Update, April 2 2020, 4:55 PM: Director of Communications for the NYS Department of Health Jonah Bruno responded to our query, stating:
The State Department of Health has not issued, or approved, any such guidance[,] but we are working with EMS providers throughout the state to ensure the health and safety of all New Yorkers, as we mount a coordinated response to the COVID-19 pandemic.
Original reporting: All guidance or protocols for health professionals (temporary or otherwise) remained subject to approval by the NYS Department of Health before it could be considered valid or enforceable, and before it could be adopted. Bruno indicated no such protocols were officially adopted or approved by the overriding NYS Department of Health. As such, we updated our rating from “true” to “unknown.”
In early April 2020, alarming news spread across social media — that Emergency Medical Services teams in New York City and on Long Island were given orders not to transport any patients who could not be resuscitated in the field:
The claim spread in several forms, first with a “reportedly” qualifier:
— FOX News Radio (@foxnewsradio) April 2, 2020
Readers commented with more news or rumors they encountered about the purported new guidelines — either that patients in cardiac arrest would be left to die, that paramedics were ordered not to resuscitate patients, or that CPR had been banned:
“Breaking: #COVID19 NY issues new guidance orders to stop CPR in the field! ‘patients in cardiac arrest should not be transported to the hospital if they cannot be saved in the field'”
Much of the discourse around the story appeared alongside an April 1 2020 WABC-TV article (“Coronavirus News: New guidelines for EMS in NYC show grim reality of COVID-19 pandemic.”) Its key points, involving cases where any patient could not be resuscitated at their location, were as follows:
NEW YORK CITY (WABC) — New guidance for EMS in New York City and Long Island says that patients in cardiac arrest should not be transported to the hospital if they cannot be saved in the field.
City officials have released stark new guidance to equally overworked ambulance crews, effective immediately, if they can’t resuscitate a patient in the field, they must withhold CPR and declare the person dead.
They can no longer continue to the hospital.
The orders to stop CPR in the field is shocking to veteran doctors who are used to doing whatever it takes to save a life.
WABC-TV also quoted FDNY Deputy Fire Commissioner Frank Dwyer as saying the referenced orders were binding, and that the department intended to “devise a plan for implementation.” Late on the evening of April 1 2020, unofficial account @NYScanner shared an image of what appeared to be a memo issued on March 31 2020 by the Regional Emergency Medical Services Council of New York City, Inc., titled “TEMPORARY Cardiac Arrest Standards for Disaster Response.” It involved a number of novel patient-handling guidelines:
We were able to track down a copy of that document, which was uploaded as a PDF to Regional Emergency Medical Services Council of New York City, Inc.’s (NYC REMAC) website and archived here. It is transcribed below:
THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
Advisory No. 2020-08
Title: TEMPORARY Cardiac Arrest Standards for Disaster Response
Issue Date: March 31, 2020
Effective Date: Immediate
Supersedes: n/a Page: 1 of 1
The Regional Emergency Medical Advisory Committee (REMAC) of New York City is responsible to develop, approve and implement prehospital treatment and transport protocols for use within the five boroughs of the City of New York. The Regional Emergency Medical Advisory Committee (REMAC) of New York City operates under the auspices of Article Thirty of the New York State Public Health Law.
The NYC REMAC proudly thanks the EMS Professionals tirelessly working to protect and serve the residents of NYC and recognizes that EMS provides an ESSENTIAL service to this city, state and country.
In order to ensure the safety of our providers while also providing care to our patients, the following changes have been made in the Cardiac Arrest procedure:
• No adult non-traumatic or blunt traumatic cardiac arrest is to be transported to a hospital with manual or mechanical compressions in progress without either return of spontaneous circulation (ROSC) or a direct order from a medical control physician unless there is imminent physical danger to the EMS providers on the scene.
• In the event a resuscitation is terminated, and the body is in public view, the body can be left in the custody of NYPD.
