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Not since 9/11 has the Emergency Medical Service endured the kind of "battlefield" conditions workers faced as March turned to April as the city's coronavirus cases, according to Oren Barzilay, president of District Council 37's Local 2507, which represents Emergency Medical Technicians.
"With 9/11 it was limited to one area of the city, but this is the entire city one day after another with no end in sight," he said in a phone interview. "FEMA has hired 500 EMTS and Medics and we now have ambulances from as far away as California on the streets."
About 20% Out Sick
The FDNY reported April 2 that 338 members, including firefighters, EMS members and civilian employees, were COVID-19 positive. Roughly 3,000 employees from the department's 15,000 were out sick, triple the 6-to-7-percent normal absence rate.
The city reported it had 1,562 COVID-19 deaths, up 188 from the previous day. New York State reported 2,373 deaths, accounting for 42 percent of the U.S. total.
A day earlier, Governor Cuomo told reporters that based on data from the Gates Foundation, the COVID19 pandemic could claim the lives of 16,000 New Yorkers, with the "apex" of the coronavirus outbreak requiring another month of quarantine.
The Gates-funded Institute Health Metrics and Evaluation projected that across the country there would be 93,700 deaths, while the Trump Administration projected a death toll between 100,000 and 240,000.
According to the FDNY, emergency medical calls shot from 3,294 on March 22 to 6,527 on March 30, ticking down a bit to 5,907 two days later. "This past week was the busiest stretch in the history of the City of New York," said Frank Dwyer, FDNY Deputy Commissioner of Public Information. "There's just nothing to compare it too."
Sent Dozens Upstate
Mr. Barzilay said that he had reports from his members that both the city's municipal and private hospitals where swamped with incoming patients. "We had to transport dozens that were on ventilators up to Albany," he said.
As a consequence of the unprecedented demand on the city's hospitals and the lack of intake capacity, for the first time ambulance crews were ordered not to transport cardiac-arrest cases to the hospital if they had not been able to restart the patient's heart at the scene.
"No adult non-traumatic or blunt traumatic cardiac arrest is to be transported to a hospital with manual or mechanical compressions in progress without either return of spontaneous circulation or a direct order from a medical control physician unless there is imminent physical danger to the EMS providers on the scene," according to the directive issued by the Regional Emergency Medical Advisory Committee of New York City.
Under New York State public-health law, REMAC is designated to "develop, approve and implement pre-hospital treatment and transport protocols for the City of New York in the event of an emergency."
'EMS in a War Zone'
"We have been saying for a few weeks that EMS is in a war zone and the public has not taken that seriously," Mr. Barzilay said. "But this directive marks a new phase, where if the patient has no pulse after we attempted to resuscitate them, we pronounce them dead right there at the scene."
He continued, "This is going to put our members in an extremely stressful and dangerous situation with family members and friends at the scene who will assume we gave up, despite all of our efforts to revive their loved one."
Vincent Variale, president of DC 37's Local 3621, which represents FDMY EMS officers, said he believed the emergency directive was "necessary considering the crisis we are in."
"But I do think there's been some confusion in the media on this," he said. "We will respond with the same procedures, the same CPR and drug treatments. The only difference is that after some time trying to revive someone, if we can't restart the heart we won't transport to the hospital. Before COVID-19, we would transport no matter what."
'Not Safe to Be Close'
He continued, "Now, if that patient has COVID-19, it is not safe for family members to be too close to their loved one. They need to have social distancing from the body. No matter what your faith or belief, this is going to be really hard on people."
For EMS union officials, who complained for years about chronic turnover, short-staffing, and an increasingly inexperienced workforce, COVID-19 is the nightmare scenario they warned about.
Mr. Variale said that years of EMS members migrating over to the better-paying firefighting side of the FDNY had resulted in loss of experience among ambulance crews.
"This is exactly the kind of situation where experience really matters, and we now have a emergency medical service where 75 percent of members have less than three years," he said. "We know from the medical literature that patient outcomes, particularly for cardiac patients, improve when the EMT has six years of experience. Now, people will die because we don't have the experience out there."