Afternoon Hands-On Sessions at FDNY Fire Academy

The training complex at “The Rock”, FDNY's Fire Academy on Randall's Island, showcases an exceptional collection of training environments that surpasses what many local departments can offer.

Among its standout features is a meticulously recreated New York City subway station where teams can practice responding to train accidents, patient entrapment, fires, and hazardous materials incidents.

For maritime emergency training, a vessel provides crews with the disorienting pitch-black conditions they would face when responding to incidents at ports. Along the East River sits a bisected passenger aircraft, dramatically positioned atop a massive rubble pile, creating an endlessly adaptable training ground where subtle modifications can increase the complexity for rescuers.

Deep within this rubble formation, haphazardly arranged cribbing creates narrow passages that require crews to navigate over, under, and around tight spaces while coordinating patient access. Within the debris field, a manhole serves as an impromptu classroom where participants evaluate different lifting and extraction tools for patient removal. A real airplane is a classroom to show how to provide “care in the air” and simulated meth labs contain realistic hazards to train responders.

These practical skill stations, led by the combined expertise of FDNY rescue paramedics, FDNY rescue company personnel, and FDNY EMS physicians, enhanced the educational experience by providing seasoned instructors who understand the conference's core mission of delivering "good medicine in bad places," as conference director Dr. Doug Isaacs of FDNY aptly describes it.

The hands-on skills stations represent arguably the most compelling aspect of the conference, allowing participants to apply rescue and medical techniques in realistic simulated incidents. Participating teams were equipped with comprehensive EMS resources, including BLS bags, 12-lead cardiac monitors, simulated medication kits, airway management tools, and a full array of immobilization and extraction equipment. What follows is a representative selection of the training stations and the essential lessons they conveyed through practical application.

Station: MCI—Vehicle into Crowd Scenario

This station simulated a scenario similar to the New Orleans incident, where a vehicle struck a crowd of pedestrians. This high-intensity exercise used high school-aged actors as patients that tested responders' triage capabilities under pressure.

Participants were faced with multiple patients simultaneously. The scenario required them to rapidly assess injuries, control life-threatening hemorrhage, and establish a

casualty collection point (CCP) for more thorough assessment and treatment. The simulation's fidelity was enhanced by realistic moulage, environmental distractions, and the genuine stress of managing multiple critical patients with limited resources.

Key Takeaways:

• Never assume vehicle-into-crowd incidents are merely accidents—approach with awareness that they may involve intentional acts or secondary devices.
• Scene safety assessment should be ongoing, as patient movement may need to be delayed until law enforcement has cleared the area.
• Resources become overwhelmed almost immediately in these scenarios, making rapid and accurate triage essential.
• Establish clear CCPs early to organize patient flow and maximize efficient use of available responders.
• Apply bleeding control interventions during the initial triage phase rather than waiting for secondary assessment.
• Maintain situational awareness beyond patient care—if something appears suspicious, report it immediately to command.

Station: Rubble Pile

Scene setup: Victims are entrapped in confined spaces, including drainage pipes, manholes, and on unstable rubble.

Key takeaways:

• Watch your step! All ground is unstable until it's made stable.
• Wear your PPE: helmet, eye protection, gloves, knee pads, rescue boots, and covered sleeves and legs.
• PPE for the victim: Rescuers are geared up for protection. Don’t forget to protect the victim, especially during extrication and the use of tools.
• Rapid triage determines who gets treated first.
• Control life threats. Deal with issues that could potentially kill patients first, such as massive bleeds or obstructed airways.
• For entrapped patients or lengthy extrications, ALS should use pain control early and often. If there is one in your system, get an EMS physician to the scene.
• Get EMS patient access and treatment started early while rescue work is ongoing.
• Think about victim removal; they may not go out the same way you came in.

