Part I of III - View Part II - View Part III

This is the first installment of a multi-part article on the history of NYC's emergency medical service.

On March 17, 1996, the New York City Fire Department became not only the primary provider of pre-hospital emergency care in the five boroughs, but the largest fire department-based EMS in the country. Many of the improvements in pre-hospital medical care that have been implemented since then have been a direct result of this merger. These advances have impacted the EMS Bureau as well as the Fire Department.

Implementation of the CFR-D program has helped create a true, three-tiered emergency medical system in New York City. Certified First Responder Defibrillator (CFR-D) is the first and basic level of training, followed by Basic Life Support and then Advanced Life Support.

Studies by the American Heart Association have shown a dramatic increase in the survival rates for out-of-hospital cardiac arrest victims who have quick and efficient CPR and defibrillation, followed by rapid access to the 911 system. The merger of FDNY and the NYC EMS has made this tiered response more seamless and effective, generating a downward trend in response times and saving the lives of countless New Yorkers every year.

These trends of lower response times and increased survival were not always the case.

In the early years (1870) of "pre-hospital" emergency care in New York City, ambulances were dispatched via telegraph from Bellevue Hospital's Centre Street branch. Ambulances were staffed with a highly trained medical doctor or surgeon from the hospital. In the first year alone, they responded to more than 1800 calls for help throughout the city.

However, as the call volume increased, if a doctor was not available to respond to a call, the hospital would place other personnel (such as an orderly or -in a rare instance- a janitor or a member of the kitchen staff) on the ambulance. With little or no training, the "ambulance driver" would respond to calls for help from the sick or injured, frequently arriving at the scene hours later without the proper equipment or training to treat the patient. Because of this lack of training and technology, the majority of the more seriously injured patients already had expired by the time the ambulance reached them and almost surely by the time they reached the hospital.

As the population continued to grow throughout the 19th century and into the industrial revolution of the early 20th century, the needs for additional training and easier access to rapid pre-hospital emergency medical care became apparent. Injuries caused by mechanical devices or as a result of industrial accidents were becoming more and more common.

From 1909 through 1929, ambulances in New York City operated under the supervision of the Board of Ambulance Service, which was presided over by the Police Commissioner. During this period, the medical community was beginning to realize the benefits of good pre-hospital medical care and rapid transport. By this time, 45 hospital-based ambulances—12 municipal and 33 voluntary-responded to almost 343,000 emergency calls annually.

Ambulance crews were comprised of motor vehicle operators (ambulance drivers) and patient care personnel with varying levels of training, ranging from hospital-ward orderlies to physicians and "ambulance surgeons." Ambulance personnel worked at their regular duties in the hospital and were "called out" when a request for an ambulance was received. This often resulted in extended response times and, occasionally, poor medical care, too. Each hospital interpreted administrative procedures and practices concerning ambulance services and operations according to its own set of rules, which almost always resulted in a significant variation of service provided.

Pre-hospital care generally was limited to a "scoop and run" operation. Additionally, ambulances transported patients back to the hospitals in which they were based, regardless of whether another hospital was closer or better equipped to handle that specific patient’s medical condition. This often left whole areas of the city without ambulance coverage. Furthermore, the Police Department had no real jurisdiction over the ambulances; they were powerless to prevent hospital administrators from assigning all of their ambulances to transfers and holding none available for emergencies.

By the late 1960s, with the annual total of emergency runs nearing 400,000, the Department of Hospitals Commissioner centralized all of the city municipal ambulances under the control and direction of the Ambulance and Transportation Division of the Department of Hospitals. For the first time in nearly 100 years, it became possible to establish uniformity in the city ambulance service, allowing for a more structured approach to pre-hospital care.

The next part of this series will feature "The paramedic is born--A new era in pre-hospital care begins."