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Objective: To determine the utility of air medical transport in a large urban environment., Methods: The authors conducted a retrospective analysis of all air medical transports of patients in the Fire Department of the City of New York EMS (emergency medical services) Command for the period of January 1, 1996, to December 31, 1999. These data were evaluated for frequency of air medical transport, patient condition at time of flight, and necessity of air evacuation., Results: During the study period, some form of air medical transport was used 182 times. Of this number, 32 were for transports of patients from a scene of an incident to a hospital within New York City; 18 for interfacility transport of patients from a hospital facility within New York City to another facility within New York City; 122 for interfacility transfers of patients from medical facilities outside of the New York City area to a facility in New York City; and ten for transport of patients from New York City medical facilities to facilities out of the area., Conclusion: The Fire Department of the City of New York EMS Command utilizes air medical evacuation for patient transports very infrequently. The parameters of New York City's large urban environment may not be conducive to air medical transport. These data seem to be consistent with experiences of other large urban cities.

A mass gathering always presents a challenge to the medical providers of a city since preparations must be made to cover any potential disasters, big or small. With a prediction of several hundred thousand people coming to the New York City area to participate in the Papal Masses, the New York City-Emergency Medical Services readied its forces of physicians, paramedics, and emergency medical technicians from throughout the region. Extensive multi-agency planning involving a Total Quality Management process was integral to the success of covering the events.

Introduction: Until now, the public health response to the threat of an epidemic has involved coordination of efforts between federal agencies, local health departments, and individual hospitals, with no defined role for prehospital emergency medical services (EMS) providers., Methods: Representatives from the local health department, hospital consortium, and prehospital EMS providers developed an interim plan for dealing with an epidemic alert. The plan allowed for the prehospital use of appropriate isolation procedures, prophylaxis of personnel, and predesignation of receiving hospitals for patients suspected of having infection. Additionally, a dual notification system utilizing an EMS physician and a representative from the Office of Infectious Diseases from the hospital group was implemented to ensure that all potential cases were captured. Initially, the plan was employed only for those cases arising from the Centers for Disease Control and Prevention (CDC)/Public Health Service (PHS) quarantine unit at the airport, but its use later was expanded to include all potential cases within the 9-1-1 system., Results: In the two test situations in which it was employed, the plan incorporating the prehospital EMS sector worked well and extended the "surveillance net" further into the community. During the Pneumonic Plague alert, EMS responded to the quarantine facilities at the airport five times and transported two patients to isolation facilities. Two additional patients were identified and transported to isolation facilities from calls within the 9-1-1 system. In all four isolated cases, Pneumonic Plague was ruled out. During the Ebola alert, no potential cases were identified., Conclusions: The incorporation of the prehospital sector into an already existing framework for public health emergencies (i.e., epidemics), enhances the reach of the public safety surveillance net and ensure that proper isolation is continued from identification of a possible case to arrive at a definitive treatment facility.