FDNY Triage Software

March 24, 2026 | Categories: B2B

Pro EMS: Computerized Triage Software

The last time you received a software upgrade notification on your smartphone or
computer, you probably paused and considered whether you wanted to undergo
the hassle. Your phone would be shutdown for a few minutes, and when it
restarted, applications would be different and you might find yourself fumbling,
possibly taking longer to use the phone than before you ran the update. Now
imagine that you’re adding software into the FDNY’s Emergency Medical
Dispatch (EMD) system that handles about 1.4 million emergency calls annually.
The citizens of New York City’s lives and wellbeing depend on how that software
upgrade goes, as well as how fast Dispatch is able to learn the new system to
make sure response time doesn’t increase. Adding Computerized Triage
Software (CTS) into Computer-Aided Dispatch (CAD) was a system upgrade the
Department and its members did not take lightly. After years of research,
procurement, testing and launching CTS in February 2017, the FDNY’s EMS
response time and accuracy has improved. This revolutionary software
incorporated into the FDNY’s emergency response will set the standard for the
nation.

“Almost every time we looked at an EMS response we said, ‘It could have been
better,’ and almost every time you can track it back to the triage being better,”
said David Prezant, MD, Chief Medical Officer at the Office of Medical Affairs
(OMA). “We pushed policy to make the triage better because it was critical and
important.”

The old triage system was a priority call system that was established in the
1980s. Assignment Receiving Dispatchers (ARDs), who are trained EMTs, were
instructed on how to ask questions and follow a paper-based system (called
Cardex) to determine on a relative rate of severity how critical each medical
call is in order to dispatch the correct ambulance. The FDNY realized
improvements could be made with response time, data tracking, dispatch
training, and accuracy of dispatching the correct resources for the call type.

“To get any big project moving forward…you need a group of people to figure out
how to get through some of the hurdles. I think that computerized triage is
certainly an example of that. Several years ago we went through all of these
paper algorithms to re-discover, re-vet, and update them all to say, ‘All right, we’re
going to spend all of this money computerizing triage, but let’s check that the
algorithms are at least what we think they should be,’” said Dr. Prezant. “So that
was a huge project that took two years between OMA, EMS Operations and EMS
dispatch. They went through every question, every answer, every paper
algorithm and they re-did them all. And then we looked for a computer software
company that would be able to do this for us and be able to link it as best as
possible to the CAD System.”

Luckily, the FDNY is careful, cautious and makes changes based on data and
analysis, so it should be no surprise that CTS was a successful endeavor.

Finding the Best Vendor
The world of EMS Dispatch isn’t very large and it’s one that Deputy
Commissioner Dolan and Dr. Prezant shopped around to find the software that
would be the best fit for the FDNY system. Deputy Commissioner Dolan’s
background involved an earlier role as a Vice President with Lockheed Martin,
which is one of the largest technology companies on the planet, and his company
had specialized in managing call centers.

“When you look at the 911 system, it’s unique; nobody understands it like the
FDNY understands it,” said Deputy Commissioner Dolan. With his background
managing call centers, he learned call-scripting software, which is essentially
what you may have experienced when calling a bank or making a flight
reservation. “Call centers are multimillion-dollar global businesses. You don’t
necessarily need to be a trade group or an EMS physician to know how to write
call-scripting software,” said Deputy Commissioner Dolan. Realizing that this was
the software EMD needed for computerized triage, he sought out those types of
companies instead of ones with medical backgrounds. “We were the first, and to
my knowledge, the only EMS system in the country that successfully bought a
computerized triage software application from a company that doesn’t bill their
application just for 911 use,” he said. Deputy Commissioner Dolan knew it was
important to make sure the company would be able to scale to the FDNY’s
volume of 1.4 million EMS incidents per year. “While that seems like a lot of call
transactions, call centers typically do in excess of millions of calls a year,” Deputy
Commissioner Dolan said.

The team decided on U.K.-based company, Infinity CCS (Contact Centre
Solutions), in April 2015, because it had a customer service model that better
suited the Department’s needs for call type algorithms. Infinity began working
with Deputy Commissioner Dolan and his team to configure their software for the
Department’s needs. They finished in the fall of 2016 when the software was
rolled out incrementally through testing phases at EMD from December through
February 2017.

