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To the editor:
The city's latest ambulance response-time figures demonstrate why EMS workforce policy and operational performance cannot be considered separately.
Ambulances cannot operate without EMTs and paramedics.
Recruitment, retention, competitive compensation, career opportunity and morale directly affect whether the city can attract and retain experienced EMTs and paramedics—and ultimately how many scheduled ambulance-hours are actually staffed and available to answer emergency calls.
Competitive compensation should therefore be viewed not only as a workforce issue, but also as an operational issue: if compensation affects recruitment and retention, it ultimately affects the city's ability to put fully staffed ambulances into service.
But workforce is only one part of the problem. Response time also reflects 911 processing, deployment, hospital patient-transfer delays, traffic, geography and available system capacity.
That relationship deserves particular attention as the City Council prepares for its Oct. 20 oversight hearing on ambulance response times.
The important management question is not simply how many ambulances are scheduled or how many vehicles the city owns. It is how much staffed and operationally available capacity exists when New Yorkers call 911—and what prevents that capacity from being available when it is needed.
The city should bring the FDNY, the Office of Management and Budget, the Office of Labor Relations, EMS labor, Health + Hospitals and the broader hospital community together to examine those factors using a common set of data and performance standards.
The goal should be to determine how much staffed capacity—and what other operational changes—are necessary to reach patients reliably within clinically appropriate standards.
A stable, adequately staffed and competitively compensated EMS workforce is therefore not simply a labor objective. It is an essential component of a reliable emergency medical system.
James T. Kerr
The author was the executive director of New York City's EMS service from 1980 to 1988, before the service merged with the FDNY.
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