title: Impact of a citywide blackout on an urban emergency medical services system.
abstract: BACKGROUND
  On 14 August 2003, New York City and a large portion of the northeastern United States experienced the largest blackout in the history of the country. An analysis of such a widespread disaster on emergency medical service (EMS) operations may assist in planning for and managing such disasters in the future.
  
  
  METHODS
  A retrospective review of all EMS activity within New York City's 9-1-1 emergency telephone system during the 29 hours during which all or parts of the city were without power (16:11 hours (h) on 14 August 2003 until 21:03 h on 15 August 2003) was performed. Control periods were established utilizing identical time periods during the five weeks preceding the blackout.
  
  
  RESULTS
  Significant increases were identified in the overall EMS demand (7,844 incidents vs. 3,860 incidents; p < 0.001) as well as in 20 of the 62 call-types of the system, including cardiac arrests (119 vs. 76, p = 0.043). Significant decreases were found only among calls related to psychological emergencies (114 vs. 221; p = 0.006) and drug- or alcohol-related emergencies (78 vs. 146; p = 0.009). Though median response times increased by only 60 seconds, median call-processing times within the 9-1-1 emergency telephone system EMS dispatch center of the city increased from 1.1 to 5.5 minutes.
  
  
  CONCLUSIONS
  The citywide blackout resulted in dramatic changes in the demands upon the EMS system of New York City, the types of patients for whom EMS providers were assigned to provide care, and the dispositions for those assignments. During this time of increased, system-wide demand, the use of cross-trained firefighter and first-responder engine companies resulted in improved response times to cardiac arrest patients. Finally, the ability of the EMS dispatch center to process the increased requests for EMS assistance proved to be the rate-limiting step in responding to these emergencies. These findings will prove useful in planning for future blackouts or any disaster that may broadly impact the infrastructure of a city.
authors.affiliation: Office of Medical Affairs, New York City Fire Department, Brooklyn, NY 11201, USA. freesej@fdny.nyc.gov
authors.forename: John
authors.initials: J
authors.lastname: Freese
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Richmond
authors.forename: Robert A
authors.initials: RA
authors.lastname: Silverman
authors.forename: James
authors.initials: J
authors.lastname: Braun
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Kaufman
authors.forename: John
authors.initials: J
authors.lastname: Clair
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data; D004189:Disaster Planning; D004190:Disasters; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D004868:Equipment Failure; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D008029:Lighting; D009519:New York City; D013689:Telephone; D013997:Time Factors; D019037:Urban Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*