When I first heard about the annual FDNY Search and Rescue Field Medicine Symposium connected with the New York City Fire Department, my first thought was, “Wow, I wish I could go to something like that.” My second thought was, “Actually, there’s no reason I can’t.” I lived a few hours train ride away, had relatives in the city I could stay with, and the price was reasonable.
After two full days of pre-conference educational opportunities ( The first on snake, spider, scorpion, and insect bites held at the Bronx Zoo, the second on burns and burn treatment at the Cornell Weill Burn Center), the actual conference began for me on Saturday and Sunday with an early morning subway ride from relatives to the Millennium Downtown New York, the conference’s chosen motel near Ground Zero, the site of the September 11, 2001 terrorist attack.
Two large red and white FDNY busses emblazoned with the department logo and lettering waited in front. I boarded one. Inside other first responders from around the nation and the world waited, some I’d met during the first two days. When full, we drove to the FDNY’s Randall Island Training Center, a 10-mile drive through Manhattan and then across a bridge on a Saturday morning. It’s a fascinating ride by itself. New York City is one of the world’s most vibrant, internationalized cities.
As we enter the training center, its scope, size and variety of training facilities begin to set in. There are several training buildings, some appear to be designed for firefighting training, others are hard to identify. There is even the front end of an airplane ready for training scenarios, as well as large, well-windowed buildings that house classrooms and offices, marked in front by statues and flag poles. A special ambulance decorated with the names of FDNY responders who gave their lives on September 11 is parked in front of the main building. Someone tells me it is attached to the FDNY recruiting division. It’s one of several reminders of this tragic day when the FDNY proved its courage and commitment to the city.
At the Training Center
Fire trucks, ambulances, and other FDNY vehicles are grouped in different areas of the large parking lot.
At the far side of the parking lot across from a chain link fence we can see the East River with Manhattan on the other side. In front of the fence, an immense training area covered with at least two stories of rubble and broken concrete sits dotted with tunnel openings, reinforcing walls, and about a third of an airplane fuselage resting on top, reachable by a ladder.
To the right of that are more buildings which I later learn include a mock up of a subway station, an area designed for practicing the use of power tools in impalement situations, a building with a special facility designed for training for elevator accidents, and another portion of the same airplane, but this time it’s the front end with the cockpit and passenger area kept intact, usable for a completely different training experiences, and several other training centers.
We were quickly ushered into the nearest building, a large, shiny building with many windows and sent to a cafeteria where a large buffet of eggs, sausage, bagels (must have bagels! It’s New York City, after all.) were waiting along with hundreds of hungry, interesting people to eat with. Then a quick trip through the vendors area, and into a large theater-style room.
Distinguished Speakers
Programming began with a brief ceremony honoring fallen responders and singing of the national anthem. Each morning had a series of 45 minute lectures. Topics varied. All were interesting and well presented. Some that made a personal impact included Dr. Murteza Shahkolahi’s sharing of his experiences and lessons learned as a medical responder during the 2023 Turkish Earthquakes. He emphasized the importance of building bridges with local responders and just what is involved in a long term operation to remove people, both living and dead, from the rubble of collapsed buildings over weeks.
Shakolahi spoke of American and International Medical and Search and Rescue teams learning to work cooperatively with local Turkish miners who while not specifically trained in rescue operations were both highly motivated and highly skilled at using mining equipment and mining engineering techniques to remove concrete, rubble, and other heavy debris as needed. Often, he said, this involved periods of respectfully watching and listening to these workers instead of jumping in and trying to take immediate command.
Trevor Glass spoke on the problem of crush syndrome, and the need for proper logistics and medical preparations before removing people who have been pinned under rubble for an extended period of time. If people are not medically stabilized prior to being freed from long term entrapment, death soon results.
Dr. Jennifer Brown, a veterinarian, put on a fascinating talk on the problems that arose in caring for the feet of human remains discovery dogs after the Maui wildfires. While these canines provided a needed and specialized service, no one had properly prepared ahead of time for their footcare and paw protection needs on the hot Hawaiian pavement, volcanic sands, and ash, all of which often had temperatures above 160 degrees Fahrenheit all day long.