Defining Segments and Call Types

“Once EMD gets a call [passed over from the NYPD Police Communications
Technicians] the ARD is responsible for triaging this in terms of both a segment
and then a specific call type,” said Dr. Prezant. “Segment defines the life-
threatening nature of the issue–the lower the segment number, the more life
threatening. Segment 1 is a cardiac arrest or a choking victim. Segments 2 and 3
are also life-threatening. Segments 4-8 are non-life-threatening medical
emergencies. Within each segment, there are multiple call types. Each call type
dictates A, what type of medical emergency it is, and B, whether it should get an
ALS (Advanced Life Support) response or a BLS (Basic Life Support) response.
Once the segment and call type is defined, then the ambulance is dispatched,”
said Dr. Prezant. Average response time of segments 1 -3 in August 2017 was
06:26, and 4-8 was 7:49. 1

Why CTS Was Needed
One of the many reasons that the FDNY wanted to move to computerized triage
was due to the increase in volume over the years. “We are currently processing
around 5,000 calls per day [during peak season] at the Emergency Medical
Dispatch center,” said Deputy Assistant Chief Napoli.
There are 450 EMD personnel assigned to the Division. On a daily tour basis,
EMD operates with approximately 75 members, which includes the Training Staff
since we are constantly updating and training, said Deputy Assistant Chief
Napoli.
“A larger group of call-takers puts heavy burden on the training and the protocol
update for the expansion we’ve done over the years. Given that, and the type of
questions that need to be asked, it was progressively getting harder to drill

The Department recently procured Tableau, a data visualization tool. “Tableau
allows us to plug in to different application data sets. The [challenge] with
computerized triage was that we’re rolling out this piece of technology that
captures data, particularly how we’re typing calls,” said Assistant Commissioner
Thomson. “Dispatch is gathering that information. But other applications are also
running at the same time that capture their own data, and they tell a story that is
really important to this incorporation of computerized triage. Tableau gave us the
ability to pull data from all the sources that we need. We never had that ability
before,” she said.
CAD data was now pulled in by the MAP unit, combined with computerized triage
data and eventually Electronic Patient Care Record (EPCR) data, said Assistant
Commissioner Thomson. “Now we could show data visualization in one
comprehensive analysis. We could examine, ‘If we’re changing something over
here, what’s the effect over there?’ And we couldn

Pro EMS: Computerized Triage Software
The last time you received a software upgrade notification on your smartphone or
computer, you probably paused and considered whether you wanted to undergo
the hassle. Your phone would be shutdown for a few minutes, and when it
restarted, applications would be different and you might find yourself fumbling,
possibly taking longer to use the phone than before you ran the update. Now
imagine that you’re adding software into the FDNY’s Emergency Medical
Dispatch (EMD) system that handles about 1.4 million emergency calls annually.
The citizens of New York City’s lives and wellbeing depend on how that software
upgrade goes, as well as how fast Dispatch is able to learn the new system to
make sure response time doesn’t increase. Adding Computerized Triage
Software (CTS) into Computer-Aided Dispatch (CAD) was a system upgrade the
Department and its members did not take lightly. After years of research,
procurement, testing and launching CTS in February 2017, the FDNY’s EMS
response time and accuracy has improved. This revolutionary software
incorporated into the FDNY’s emergency response will set the standard for the
nation.
“Almost every time we looked at an EMS response we said, ‘It could have been
better,’ and almost every time you can track it back to the triage being better,”
said David Prezant, MD, Chief Medical Officer at the Office of Medical Affairs
(OMA). “We pushed policy to make the triage better because it was critical and
important.”
The old triage system was a priority call system that was established in the
1980s. Assignment Receiving Dispatchers (ARDs), who are trained EMTs, were
instructed on how to ask questions and follow a paper-based system (called
Cardex) to determine on a relative rate of severity how critical is each medical
call is in order to dispatch the correct ambulance. The FDNY realized
improvements could be made with response time, data tracking, dispatch
training, as well as accuracy of dispatching the correct resources for the call type.
“To get any big project moving forward…you need a group of people to figure out
how to get through some of the hurdles. I think that computerized triage is
certainly an example of that. Several years ago we went through all of these
paper algorithms to re-discover, re-vet, update them all to say, ‘All right, we’re
going to spend all of this money computerizing triage, but let’s check that the
algorithms are at least what we think they should be,’” said Dr. Prezant. “So that
was a huge project that took two years between OMA, EMS Operations and EMS
dispatch. They went through every question, every answer, every paper
algorithm and they re-did them all. And then we looked for a computer software
company that would be able to do this for us and be able to link it as best as
possible to the CAD System.”

