Voices of MSOC: Quick Q&As With Top Leaders From the Show

See also:

• Report: The 2022 FDNY Medical Special Operations Conference
• MSOC: Afternoon Skill Stations
• Bonus Photo Gallery: MSOC 2022

Assistant Chief John Esposito is chief of the New York City Fire Department’s Special Operations Command. He has 31 years of experience and has worked extensively in the areas of counterterrorism, high-rise safety, technical rescue and maritime safety.

Battalion Chief Joseph Downey has 37 years of experience with the FDNY and is assigned to the Special Operations Command as the rescue battalion commander. He has been a task force leader for the urban search and rescue New York Task Force 1 (NY-TF1) for the last 20 years and is the national representative for the FEMA USAR system.

EMS World: What have been your major changes in the areas of special operations in terms of EMS?

Esposito: We saw a need to not just rescue patients but to have them treated and survive beyond the rescue. Our technical rescue is provided by squad companies and rescue companies in the FDNY. In my opinion they are among the most experienced in the world, but our rescue people are not “medical.” Practicing prehospital medicine is a disposable skill if you don’t use it regularly. 

Downey: The rescue medics have skills and capabilities. The logical next step was to integrate rescue medics into special operations practices.

EMS World: How do you make it all work?

Esposito: Dr. Doug Isaacs has been instrumental in the process. We continue to learn to work together and manage personalities to be a cohesive unit. It is a challenge, but as one giant agency it is a force multiplier.

Downey: The training with props like we have here at the Rock (the FDNY training academy on Randall’s Island) has been great for EMS. We have also been doing work with water rescue and flood rescue.

Esposito: During incidents rescue medics are treating patients, not doing rescues. Our rescue companies or squad companies make access, rescue medics get in and treat, and then they remove the patient together. At a recent high-rise fire, we had a baby on an upper fire floor who needed care. Rather than bring the baby through heavy smoke and heat, rescue medics went in with gear and SCBA, sheltered in place in a warm-zone apartment, and managed the patient until they could be safely removed. In the past that would not have happened. We now preposition rescue medics with our FAST (firefighter assist and search team) teams to rapidly treat our people who may become injured on a fire scene.

EMS World: Do you have any advice for folks who are looking to replicate your program?

Esposito: Make sure you include EMS in all your fire-based rescue and suppression drills. People need to keep an open mind.

Downey: Work together. Combine the rescue and the EMS. Going to a class doesn’t make you an expert. Certified doesn’t mean qualified. Experience and practice give you both to be effective.

Deputy Assistant Chief Ian Swords is EMS city north commander and chief of EMS special operations.

EMS World: What is the best part about this conference?

Swords: Attendees and presenters are so collaborative. Attendees learn not just from the presenters but also from each other.

EMS World: How is the integration of the rescue medic program going within FDNY special operations?

Swords: Very well. It is a good partnership. Rescue medics are being integrated into FAST teams with FDNY fire suppression. We had a high-rise fire a few months ago where they were able to treat patients on the fire floor and on the scene in the warm zone. We have also integrated fire and EMS by placing rescue medics on fire boats and engaging them in water-rescue cross-training.

EMS World: Any advice for others looking to emulate your program?

Swords: Work closely with your medical directors. They should be an instrumental help with protocols, equipment selection, and training. For additional integration, work with both fire suppression and law enforcement. For example, we have upgraded our rescue task force program. It has evolved by adding a lot of training, ballistic protection, and lots of NYPD integration.

Pamela Lai, MD, PhD, MSc, is FDNY deputy medical director and associate medical director for special operations. 

EMS World: What are some new programs or innovations you’re working on?

Lai: I’ve been working with the rescue medic program on protocols and procedures as one of the special operations medical directors. It’s a unique program, with a combination of advanced patient care and rescue techniques that’s really effective in a lot of situations. What we’re doing with the rescue medic program exemplifies a lot of what this conference is about: getting people from different disciplines to work together and getting patient treatment started earlier to save lives.

EMS World: What is the most important takeaway from this conference?

Lai: Collaboration. In special operations you have people working together from EMS, fire, and law enforcement, and we usually do that well. Part of what makes this conference special is how it brings everyone together.

Douglas Isaacs, MD, is deputy medical director for the New York City Fire Department. He is the medical director for Manhattan, the Special Operations Command, Safety Command, and rescue paramedic program; chair of the Medical Equipment Committee; medical team manager for NY-TF1; program director for the FDNY-Northwell Health EMS fellowship; and director of the FDNY’s annual Medical Special Operations Conference.

EMS World: What is your favorite thing about the MSOC conference?

Isaacs: My favorite thing about the conference is the people. They share knowledge and skills with each other and impact lives! I hope people will take that knowledge back to their departments and share it with others. Isn’t that the highest form of learning, when you can teach a skill to someone else?