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Juvare Case Study

Streamlining Pre-Hospital to Hospital Communication for Mass Casualty Incidents in New York City

Executive Summary

When a mass casualty incident (MCI) happens in New York City, hospitals and the fire department EMS (Emergency Medical Services) collaborate to ensure hospitals are prepared to care for the resulting patients. For years, this relationship centered on a time-consuming manual process whereby EMS dispatchers called hospitals to understand their capacity for critical and non-critical patients.

hospital emergency room staff

Leveraging existing technology, Greater New York Hospital Association (GNYHA) and EMS dispatchers have used GNYHA’s Sit Stat 2.0 system—powered by Juvare EMResource—to streamline pre-hospital to hospital communication by simplifying the creation of an MCI event, automatically notifying all stakeholders, tracking acknowledgement and receipt of notifications, and minimizing the opportunity for error and false notifications.


Any critical incident with the potential to produce five or more patients in New York City is considered an MCI. Multiple MCIs can happen on any given day resulting from fires, motor vehicle accidents, HazMat (hazardous material) events, civil unrest, and acts of violence. Once declared, an MCI gets a Level of A, B, C, or D based on the severity of the event and the number of expected patients.

"When a mass casualty incident (MCI) happens in New York City, hospitals and the fire department EMS (Emergency Medical Services) collaborate to ensure hospitals are prepared to care for the resulting patients."

Most MCIs are Level A, with a small number of Level Bs each year. Since the level designation was added in 2017, there have been no Level C or D incidents.

Citywide EMS dispatchers are responsible for prehospital to hospital communication anytime an MCI occurs. Before the process was streamlined, an MCI declaration triggered a manual process requiring a string of verbal communications between EMS dispatchers and personnel in the hospital emergency department (ED), and then additional internal communications between the ED and hospital stakeholders to prepare for the potential patient surge.

healthcare worker on phone

This manual process was time-consuming; relied heavily on verbal communication, which can
result in the inaccurate transfer of information and delays in internal hospital preparation; and was difficult to track for improvements in efficiency and effectiveness.

Improving the process required updating and training both EMS dispatchers and internal
hospital staff. EMS dispatchers required a system that could simplify the creation of an
MCI event, automatically notify all stakeholders, and track acknowledgement of the calls while
minimizing manual burden and the opportunity for error or false notifications. GNYHA hospitals needed a solution that could simultaneously notify numerous hospital stakeholders of an incoming patient surge, including calling the “red phone” in the ED. The system needed to place multiple calls to ensure notification receipt and required repeat and replay functionality to ensure communication effectiveness.


To improve the pre-hospital to hospital communication process for MCIs, GNYHA and the fire department focused on technology. Leveraging the power of Juvare’s EMResource and Amazon Web Services (AWS), GNYHA and the fire department built a process within Sit Stat 2.0 to streamline the MCI creation workflow for EMS dispatchers, automate simultaneous calls to pre-determined hospitals (based on the location of the incident and the MCI level), and send notifications to any additional hospital personnel so that all stakeholders receive the same information.

emergency response center with handheld radios in foreground

GNYHA and the fire department worked with Juvare to configure and implement a solution
to support the objectives of the MCI notification initiative. Notable features include:

      • Simplified user workflow to create an MCI
      • Redesigned Start Event/Schedule Event interface
      • Redesigned set defaults to limit human error
      • Automated voice notifications for the “red phone” and notification groups
           • System will call up to three times to ensure the notification is delivered
           • Repeat and replay call functionality to improve information transfer
           • Real-time tracking of voice notification acknowledgement


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