The project got the support of the Commissioner of the New York City Fire
Department, Daniel A. Nigro, and eventually the support of the mayor’s office by
late summer of 2015 before they vetted the software company. “That’s where
Deputy Commissioner Edward Dolan was very helpful,” said Dr. Prezant. “He re-
directed our efforts towards the software company [we went with] and that
occurred within about a year,” said Dr. Prezant. “We knew computerized triage
would be beneficial eventually because we could analyze questions, accuracy,
and make changes based on what we learned. But we were concerned that…this
might actually wind up taking more time rather than less time,” Dr. Prezant said.
And the lives of New Yorkers were at stake.
Luckily, the FDNY is careful, cautious and makes changes based on data and
analysis, so it should be no surprise that CTS was a successful endeavor.
Finding the Best Vendor
The world of EMS Dispatch isn’t very large and it’s one that Deputy
Commissioner Dolan and Dr. Prezant shopped around to find the software that
would be the best fit for the FDNY system. Deputy Commissioner Dolan’s
background involved an earlier role as a Vice President with Lockheed Martin,
which is one of the largest technology companies on the planet, and his company
had specialized in managing call centers.
“When you look at the 911 system, it’s unique; nobody understands it like the
FDNY understands it,” said Deputy Commissioner Dolan. With his background
managing call centers, he learned call-scripting software, which is essentially
what you may have experienced when calling a bank or making a flight
reservation. “Call centers are multimillion dollar global businesses. You don’t
necessarily need to be a trade group or an EMS physician to know how to write
call-scripting software,” said Deputy Commissioner Dolan. Realizing that this was
the software EMD needed for computerized triage, he sought out those types of
companies instead of ones with medical backgrounds. “We were the first, and to
my knowledge, the only EMS system in the country that successfully bought a
computerized triage software application from a company that doesn’t bill their
application just for 911 use,” he said. Deputy Commissioner Dolan knew it was
important to make sure the company would be able to scale to the FDNY’s
volume of 1.4 million EMS incidents per year. “While that seems like a lot of call
transactions, call centers typically do in excess of millions of calls a year,” Deputy
Commissioner Dolan said.
The team decided on U.K.-based company, Infinity CCS (Contact Centre
Solutions), in April 2015, because it had a customer service model that better
suited the Department’s needs for call type algorithms. Infinity began working
with Deputy Commissioner Dolan and his team to configure their software for the
Department’s needs. They finished in the fall of 2016 when the software was
rolled out incrementally through testing phases at EMD from December through
February 2017.

“When we were interviewing Infinity, we sent them some of our call types and the
questions associated with them and they mocked up a call-scripting algorithm
using our triage,” said Deputy Commissioner Dolan. During Infinity’s
presentation, they were able to show the team that they could change questions
for a call type’s algorithms on the fly.
“The system is entirely configurable. It’s entirely subject to whatever changes
either our physicians want or our dispatchers determine we need or external
events determine. If we’re concerned about Ebola and wanted to throw in the
question, ‘Have you traveled to West Africa in the last 21 days?’ we can do that
now with administrative rights to the system,” Deputy Commissioner Dolan said.
[Possibly side bar?] Defining Segments and Call Types
“Once EMD gets a call [passed over from the NYPD Police Communications
Technicians] the ARD is responsible for triaging this in terms of both a segment
and then a specific call type,” said Dr. Prezant. “Segment defines the life-
threatening nature of the issue–the lower the segment number, the more life
threatening. Segment 1 is a cardiac arrest or a choking victim. Segments 2 and 3
are also life threatening. Segments 4-8 are non-life threatening medical
emergencies. Within each segment, there are multiple call types. Each call type
dictates A, what type of medical emergency it is, and B, whether it should get an
ALS (Advanced Life Support) response or a BLS (Basic Life Support) response.
Once the segment and call type is defined, then the ambulance is dispatched,”
said Dr. Prezant. Average response time of segments 1 -3 in August 2017 was
06:26, and 4-8 was 7:49. 1

