieutenant Ricardo Quinn

Station 57
Bedford-Stuyvesant Station
9/11/01
EMT Tracy Allen-Lee

Station 10
Yorkville Station
9/24/97
EMT Andre R. Lahens

Station 39
4/25/02
Lieutenant Barbara Poppo

Station 39
1/21/01
Lieutenant Brendan D. Pearson

Station 23
Rossville Station
4/23/05
Paramedic Carlos Lillo

Station 49
Astoria Station
9/11/01
...and to all those who have died of World Trade

Center-related illnesses since bravely and selflessly
contributing to the rescue and recovery efforts.
Paramedic Deborah Reeve
EMS Station 20
Morris Park Station
3/15/2006
EMT Anthony J. Ficara

EMS Station 43
Gravesend Station
6/15/2012
Paramedic John W. Wyatt, Jr.

EMS Station 22
Willowbrook Station
9/24/2013
Lieutenant Brian Ellicott

Bureau of Communications
EMS Dispatch
11/26/2007
EMT Joseph V. Schiumo

EMS Station 20
Morris Park Station
12/9/2012
EMT Luis de Pea

EMS Station 13
Washington Heights Station
11/7/2013
Paramedic Clyde F. Sealey

Bureau of Health Services
Headquarters
4/12/2009
Paramedic Ruben I. Berrios

EMS Station 20
Morris Park Station
12/10/2012
Lieutenant Michael F. Cavanagh

EMS Station 16
Harlem Station
12/2/2013
Paramedic Carene A. Brown

Bureau of Training
EMS Academy
12/22/2009
Lieutenant Douglas Mulholland

EMS Station 35
Williamsburg Station
5/28/2013
Captain William C. Olsen

EMS Station 23
Rossville Station
6/1/2014
EMT Freddie Rosario

EMS Station 4
Lower East Side Station
6/15/2010
Paramedic Rudolph T. Havelka

Bureau of Training
EMS Academy
7/9/2013
Lieutenant Thomas Giammarino

EMS Station 31
Cumberland Station
10/7/2014
Deputy Assistant Chief

John S. McFarland
EMS Operations
Headquarters
2/6/2012
EMT Francis A. Charles

EMS Station 58
Canarsie Station
8/27/2013
#FDNYEMS20

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PROEMS

By Daniel A. Nigro, Fire Commissioner

PROEMSthe Departments first ever magazine highlighting the medical training,

Building Blocks for

By Deputy Chief Nicholas Del Re

By Chief Medical Officer, Special

By Chief Medical Director,

By Assistant Chief Joseph W. Pfeifer

On the Front and Back Covers

Avoiding the Spread of Communicable

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

If symptoms and travel history suggest

municable disease, but particularly Ebola

Assure early identification of the

Fit-tested respirators and eye protection

undertaken, including aggressive hand

Keep hands away from face.

About the Author:

Registration Open for 2016 FDNY

he FDNY and the FDNY Foundation

involved with increasing the survivability

The three-day conference will consist of

Preparing for Success

The What Ifs--How Preparing for Ebola

New York City. A physician working for

to even more rigorous levels of preparedness.

The exercise series used two methods for

Ready for Anything. FDNYs Exercise

hospitals, including the many lessons

Playing it Safe. FDNY units take part

Donning and Doffing Procedures

infectious control ensembles

You should attach your Department-issued hand sanitizer to

Don your first pair of nitrile

The edge of the hood should

In the event non-Haz-Tac

The Conditions Officer should

Find a surface where you can

When removing the shroud,

Unzip the suit carefully so as

PHOTOS BY EMS ACADEMY

Slip your feet into the suit and

suit, which should be taped).

fingertips of the outer glove in order to

1 Kimberly-Clark A60 Suit

area. Remove the second foot from the

Place all used bleach wipes into the

When Haz-Mat is on-scene, they will

About the Author:

Follow Department policy and guidelines

FDNY Infectious Control Ensemble

Scene Management at New York Citys

residence in Upper Manhattan, along with

Debrief. Chief Sullivan speaks with

Lieutenant Caballero continued to ensure

2) The inability to gain entry into the

Dr. Dario Gonzalez on Being Dispatched to

FDNY PRO Podcast with a colleague of

fection resulted in death or critical illness.

Department of Defense (DOD) and World