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Get Real: Training at FDNY’s Medical Special Operations Conference 


The name of the game at the FDNY’s Medical Special Operations Conference (MSOC) is realism in training. Providing the best training experience possible requires the coordinated effort of many teams, starting with the FDNY’s leadership. The various disciplines within the department, EMS operations, hazardous-materials battalion, rescue school, fire academy, and EMS academy all work together to the benefit of the attendees.

Deputy medical director Doug Isaacs, MD, medical director for FDNY's special operations command, is proud to know MSOC attendees train so they’re ready for the real deal when it happens.

“The whole idea of MSOC is to provide a gathering place for people around the world to discuss the medicine of special operations,” Isaacs says. “It’s a privilege for us to be able to host this conference, and we not only realize the impact it has on others, but we also learn just as much from them as they learn from us.”

Isaacs has been hosting this conference at FDNY for the last six years. In that time the conference has become a reunion spot and gathering place for rescuers from around the world to meet and share best practices. 

This year attendees hailed from Chile and Korea, California and Florida, border patrol and the Secret Service. Subject-matter experts came to speak and teach, including FEMA task force member Dipesh Patel, MD, who works as the medical team manager for the Los Angeles County Fire Rescue Task Force. Patel delivered a lecture on the challenges and planning procedures he encountered when his team was deployed to the 2017 earthquake in Mexico, and says he loves the opportunity to speak at MSOC:

“This conference is unmatched in the caliber of talent it attracts. The interactions and discussions that occur here over what may seem to be a brief period of time are improving the care of the out-of-hospital patient in very significant ways.”

Attendees at the May 3–6 event were treated to a balanced conference program of classroom time with expert lecturers and then afternoons filled with scenarios in the elaborate training facilities of “The Rock,” FDNY’s site on Randall’s Island in Manhattan.

Many signed up for the preconference workshops which included an advanced K9 care course, bioskills procedure lab, medical task force leaders workshop, and two-day Tactical Emergency Casualty Care course. Isaacs and his team also put on an intense EMS competition Friday night, a simulated ship accident using the FDNY’s ship simulator; Miramar (Fla.) Fire-Rescue won for the second year in a row.

Other speakers delivered information on best practices for pain control, the use of UAVs (drones) in MCIs, and the somewhat mysterious “suspension syndrome,” which is the phenomenon of rescuers developing symptoms after being suspended from a harness for a prolonged period. 

Neighboring New Jersey sent MONOC medical director Mark Merlin, DO, to the conference. He delivered a talk on physician field response, discussing the many responsibilities of a physician on the scene of an EMS or fire call. 

“FDNY’s MSOC brings together a unique group of instructors with expertise in special operations,” Merlin says. “For anyone in EMS who wants to learn the latest rescue techniques, this is the one conference I wouldn’t miss.”

Attendees seemed most enthusiastic about getting wet, dirty, and tired from the hands-on skill stations and scenario practice. Whether a multiple-car collision with victims trapped, fluids leaking and limited access to patients; a patient stuck in a pipe who must somehow be placed on a Sked and extricated; or a building collapse involving entombed live victims whose only visible body parts are a leg and an arm, it was clear attendees needed to be ready for the reality.

And they were: Students donned their full uniforms from wherever they hailed. Federal agents and military rescuers came to the conference wearing exactly what they’d wear in the field: flak jackets, radios with hand mics, headphones, ammo clips, flashlights, helmets, eye protection, gloves, and tourniquets.

While it is one thing to simulate or verbalize the various elements of a car crash while training in a classroom, it is entirely another to ask your EMS providers to don their PPE, access the patient through a broken window, start an IV in a tight space, and then intubate a seated driver who is being crushed by the steering wheel. 

FDNY’s MSOC coordinators are clearly in the business of replicating these scenarios so trainees get the most realistic versions of calls possible. These experiences motivate EMS, fire, and rescue teams to do the same: practice like we play. 

See a special gallery of photos on Facebook

Hilary Gates, MAEd, NRP, is senior editorial and program director for EMS World. Reach her at

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