1 http://www1.nyc.gov/assets/fdny/downloads/pdf/about/citywide-stat-2017-
08.pdf

4
everyone on every question or every possible scenario. It’s a logical progression
to go to an electronic format where things can be changed or things can be
designed by a more efficient way,” said Deputy Assistant Chief Napoli.
Another factor for consideration was that there were inconsistencies amongst
ARDs’ responses.
“One desire was to improve the participation and ensure that we’re actually
asking the same questions for every call regardless of who is staffing the
telephone that shift,” said Deputy Commissioner Dolan. While an experienced
ARD may be used to taking a shortcut or two to get a faster response and send
out the assignment to the appropriate borough Radio Dispatch to find the closest
ALS or BLS ambulance, the Department wanted uniformity amongst the ARD
call-takers.
“We’;ve always looked for a better way of doing [triage and we knew that was to
go electronic. But the next problem we had to deal with was using a computer
system that was so immense and so heavily relied on,” said Deputy Assistant
Chief Napoli. EMD didn’t have an option to go offline to update CAD with this
CTS. Thousands of lives were at stake.
EMD Azure McPherson has been working in EMD for six years and said she
likes the CTS system better than Cardex. “The CTS is easier than the Cardex
because you had to turn away from the computer and flip through the Cardex to
make sure you asked the right questions to get the call types. Now, with CTS, it’s
like Cardex is built into it. You scroll down to what the [situation is] and from there
you ask the caller questions. You don’t have to turn away from the screen,” EMD
McPherson said. There’s a drop-down menu in front of the call-taker, and based
on what you select as an answer, the next question is prompted, said EMD
McPherson. “The computer makes the decision and it [forces you] to ask all of
the questions. Whereas with the Cardex, you may have missed a question or
two. With the new system you can’t click ‘next’ until you ask the question, which
is better for the callers and us. It just makes everything easier because you’re
asking all of the correct questions to get the correct call type,” EMD McPherson
said.
“Now that these algorithms, these branch questionnaires, are all computerized, it
gives us the opportunity to say, ‘This is the way everyone is going to do it,’” said
Dr. Prezant. “We’re monitoring it, and if processing call types is taking longer
than is necessary, we’re going to make changes. We’re able to monitor every
aspect, and in fact, we have found out, which we never knew before, that every
question adds 7 seconds on average, to the time interaction,” said Dr. Prezant.

[SIDEBAR]
How NYC’s 911 System Works

5
NYPD Police Communications Technicians (PCTs) receive the initial 911 call in
NYC. They will then make the determination as to what type of emergency is
being reported and pass along as appropriate. If it’s medical, they conference in
an EMD ARD to triage the assignment. “Once an appropriate call type is
identified utilizing our Computerized Triage System, the assignment is sent to the
appropriate borough Radio Dispatcher (RD) to find the closest ambulance,” said
Deputy Assistant Chief Napoli. “ Our CAD system suggests the most appropriate
unit response, but the RD must agree and release the assignment, then verbally
announce it on the radio frequency to the responding units,” he said.

The Technology
“Automation is the way to go in terms of improving the quality of service and to
do more with existing resources,” said Chief Information Officer and
Commissioner Benny Thottam. “There’s always an opportunity to automate new
processes and the Fire Department took on the challenge and was successful.
This has improved the response time already and I think it will improve the
response time tremendously while assigning the best resources depending on
the nature of the incident.”
The IT Department is responsible for enabling technology, said Commissioner
Thottam. That involves doing the pilot, working with the vendor to ensure service,
and the teams to provide guidance so that they can use the software,
Commissioner Thottam said.
Translating Data Captured and Applying It
The technology is critical to this triage project, but the FDNY also understood the
role research and data analysis played in creating a successful computerized
triage software operation. Assistant Commissioner Kat Thomson works in the
Bureau of Management Analysis and Planning (MAP) and said their branch
complements technology in areas where it’s appropriate. “We take data that’;s
warehoused by the agency and collected through applications, and then we use
that data. We’re the end users of data that technology is responsible for
procuring and protecting,” said Assistant Commissioner Thomson.
MAP got involved in the triage project in October of 2016. “Once technology said,
‘We’re going to do a cutover,’ which meant we were going to adopt this technology.
We want to know that this technology isn’t going to create any adverse effects. In
the past, technology would have run automated reports, which could show
hourly, daily, and weekly response times for a particular borough,” said Assistant
Commissioner Thomson. “ They’re good at packaging data and making sure the
systems are protecting data, encrypting data, but they’re not analysts with data,
not in the way that our shop is. Our MAP department grew and now we have
much better ability to analyze data,” she said.

