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A Poignant EMS Week Amid a Historic Pandemic George W. Contreras, M.E.P., M.P.H., M.S., CEM, FAcEM

National EMS Week is an annual event throughout the United States which celebrates and recognizes the hard work that all EMS providers do on a daily basis – from emergency medical technicians (EMTs) up to paramedics. These EMS providers can be paid, volunteer or a both (but at different agencies). No matter what the level, just remember that this person made a conscious decision to help someone in need, even while putting themselves (and/or their loved ones) at increased risk. During this ongoing COVID-19 pandemic across the country, the acts of courage, dedication and compassion could not have been clearer. On the east coast, New York, New Jersey and Connecticut contributed a large percentage of the total cases and deaths in the United States. To look even deeper, New York City (at the epicenter of New York State and the United States) and its EMS system was deeply impacted. When I meet people at a conference or seminar and I tell them that I am paramedic in New York City, the majority of the time I get: “Wow, so you work for FDNY?” I immediately inform them that I do not work for the Fire Department of New York (FDNY), but I am still a paramedic in the 911 system in New York City. In order to remove that confused look from their faces, I quickly jump into my educator mode and provide them an overview of the 911 EMS system in NYC. From 1970 to 1996, the NYC Health and Hospitals Corporation (HHC) had oversight of the EMS in NYC and it was known as NYC EMS. Then in 1996, for a myriad of reasons and contributing factors, the FDNY took over EMS and absorbed its operations. There are now two main divisions: suppression and EMS. And just like that, FDNY EMS was born. Many people (including some New Yorkers) do not realize that New York City does not have enough total resources to respond to

the 1.8 million EMS calls (as in 2018). Private hospitals in NYC provide approximately 35% of the personnel and ambulances that respond to NYC 911 EMS calls in collaboration (via contract) with FDNY EMS who provides the remaining 65%. Together private hospitals and FDNY EMS provide the 911 EMS to the residents and visitors of New York City. Some hospitals also subsequently subcontract with private ambulance companies who work and represent the hospital while providing the emergency service. So, someone such as myself who works for a hospital (for almost three decades) is still a 911 NYC paramedic in one of the largest and busiest EMS systems in the world. All EMTs and paramedics (regardless for whom they work) are certified by the New York State Department of Health Bureau of Emergency Medical Services (NYS DOH BEMS). The Regional Council of EMS in NYC (REMSCO) issues the protocols by which all personnel must follow while adhering to NYS DOH BEMS statewide protocols. FDNY EMS also has its policy and procedures for its members and participating hospitals. Over the past ten years, the annual call volume has steadily increased with 2018 having the highest annual volume of 1.8 million calls. Previously the highest call volume within a 24-hour period was on September 11, 2001. During the peak of the pandemic in late March and early April, the daily EMS call volume reached unprecedented records and even surpassed 7,200 (including administrative entries) calls within a 24-hour period. This unprecedented territory of high call volume combined with staff shortages (due to quarantine or actual sickness) among EMS and the hospitals overwhelmed with surge capacity resulted in various protocol changes which drastically changed how we performed our duties. I commend the NYC REMSCO for taking actions to protect all EMS providers during these times of crisis. Some of the specific disaster protocols in NYC included modifying cardiac arrest protocols, recommending patients with mild symptoms to stay home, modifying ambulance staffing levels, extending current certifications and even recertifying personnel with recently expired credentials. All of the COVID-19specific policies have since been rescinded and we are back to pre-COVID-19 operations. At the peak of the first wave, it was even necessary to activate the National Ambulance Contract (NAC) and soon there were additional ambulances and EMTs and paramedics from all over the United States. It was so surreal to see out-of-state license plates and different uniforms patrolling the streets of New York City. I want to send those out-of-towners a special thank you for coming to assist us in our darkest hour.