Station: Rebar Impalement

Scene setup: Simulated patient (manikin) impaled on multiple pieces of rebar in concrete and another impaled on a high point from a simulated fence

Key takeaways:

• Stabilize the patient with a tripod (first choice). Ground cribbing or a backboard that is held would be your last choice due to ground contact, but be as creative as you need to be.
• When cutting with saws, many will generate heat. Soak a trauma pad with sterile water and place it right by the cut to cool the rebar prior to cutting. Have a rescuer keep a bare finger on the rebar to monitor the heat the patient is getting.
• Utilize pain control early and often.
• Manage life threats: airway and massive bleeding control. 
• Rescue and EMS need to work together to know the size of the rebar cut needed to fit the patient with the impaled object in the ambulance. Leave the rebar in place and cut only what you need to free the patient and get them in the ambulance.
• The battery-powered band saw generated far less heat and vibration compared to a rotary saw, reciprocating saw, or traditional K12 saw.

Station: Drones

The FDNY Robotics unit demonstrated several of their drones that are used for surveillance. They also demonstrated some brand-new technology in which a drone could monitor a patient’s vital signs while hovering above them in a simulated hazardous atmosphere.

Station: Threats in the Environment

This station immersed participants in the hidden dangers of drug manufacturing operations (i.e., meth labs and improvised explosive device (IED) scenes.) Set up in a realistic urban apartment setting, the station featured subtle indicators of chemical hazards, makeshift lab equipment, and potential booby traps.

FDNY hazardous materials specialists guided participants through the space, pointing out easily overlooked danger signs while sharing first-hand experiences from actual responses. Instructors demonstrated proper assessment techniques and safety protocols, emphasizing how normal objects such as soda bottles or pressure cookers can pose extraordinary threats when repurposed for illicit activities.

The station featured actual components (rendered inert) found in previous responses, giving participants hands-on experience with identifying potentially hazardous scenes before they become dangerous. Comprehensive hazard recognition is considered so vital that FDNY cycles its entire staff through this specialized training approximately every 18 months.

Key Takeaways:

• Develop heightened situational awareness when approaching any scene, looking beyond the patient to assess environmental threats.
• Recognize indicators of soda bottle meth labs, including chemical odors, discarded precursor containers, and plastic tubing.
• Differentiate between drug manufacturing operations and other chemical activities by identifying specific precursors, equipment configurations, and waste products.
• Preserve potential crime scenes while still delivering effective patient care by minimizing unnecessary contact with surfaces and items.
• Never assume it's safe to touch switches, doorknobs, or other common items at suspicious scenes—they may be rigged as traps.
• Learn to identify materials associated with homemade IEDs, including specific powders, pressure vessels, and timing devices.

Station: Simulation Aids for Emergency Care

The Simulation Aids station showcased cutting-edge training technologies that are changing emergency medical education. Participants had the opportunity to interact with

various high-fidelity manikins specially designed to simulate realistic bleeding scenarios. These advanced training tools allowed hands-on practice with hemostatic agents and tourniquets in a controlled environment before encountering these critical situations in the field.

Instructors demonstrated a comprehensive array of bleeding control devices, highlighting their appropriate applications across different anatomical regions. Special attention was given to specialized equipment that addresses challenging hemorrhage control situations where standard tourniquets might prove ineffective. Beyond physical simulators, the station featured emerging virtual reality platforms. These immersive systems create realistic high-stress environments that help providers develop critical decision-making skills while maintaining situational awareness.

Key Takeaways:

• Familiarize yourself with junctional tourniquets designed for controlling hemorrhage in anatomical transition zones like the armpit or high on the thigh where standard tourniquets are ineffective.
• Virtual reality simulators offer valuable training for high-stress environments, allowing providers to practice clinical decision-making without risk to actual patients.
• New VR airway management devices can record and store up to 200 previous intubations, with capability to upload footage directly to patient records for quality assurance and education.
• Manual intraosseous devices that require no batteries or power sources beyond hand strength provide reliable vascular access options in austere conditions.
• Regular practice with simulation technology builds muscle memory and decision-making confidence that transfers to real-world emergency scenarios.