March 24, 2026 | Categories: B2B
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 and 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 well-being 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 our 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. Dispatchers, who are EMTs, were trained 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 Edward 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 teams 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 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 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.
Defining Segments and Call Types
“Once EMD gets a call, the dispatcher 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.
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 through the emergency medical dispatch center,” said Deputy Assistant Chief Napoli. There are approximately 450 EMT dispatchers. “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 needs to be asked, it was progressively getting harder to drill 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 responses by the dispatchers themselves.
“One desire was to improve the participation and ensure that we’re actually asking the same questions for every call regardless of who’s staffing the telephone that shift,” said Deputy Commissioner Dolan. While an experienced call-taker may be used to taking a shortcut or two to get a faster response and send out the ALS or BLS ambulance, the Department wanted uniformity amongst 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 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 int0 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 from 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 the questions. Whereas with the Cardex, you may have missed a question or two. With the 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,” 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 certain call types are 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.
The Technology
“Automation is the way to go in terms of improving the quality of service and to do more with existing resources,” said 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,’ that meant we were going to adopt this technology. We want to know that this technology isn’t going to create any adverse effects. So 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 MAPS department grew and now we have much better ability to analyze data,” she said.
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 and captures data, particularly how we’re typing calls,” said Assistant Commissioner Thomson. “Dispatch is gathering that information. But other applications that 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 was 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 that 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’t do that before,” Assistant Commissioner Thomson said.
“MAP to me was the best thing since sliced bread because I’m able to trove the efficiency of my 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 the 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 call-taker is asking questions about age, and asking yes and no questions, the system is running and the data is taken, and then put that data into Tableau. At the same time, we’re moving ambulances with CAD and there are time stamps associated with moves.
“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 OMD. Dr. Prezant can look at the data and tinker with the questions to determine the best order, while communications works to make sure those questions don’t make response times go up. 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 very 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 diagnosis,” 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 an EMD 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 dispatching units 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 person 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. There’s no problem we couldn’t understand,” 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, where we can 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 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 Dispatch, EMS responding to the call, and the patients. “Ten years ago if we had something like that taking place, I would have put up big sign in the core 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 almost, 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 10 years ago. And 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, it’s run by us, 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 probably within 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 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 that 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.
The Hardware
“This was a product that was already built and we installed it in our environment, so we didn’t need a lot of equipment and hardware,” said Commissioner Thottam. There was a one-time cost for initial setup, configuration and integration with the EMSCAD system. The main expenses for the triage software were licensing. Additional equipment needed were Windows servers and some networking equipment, Commissioner Thottam said.
The FDNY Always Has a Backup
“We have backup systems so if something does happen to the [triage software] we’d go to a backup system so it’s redundant,” said Commissioner Thottam. “The EMS CAD system is configured in such a way that if CTS goes down it won’t impact the CAD system and they would go back to the Cardex. We have redundancy in place for the computerized triage system, but no system is bullet proof.”
“Even if for some reason technology goes down, EMD is still prepared to answer calls using simplistic copy on paper as a backup,” said Deputy Assistant Chief Napoli. “I rely more on the training for the ARD (Assignment Receiving Dispatcher) to be able to efficiently know what to ask and what not to ask to make sure the call types are processed correctly [should the triage software go down].”
The FDNY’s EMD is One of A Kind
“We have the only triage system in the country that the end user can configure at will,” said Deputy Commissioner Dolan. “Because we have a full time management analysis and planning team, and we have invested in statistical software packages that can help us display data across from multiple data sources, in a very easy to see dashboard that you can put on your computer monitor or send around in real time, you can even make the information accessible to people and email it to them as a PDF.
“Computerized triage software is better for everyone on an operational basis because it gives us a higher reliability that we’ve captured the severity of the call accurately to the extent that that’s possible that 1.4 million New Yorkers that call us for help every year, aren’t medical experts and there’s limit to how accurately we can get a call classified,” said Deputy Commissioner Dolan. We found with computerized triage, that the percentage of calls that start off as a lower priority call and later get upgraded to a higher priority due to the patient’s deterioration went down by another percentage point. That’s one way of showing that we’re capturing calls more accurately and we’re better able to fine tune what type of emergency we’re responding to so it’s better for everyone, both in the Dispatch center and the units responding to incidents.
“We’re NYC accredited,” said Assistant Deputy Chief Napoli. “This software is efficient and fast and allows our efficiency and accuracy to go hand in hand. I have already seen that this product is saving lives. I am working with the most highly trained professionals in the world in Emergency Medical Dispatch. This software has made it easier so that they don’t have to remember what the next step is, as to what they have to do and where they need to go,” said Assistant Deputy Chief Napoli.
“From a management perspective, I think one of the biggest reasons for the success in this project was that we involved all the different disciplines both within the Fire Department and when we reached out to the private sector, we didn’t limit ourselves to just the available vendors that were kind of the obvious choices,” said Deputy Commissioner Dolan. “We took a step back and evaluated what we really needed. To the extent that you can use existing software products in an innovative way, that sometimes might be better rather than trying to reinvent the wheel and buy something that’s just built for 911.”
“A the major achievement in the 911 system this year, has been the success of computerized triage,” said Dr. Prezant. “We’ve implemented a whole new system that takes care of 1.4 million calls per year and we’ve implemented it without a hitch. We’re already seeing success. I think it’s a huge accomplishment. And it also builds confidence in doing something in the next project, right. When you build an effective team and you have success, that builds confidence for the next project. And it just keeps feeding on itself. So people have to trust us, that if we have something new that we’re going to do, that we’re going to implement it in this measured, reasonable approach,” Dr. Prezant said.
[SIDEBAR]
What Other Departments Should Consider Before Taking on This Endeavor
Make sure you get good support from your vendor, suggests Commissioner Thottam. “ “We went with a vendor (solution) that could configure the tool the way we wanted. It’s critical to test and pilot before implementation because this is a critical operation. When algorithms are not perfected, it can have an adverse effect [on the patient].”
Other Departments should make sure that the tool they’re considering fits in their environment, said Commissioner Thottam. “You don’t want to put new technology in an environment that doesn’t support it. Otherwise, it’ll be more expensive to maintain and support.
For other call-takers who might take this system on, EMD McPherson suggested they be open to learning computerized triage.” Once you see how it works and how fast you can drop a call, I think they’ll like it. You don’t have to flip from the screen to the Cardex to see the call type and then look back at the screen. Everything is one the screen. Even during first aid, you’re able to click what you think it is and type in everything. I’ve done CPR over the phone since this launched and think CTS is easier for that. Once you click, you read everything for first aid and the call right there. You can also see how far away the unit is or if it pulled up yet. You’re not twisting and turning form the screen to look at the Cardex. The prompts are all in one place,” EMD McPherson said.
Leave a Reply