U.S. Air Force Pararescue Specialists put on two different presentations. The first, on Saturday, dealt with low light operations and skills needed to properly provide EMS care and Rescue response in low light conditions. The second, on Sunday, was an overview of the field of military Pararescue operations, how it developed, and a brief overview of how combat rescue operations are conducted.
Another very important talk on Sunday discussed analgesics and sedation and covered the pros, cons, risks, and required considerations in the administration of ketamine and alternative substances.
After two full days of intense, pre-conference educational experiences, and a lot of getting up early to catch public transportation and staying up late to spend time with relatives and New York City friends, my brain already felt full. There was a recognition that if I only absorbed 30% of the information presented, I was still absorbing a great deal of information and leaving with more than I came in with, even if I were to miss a lot. I know others felt the same way.
Lunch on Saturday was a cook-out with hot dogs, hamburgers, veggie burgers, and more. Members of the FDNY’s non-profit arm, the same organization that had done so much to make this conference happen, cooked these for an incredibly long and patient line of hungry first responders.
Hands-On Training
While some conference participants chose to attend more lectures in the afternoon, those who chose hands-on training were gathered, divided into two large groups, taken in different directions, then subdivided again. We were told to put on our safety gear and given a quick look over. Nobody seemed to care except me that I was wearing a $12 construction style, hard hat, while the other 7 members of my group were wearing high quality rescue specific helmets costing several hundred dollars each.
We were led to one of the fire training houses on the other side of the parking lot. Consisting of concrete cinder block walls covered with bare paint, three stories high, crudely fashioned wooden floors, walls, and doors that resembled a barn, with some rooms partially divided into stalls, these reinforced the barn-like impression.
Our first scenario was on the second floor where a very serious man drilled us on control of bleeding and treatment of high-powered bullet wounds. The windows were shut, and it was dark, although there was still some light. This included practice with applying commercial tourniquets, applying pre-prepared “Israeli bandages,” and wound packing with roller gauze.
After that, we were paired off into twos. My partner was tall, healthy looking, and he appeared to be in his early 30s. We were handed a shoulder bag full of bleeding control supplies and instructed that when signaled, we were to go through a door into a stall, and we would see a large plastic sheet. We were then to pull back the plastic sheet and treat whatever we found. This was our “lane.”
Shortly before we received the signal, a switch was activated. Artificial smoke began to blow into the area, obscuring vision, and recordings of people screaming for help were broadcast through the area.
We went in and I pulled back the plastic sheet, revealing an anatomically correct, rubber mannikin with a bloody stump for its right leg, signs of bleeding in the left arm pit, and a chunk of the left testicle missing and covered with the same artificial blood.
My partner announced he’d take the leg as he applied a tourniquet. I began packing the armpit, and after that applied a pad and pressure to the testicle.
Soon, mission completed, we were asked to remove our treatments, and make way for the next two person team.
During conversation afterward, I discover that my partner is a doctor. It turns out that of the eight of us, half male, half female, five are doctors, two are EMTs, and one a paramedic, all Americans, several ethnicities represented, and from several states.
The next lane was applying airway techniques, both BLS and ALS, again in lowlight, smokey, noisy conditions using training mannikins that were often in awkward positions or angles.
The third involved starting and applying IVs. Although I have trained in starting IVs, as an EMT, it is not within my scope of practice. Therefore, I was rusty. Again, imaginative angles and difficult situations as well as the low light, artificial smoke, and recorded screams make this a challenging and unusual training opportunity. I watch with interest as someone begins an IV on a rubber training arm, but does so through a small hole near the ground from the far side of a wooden wall.
Much of the educational programming, has emphasized how rapid fluid replacement is essential in many rescue scenarios. These include treatment of severe burns and crush injuries.
For the second half of the afternoon, we leave this building. When we reach the parking lot, we are gathered again and ushered to a different training building where we learn a method of packaging people for transport quickly using layered combinations of space blankets and regular army blankets that have been pre-folded in a way that makes it easy to wrap them around an injured person.
