Emergency Medical Care in the Rockaways

“Where you live should not determine whether you live.”

Not all hospitals are the same!• The Rockaway peninsula has natural and urban

geographic barriers and has only hospital on the peninsula.

• St John’s Episcopal is a community hospital but it does not provide the same level of care as Jamaica Hospital, a Level I Trauma Center (LITC).

• Rockaway does not have these services:• Advanced Trauma Care • Emergency Interventional Cardiac Catheter Care (EICC)• Pediatric Intensive Care

Why is this improtant?

• Serious trauma, multiple fracture , bleeding, head injuries, stabbing, and gun shot wounds preferably should be treated in LITC– LITC care offers the best chance for survival if

treated within 60 minutes, the “golden hour”.– A significant heart attach (MI) once identified

needs to be treated at a EICC hospital• Rockway has neither LITC of EICC!

How much time does it take to get LITC of EICC for Rockaway?

• There is no public data available estimating the distance and the travel time to access to a LITC or EICC for the Rockaways

• Since the time to LITC was not previously reported in the literature the Center Studying Health Care Delivery (CSHCD) developed a method to estimate the time to LITCs.

• Method: Google Maps directions application was used to collect the time and distance to travel between the five Rockaway zip codes and four proximal LITC at 10 AM and 6 PM compared to the other nine other geographic neighbors in Queens. 

Findings • The median time to Jamaica Hospital the closest Level I Trauma

Center to the Rockaways is 48 minutes at rush-hour (RH) and 26 minutes during non-rush-hour (NRH) compared to 22/12 minutes for rest of Queens.

• At times Jamaica Hospital will be put on diversion and the next closest LITC is New York Hospital of Queens that is 52 minutes during RH and 29 minutes during NRN

• The next closest LITC Elmhurst Hospital that is 55 minutes during RH and 35 minutes  

• Due to it proximity Brookdale Hospital in Brooklyn is a Level I Trauma Center is an alternative with the median time is 45 minutes during rush-hour and 23.5 minutes at other times.

 

Travel Time in Minutes to Jamaica Hospital LITC for Rockaway Areas Rush-hour

58 5856

4042

4850

4644

38 38

50

0

10

20

30

40

50

60

70

Rockaway Point Roxbury Neponset Rockaway Beach Arverne Far Rockaway

JHMC

BHMC

Average Time to LITC Non Rush Hour Rockaway vs the rest of Queens

0

5

10

15

20

25

30

Jamaica Hospital NY Hospital of Queens Elmhurst Hospital

Rockaway Minutes

Queens Minutes

Average Time to Level I Trauma Centers at 10 AM for all of Queens areas

0

5

10

15

20

25

30

35

Northeast Queens

North Queens

Central Queens

Jamaica Northwest Queens

West Central Queen

Rockaway Beach

Southeast Queens

Southwest Queens

West Queens

JHMC

NYHQ

EHMC

What can be done?

What happens how?

• A ambulance with and emergency patient uses lights and sirens’ to notify the vehicles in its way to move out of the way

• Ambulances and fire trucks passing an intersection poses danger to traffic approaching the signal from other roads.

• These vehicles must slow up an proceed through the intersection many times through red lights

• This imposes considerable delay in response time.• It also leads to accidents and deaths

What can be done to improve time to LITC in the Rockaways?

• Traffic Signal Preemption is a practical solution to improve time to LITC for the Rockaways

• Reducing delay and increasing response time and road safety with minimum cost.

Common Traffic Preemption Devices

• Acoustic devices – Audio sensors to detect the pattern of waves from the siren of an

emergency vehicle. – Disadvantage of this system is that traffic preemption can be easily

triggered in the wrong direction or at the wrong intersection

• Line of sight– Emit a fine beam of infrared light towards traffic signal in front of the vehicle.

Sensors at the intersection detect the beam.– The additional cost hardware in both the ambulance and the intersection is

high. The system is insecure and hardware to trigger preemption illegally can be easily forged.

• Localized radio signals– Use radio signals to trigger preemption– Hardware is still a major expense– The most reliable system

ROCKAWAY BEACH PILOT PROGRAM FOR TRAFFIC SIGNAL PREEMPTION USING GLOBAL POSITIONING SYSTEM (GPS)

What is a Traffic Signal Preemption using GPS ?

• The proposed model will use GPS hardware, already existing in most smart phones, to receive transmit GPS signals.

• These signals are transmitted to a central server which can communicate to traffic signal controllers via Internet.

The model consists of 3 main components

1. An Arduino Microcontroller at each traffic intersection with an Ethernet Shield to enable it to connect to the Internet.

2. Android Application for an Android Smartphone will have to be carried by the staff of each ambulance. This app will receive GPS coordinates and transmit the same to a web server.

