UFA: Slower EMS Response Times Hurt Firefighter Performance, Too

Chief Leader - October 03, 2020

by BOB HENNELLY

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The significant uptick in Emergency Medical Service response times can also slow fire-company responses to fires, according to Andy Ansbro, the president of the Uniformed Firefighters Association.

According to the Mayor's Management Report, the time elapsed from when a call came into a dispatcher until an FDNY ambulance arrived on the scene went from an average of 9:22 in fiscal 2019 to 10:19 in the fiscal year that ended June 30.

Engine Companies 'Stuck'

"When the FDNY EMS system is overtaxed, fire-engine companies can end up stuck with a patient waiting for EMS and transport," Mr. Ansbro said during a phone interview. "Legally we can't leave a patient until EMS arrives."

The Management Report attributed the spike in response times to "the unprecedented demand on the EMS system during the peak months of the crisis" and "was exacerbated by high levels of medical leave among EMS employees."

Last fiscal year, the city's daily average for "peak ambulances in service" was 491, up from 460 the year before. Last year's calculation also includes 250 additional ambulances provided by the Federal Emergency Management Agency for the busiest weeks of the initial wave.

The MMR figures include the period starting March 7, when the FDNY ordered firefighters not to respond to medical emergencies related to respiratory distress out of concern that one Firefighter's infection could put an entire firehouse at risk of being placed under quarantine. That order was rescinded on April 23.

Hampered by Hyped Calls

Mr. Ansbro said in normal times when fire companies are first on the scene to provide cardiopulmonary resuscitation, their quicker responses can be the difference between life and death, "but all too often it occurs that we are on an over-exaggerated medical call and miss a fire call in the process."

The city, reflecting a national trend, has seen a significant decline in fire-related calls, while experiencing an exponential rise in the volume of medical-aid requests. According to the National Fire Protection Association, between 1985 and 2015, fire departments recorded a three-fold increase in call volume, but almost two-thirds of those calls were for medical aid or rescue.

The Fire Department gets 1.8 million calls a year, and in fiscal year 2020 just 25,993 were for structural fires and 12,507 for vehicle or other outdoor-fire responses. It recorded 560,000 life-threatening emergencies.

That total includes the height of the first wave of the COVID pandemic six months ago, when EMS call volume surged to record levels of several thousand daily calls. Fatal cardiac calls spiked almost ten-fold from the year before, with some days producing 200 such calls.

In fiscal year 2020, the FDNY got 32,831 reports of patients in cardiac arrest or choking (segment-one incidents), representing a 25-percent increase compared to FY 2019," the report stated.

'Must Get There Sooner'

Mr. Ansbro said he was troubled by the marked decline in the rate of survival in the cardiac-arrest cases.

According to the Management Report, just 21 percent "of confirmed cardiac arrest patients" were revived, a decline of eight percentage points compared to the same period a year earlier. Because of the pandemic's demand on city hospitals, for the first time EMS crews were ordered not to transport cardiac-arrest cases if they were unable to restart the patient's heart at the scene.

"The only way to improve on this is to get there sooner---getting their faster saves lives," Mr. Ansbro said. "There's people that we are not saving because we are not getting there soon enough to start CPR."

"The American Heart Association's scientific position is that brain death and permanent death start to occur in 4-6 minutes after someone experiences cardiac arrest," according to EMS World. "Cardiac arrest can be reversible if treated within a few minutes with an electric shock and ALS intervention to restore a normal heartbeat. Verifying this standard are studies showing that a victim's chances of survival are reduced by 7%-10% with every minute that passes without defibrillation and advanced life support intervention. Few attempts at resuscitation succeed after 10 minutes."

Fewer Firefighters Burned

The shutdown of many city businesses and schools and the reduction in foot and vehicular traffic appears to have reduced the volume of fire calls. The Management Report stated, "Fire company runs between fiscal year 2019 and fiscal year 2020 decreased 14 percent due to an 11-percent decrease to medical emergencies and a 19-percent decrease to non-medical emergencies."

Arson fires, however, jumped from 1,329 in fiscal year 2019 to 1,495.

Fiscal year 2020 saw a decline in firefighters' on-the-job burn injuries to 210, down from 223 in fiscal year 2019. Medical leaves dipped from 3,994 to 3,361 over the same period.