“MAP to me was the best thing since sliced bread because I’m able to track the
efficiency of the ARDs’ dispatches based on the data that’s being generated,”
said Deputy Assistant Chief Napoli. “[We were able to show] that some call type
questions don’t work and we can save time by getting rid of a question since it
only added to the response time. You want to do something that’s tried and true
and analyzed and developed throughout this entire process.”
Using Data To Improve Call Response Times
The questions and the speed and the accuracy of the questions are a subject
overseen by the medical director, so they had to meet clinical requirements, said
Deputy Commissioner Dolan.
“The software had to meet the technical network, firewall, security, speed, and
reliability requirements of our technology group, and then it had to be able to be
plugged into MAP,” said Deputy Commissioner Dolan.
“The goal of computerize triage is to do a better job of typing patients on the
phone so there will be improvements in accuracy and speed of the response,”
said Assistant Commissioner Thomson. With this new triage, the software is
taking the answers to the questions call-takers ask and compiling the data, she
said. “That results in complex, multidimensional structured data. While the ARD
call-taker is asking questions about age, and asking yes and no questions, the
system is running and the data is captured, and then that data is feeding into
Tableau. At the same time, we’re moving ambulances with CAD and there are
time stamps associated with moves,” she said.
“For example, we can see that we’re dispatching this ALS unit from this location
at this time point and it creates a record in a different application. We take that
data and we marry it with the data from triage. Then MAP will sit down with Communications and OMA. Dr. Prezant can look at the data and tinker with the
questions to determine the best order, while Deputy Assistant Chief Napoli and
his EMD department makes sure those questions don’t cause response times to
increase. We take a look at all of the data we’re acquiring, put it on one page and
address it at a conference table together where and we can zero in on all of the
details during the rollover. We’re examining everything at the most granular level,
which is also new for the agency and very important,” Assistant Commissioner
Thomson said.
“Using the new computerized triage questioning data, we’re able to identify the
most common pathways that people were taking to arrive at a certain
[conclusion],” she said. “We identified some questions were creating
inefficiencies. We were asking questions that…weren’t critical. Looking at the
information, we were able to say, ‘Let’s ask a more important question first so we
can speed up our ability to triage, to make a determination of what type of patient
we have, so we can send the correct resources,” Assistant Commissioner
Thomson said.
“I call it ‘trimming the fat.’ You’re cinching up all these little inefficiencies that are
out there. It’s a huge, complex, organic problem you’re trying to solve,” said
Assistant Commissioner Thomson.
“For all of our calls, processing time went down by 6.7 seconds after CTS was
up and running,” said Deputy Commissioner Dolan. “We also found that
processing times for our high-priority calls, those that are potentially life
threatening, went down by 3.6 seconds,” he said.
Training on the Software
“My Dispatch team went through extensive training back and forth to make sure
this was going to work,” said Deputy Assistant Chief Napoli. “I told the training
classes that they were simply being guided by the analysis that we developed.
I’m not turning them into robots, but they have to ask the prompted questions and
use the drag and drop features to now arrive at an appropriate call type. While
asking more questions does give the dispatcher more knowledge about the
situation, it doesn’t help with the response of the ambulance,” said Deputy
Assistant Chief Napoli.

“It was very important to have a test system in place, where we could test
something out without shutting down the 911 system,” said Dr. Prezant. “So the
old version was still live, but the new version was in a test area, and we would
test that for a week or two, and make sure that we hadn’t created any problems
by accident. Then we would move it over to the live platform.”
“In the beginning, we did testing, then when we were taking live calls, some
[members] were kept in a different room trying out the new system,” said EMD
McPherson. “The people who were in charge of CTS were right there in the room