3. A web server which receives GPS coordinates of the emergency vehicles and then sends preemption signals to traffic signal controllers accordingly.

Ambulance receives GPS coordinates from satellites and then transmits the coordinates

Traffic control devices in most of NYC

Manhattan RemoteCommunications Unitcirca 1995

Can not support traffic light preemption !

Original Electro-Mechanical Controllerscirca 1950’s - 1990

Signal Dial, 12 Step18 & 24 Circuit Cam Shaft

New York City: Traffic Management for a New EraNew TransCore-Installed Signal Controller

Manhattan RemoteCommunications circa 1995

The new systemDome MIMOAntenna

Wireless Router

Traffic Controller

Signal DisplaySwitches

Can support traffic light preemption!

First Steps • The Center for Studying Health Care Delivery is

championing the need to improve time to LITC for this community.

• What is needed now:– Seek data from FYND to support the issue of delays to LITC

and EICC.– Seek permission from the NYC DOT to design a pilot trial to

set up on route to Jamaica Hospital from the Rockaways.• The Center for Studying Health Care Delivery to design

and implement this pilot route to Jamaica Hospital.

Rockaways Major Health Care Issues

What is the differences in mortality comparing Rockaway with the other Queens?

• This data is from a NYS DOH 2010 report published in 2011

• This data helped the CSHD begin our first effort to understand and reduce the mortality differences between the Rockaways and the rest of Queens.

• What are the differences in mortality for Rockaway and the rest of Queens?

Death Rates/100,000Rockaway and Queens

Heart Disease Malignant Neoplasum 0

50

100

150

200

250

300

350

400

450398.6

180.9213.3

129.3

Rockaway Queens

Deaths/100,000Rockaway vs Queens

Chronic

Resp Dise

ase

Diabetes M

ellitus

HIV

All case

s 05

1015202530354045 42.6

21.7

8.7 8.1

16.1 16.1

3.5 5Rockaway Queens

Death Rate by Community Districts NYC 2010

• The community district with the highest age- adjusted death rate:– Brownsville (9.2). – Morissania (8.5)– The Rockaways (8.1)– Central Harlem (8.0)– Bedford-Stuyvesant (8.0)

• The lowest age-adjusted death rate was found in:– Bayside (3.6). – Queens Village (4.0),– Greenwich Village/SoHo (4.3)– Murray Hill (4.4)– Flushing (4.4).

All Causes Age-adjusted Death Rate by Community New York City, 2010

Heart Disease Death Rate Community District  NYC 2010

• The community district with the highest age-adjusted death rate for heart disease was– The Rockaways (366.2 per 100,000) – Port Richmond (294.4)– Willowbrook/ South Beach (270.6),

Bedford-Stuyvesant (268.2)– Brownsville (267.8).

• The community district with the lowest age adjusted death rate for heart disease was:– Greenwich Village/SoHo(127.5). – Battery Park/Tribeca (132.3)– Upper East Side (138.1)– Queens Village (138.1)– Bayside (139.7).

Heart Disease Age-adjusted Death Rate by Community New York City, 2010

Cancer Death Rate by Community District NYC , 2010

• In 2010, the age-adjusted cancer death rate was: – Brownsville, 201.5 – Morrisania (198.6), – Central Harlem (190.4)– Port Richmond (182.3)– Coney Island (179.8).– Rockaway (175.1

• The lowest age-adjusted cancer death rate was found in:– Jackson Heights (99.8)– Queens Village (99.9)– Bayside (104.5)– Fresh Meadows/Briarwood (110.5)– Flushing (111.3).

Malignant Neoplasm  Age-adjusted Death Rate by Community New York City, 2010

Homicide (Assault) Death Rate by Community District NYC  2010

• In 2010, the homicide death rate was– Brownsville, 28.9 per 100,000

Bedford-Stuyvesant (22.9)– Mott Haven (18.4)– Morrisania (17.6)– Hunts Point (15.3).– Rockaway (7.4)

• The lowest homicide death rate was found in:– Murray Hill (0.7)– Bay Ridge (0.8)– Borough Park (1.0)– Midtown Business District (1.0)– Greenwich Village/SoHo (1.1).

Center Studying Health Care Deliver (CSHD)

• After Hurricane Sandy we both observed while commuting from home to work and back the major geographic disadvantages the Rockaway Peninsula faces in terms of rapid access to emergency care.

• The CSHD was started by Dennis and Catherine Graham who have over 70 years of combined health care experience.

• Since Hurricane Sandy we have been studying the deficiencies in Health Care Services for the people of the Rockaways.

• In our first study we measured the time to Level I Trauma Care and emergency cardiac care for the people living in Rockaways.