At the end of the day, we are loaded on the busses and taken back to the conference hotel.
Active Shooter Training
Sunday morning was structured in the same way as Saturday, but Sunday was our day for the active shooter in the subway scenario training.
This began with each of us being outfitted with FDNY SWAT team ballistic armor, followed by more wound packing practice and tourniquet drills. This time, though, we not only practiced putting tourniquets on others, but also on ourselves one handed. One of the trainers from the FDNY shows me how leaning against a wall or pillar can pin the tourniquet in place, can make self-application easier.
Next we are shown how to use a flexible, draggable patient moving device considered ideal for extracting injured people from many dangerous situations including active shooter situations. Basically, a semi-rigid, thick, heavy plastic sheet with one set of straps for holding a patient and a second set to drag it.
Such devices are available from several manufacturers, and they are easy to roll up, carry, easy to unroll, and one of the most ergonomically sound (for the dragger) ways to move injured people quickly a short distance across a smooth surface such as one might find in an active shooter situation.
Randall Island Training Center includes a mock-up of a subway station. This amazing structure includes both the upstairs section which houses the turnstiles and the ticket booth, as well as the downstair section which includes a subway platform and some rail areas.
We line up double file, dressed in our FDNY body armor, carrying our medic bags, each containing several tourniquets of varying quality (my impression was that although most of the tourniquets we handled were top-notch, the training program had become the dumping ground for sub-standard tourniquets that had been donated to the department) and our rolled-up patient slide devices. We have been told to treat the people we see.
As we open the door and enter the imitation subway platform through a side door, we’re met with artificial smoke, recorded screams of people begging for help, strange lights, and, surprise, lots and lots of teenagers and even younger children screaming at us to save their relatives and asking if they would be okay. They were members of the FDNY Youth program (or, I suspect, in a couple cases, perhaps their younger relatives).
On the Pile
Afterward, we turned in our training equipment and wandered over to the “rubble pile” and related training areas.
On the north side of the pile, several people clustered around a pair of rubber mannikins whose limbs were impaled on steel rods jutting out from concrete blocks. Some, under the guidance of FDNY instructors, were practicing using circular saws to cut the rods in order to prepare impaled people for transport. Behind them, food was cooking on an outdoor grill, and a couple of very large dogs watched, bored, tied just beyond reach of the fires and training tools. Despite the seriousness of the subject, the atmosphere was relaxed and friendly. I learned that at least some of these impalement training scenarios were based on actual incidents, often elevator accidents, that the FDNY had responded to.
We watched with interest, asking questions about not just the training but the dogs, too, before heading down the trail, a couple hundred yards to the main portion of the rubble pile.
The rubble pile was well named. Although partially a built-up structure with some walls and interior rooms reachable by tunnels, there were pieces of concrete and stone everywhere, both inside and outside the tunnels. Training scenarios involved crawling through tunnels to reach patients and then treating them or verbalizing what would be done or called for if specialized equipment or assistance were needed. It became very clear, very quickly why all participants had been required to show up with knee pads on. I participated in two of these scenarios. Many did a third, but time became a factor.
A much more mundane but equally fascinating station involved displays of equipment and informal explanation and question and answer periods with members of the FDNY drone unit. They showed both through video clips and real life demonstration the capabilities of the drones and how they could be used to not just air lift and drop medical supplies, blood transfusion, and even life jackets and floatation devices to people who might need them but how their cameras could give visual and infrared displays of a fire or other emergency scene. It was amazing how infrared imaging can give a clear picture of what’s happening even in a smoke filled fire scene.
Final Thoughts
The day ended and we returned by bus to the hotel where we convention participants went our separate ways. For me, that meant catching a train upstate. Yet, even after the conference, the training, the skills, the confidence-boosts, the renewed enthusiasm for the field, and the appreciation for what not just me but countless others in this field are not just doing every day but also actively preparing to do remain. The FDNY Search and Rescue Conference was a wonderful experience, and I was glad to have taken advantage of the opportunity to attend.