to help us along if something wasn’t working the way we expected. We would tell
them, ‘The system isn’t asking this, or, It should be asking that,” EMD McPherson
said. The supervisors were there to provide extra help during that time CTS went
live and was being tested by a small group of Dispatch.
With this unique software, EMD was able to analyze, “Which people are
struggling with the new software?" or “What times of day are we the slowest?”
said Assistant Commissioner Thomson. “We could also answer the question of,
‘How much training each call taker needed before we can turn them loose on the
new software?’ The data showed that the first five times a call-taker used
computerized triage, they were usually very slow.” At around 50 calls, then they
were back to normal speed, were answering the phone efficiently, and
[identifying the call type] at the same speed they did while using the Cardex
system, said Assistant Commissioner Thomson.
“Previously, this data would have been a big question mark. We would have
rolled this out and then we would have looked a month later at response times,
and realized, ‘Well, it looks like there’s 30-second increase.’ Now, we can say,
“No. For ARD A, in terminal B, at times C, and it was call type E, you had a
certain second increase." We could get right to core of the problem every single
time,” said Assistant Commissioner Thomson.
“Overall, my experience with CTS has been very good. People tend to be against
change,” said EMD McPherson. “When you’re used to doing things a certain way
for a long time, it takes some getting used to in order to click one thing and then it
jumps to the next screen. In the beginning, people were a bit frustrated, but now
everyone went through it, and everyone knows how to do their job.”

“With CTS, you’re making sure you do everything correctly. In the beginning, we
gave our feedback on certain first aid protocol and what certain call types should
be. They made some fixes based on feedback we had. To me, CTS is faster,”
said EMD McPherson.

Changing Algorithms in Real Time
“Right now if there was [an outbreak] taking place in the city of New York where
we had to ask specific questions related to the operation, we potentially can
make that change on the fly, and add another set of questions right into the
algorithm,” said Deputy Assistant Chief Napoli. “For example, if we had a
smallpox virus outbreak in lower Manhattan, we could interject a question this
afternoon that asks if the patient has been south of 23rd street in Manhattan
recently. And we can begin isolating specific questions to help determine if the
patient may have smallpox,” he said. That flexibility and speed enhanced by this
technology is useful for personnel at EMD, for the EMS members responding to
the call, and for the patients. “Ten years ago if we had something like that taking
place, I would have put up a big sign in the call receiving area, also called
Assigned Seating Dispatching, that said the same thing about asking those

questions of anyone who was south of 23rd street in Manhattan in the last 24
hours,” said Deputy Assistant Chief Napoli.
“The biggest part of this triage software is the fact that we have to be able to
change the questioning to go with the ‘crisis du jour’ if you look at it that way,”
said Deputy Assistant Chief Napoli. “Because there are things happening in this
world that none of us would have dreamt about 10 years ago or even believed
then. We have to be able to adapt and mold ourselves accordingly with what’s
happening,” said Deputy Assistant Chief Napoli.
“The managerial analysis part of it was designed by us, we run it, and it’s
molded by us,” said Deputy Assistant Chief Napoli. “I’ve changed the reports
numerous times with them because what was important to us last month is not
necessarily important to us this month. If I need an analysis on something
specific now, I know I can pick up the phone and within a day or two, our analysis
makers can come back to me and give me that data.”

Improving Call Types and Segments
“Our main question we’re answering is, ‘What’s the impact of this new system
overall on response times?’ but then MAP breaks that down even further,” said
Assistant Commissioner Thomson. “We examined, ‘What’s the impact of this
cutover on our most critical call types?’ because we care about those the most.
We were able to isolate out cardiac arrest calls or a difficulty breather or other
life-threatening call types that we don’t want to have an adverse impact on. And
then, we looked at them using Tableau to find the outliers where calls were
slowing down,” she said. “We could see where phone calls or triage outputs were
making things slower by examining the time elements. And you can pull those
out and you can quickly slice and dice and look at them and see what the
problem is and publish it with them in a way that has never been possible
before. So we would take on call type by call type, response time issues, and
then we could diagnose and improve times,” said Assistant Commissioner
Thomson.
“These segments and call types are the most important things,” said Dr. Prezant.
“They’re in our power to change, we have the power to know through accurate
analytic information what we need to do to improve our system. And the system
needs to improve in a dynamic way. And if we achieve that—and we have
already demonstrated that we are achieving that—then…the people benefit. We
get there faster and we get there faster with the right resource,” said Dr. Prezant.