• In the event NYPD response is delayed call the following:
o NYPD DOA Removal: 646-610-5580
Current and Updated Protocols can be accessed at the Regional EMS Council website: www.nycremsco.org.
Owners/operators of Ambulance and ALS First Response Services providing prehospital medical treatment within the five boroughs of the City of New York are responsible to provide copies of the NYC REMAC Prehospital Treatment Protocols to their personnel, and to ensure that Service Medical Directors and EMS personnel are informed of all changes/updates to the NYC REMAC Prehospital Treatment Protocols.
On NYC REMAC’s “About Us” page, a brief explanation of the organization’s purpose and scope appeared:
The Regional Emergency Medical Services Council of New York City, Inc., is a not-for-profit, tax exempt corporation created in 1974,whose function is to improve and coordinate emergency medical services in New York City. In 1976 the Council was designated by the Commissioner of Health of the State of New York as the Regional Emergency Medical Services Council of New York City under Article 30 of the Public Health Law.
The Regional Emergency Medical Services Council of New York (REMSCO), is responsible to the State of New York for coordinating medical services in all five boroughs of New York City. The Council was established and designated to be the policy and administrative authority within the New York City region.
The Regional Emergency Medical Advisory Committee (REMAC) was established to provide medical control for the EMS System.
REMAC develops policies, procedures and triage, treatment and transportation protocols which are consistent with the standards of the New York State Medical Advisory Committee but address the specific needs of New York City.
We tried to contact regional EMS authorities in Suffolk and Nassau Counties on Long Island, the balance of areas reportedly covered by the new advisory. We will update this page if we hear back from any of the agencies we contacted.
We also located a March 29 2020 Nassau County EMS advisory about transport and cardiac arrest [PDF], involving the following updated directive:
NO adult medical cardiac arrest is to be moved to a hospital with manual or mechanical compressions in progress without either return of spontaneous circulation or a direct order from a medical control physician unless there is imminent physical danger to the EMS providers on the scene.
On April 2 2020, WNBC carried a similar report about EMS protocols on Long Island and in the five boroughs of New York City, “Grim New Rules for NYC Paramedics: Don’t Bring Cardiac Arrests to ER for Revival.” In summarized bullet points at the top of the page, WNBC clarified the scope of the orders and the areas affected (New York City, Suffolk County, and Nassau County):
• A regional EMT group has issued new guidelines almost unthinkable even days ago — if someone’s in cardiac arrest and you can’t revive them in the field, don’t bring them to the emergency room
• The guidance from the Regional Emergency Medical Services Council of New York City applies to the city as well as Nassau and Suffolk counties. The group, known as REMSCO, is the state-designated coordinating authority for the region
• The newly implemented order takes effect [on April 2 2020] in an effort to control the surge of patients in hospitals due to the ongoing COVID-19 pandemic
In the broader article, WNBC detailed some of the new protocols’ provisions, including directives for handling the bodies of patients not transported to hospitals for resuscitation:
The guidance from the Regional Emergency Medical Services Council of New York City applies to the city as well as Nassau and Suffolk counties. The group, known as REMSCO, is the state-designated coordinating authority for the region.
Typically, if someone has had cardiac arrest, and even if there’s no blood flow, EMS units will perform CPR and other lifesaving measures while en route to the hospital. Now, with very limited exceptions, that’s not to happen.
Additionally, REMSCO says if the body is in public view, the EMTs can call NYPD to safeguard the body until the Medical Examiner or funeral home can pick it up.
Although initial reporting on the revised EMS guidelines in New York City and on Long Island were initially framed as rumors (and some of the initial claims were inaccurate), the underlying claim is true. As of April 2 2020, Emergency Medical Services (EMS) were provided binding guidelines wherein patients in cardiac arrest and those unresponsive to cardio-pulmonary resuscitation (CPR) would no longer be transported to the hospital. The guidelines affected the five boroughs, Nassau County, and Suffolk County, and included information about safeguarding the bodies of patients not resuscitated during those calls.