The Coming Collapse of EMS is a City Budget Decision

New York City is at a critical crossroads in its emergency response system. That's a polite way of saying it may collapse this summer. While City Council voices (notably Speaker Julie Menin and Fire and Emergency Management Chair Joann Ariola) advance a proposal to add a fifth firefighter to engine companies at an estimated cost of $91.7 million annually, the city’s 911 EMS system continues to face a deepening crisis of deep understaffing, burnout, and low wages.

FDNY EMS, paramedics and EMTs, respond to roughly 85 percent of all 911 calls, including overdoses, cardiac arrests, shootings, and psychiatric emergencies. Yet despite carrying the overwhelming majority of emergency workload, EMS remains the lowest-paid branch of the FDNY.

FDNY EMTs and paramedics currently earn significantly less than firefighters, even though they respond to a far greater share (85 percent) of 911 calls:

• A firefighter with 5.5 years can earn $109,352 (excluding overtime & benefits).

• A typical FDNY EMT with similar 5 years earns $59,534.

• A typical FDNY Paramedic with similar 5 years earns $75,872.
  

Because of that gap, members of the NYC Council and EMS unions have long argued that EMS should receive pay parity with firefighters, even though official administration cost estimates have widely differed ($83 million as per former City Council Member Justin Brannan to $310 million more per year-full wage/benefit parity).

District Council 37 Locals 2507 and 3621 have warned that as many as 1,500 municipal EMS workers may resign or "promote out" this year due to decades of wage stagnation and lack of systemic reform. Local 1199 of the Service Employees International Union is facing the shut down of hospital based units as has occurred at Northwell and RUMC.

Call volume continues to climb toward COVID-era levels (above 6,500), while ambulance staffing shortages drive response delays and forced overtime across all five boroughs. FDNY end-to-end response times are a deception; the response times are above 18 minutes because they do not factor in time from apparatus to patient.

This is not a question of firefighters versus EMS. Firefighters deserve proper staffing and resources.

But public safety policy must reflect operational reality: EMS handles the vast majority of emergencies in this city every day. Yet proposed investments continue to favor politically visible fire suppression staffing expansions over the less visible but far more heavily utilized ambulance system.

City estimates for meaningful EMS wage parity and staffing stabilization range widely, but even the highest projections, approximately $310 million annually, represent an investment directly tied to the system responsible for most life and death emergency responses. Meanwhile, engine companies increasingly function as medical responders due to ambulance shortages, underscoring the imbalance in current priorities. But it is not a definitive level of care and they do not transport anyone.

The question before the Council is simple: should scarce public resources be directed toward marginal fire staffing increases, or toward stabilizing the EMS system that New Yorkers rely on most?

Without urgent investment, response times will continue to rise, experienced clinicians will continue to leave, and public safety outcomes will deteriorate further. The consequences of continued delay are already visible across the city.

The City Council must ask itself what matters more for public safety: adding a fifth firefighter to engine companies responding to roughly 110 fire incidents a day, or strengthening the EMS system handling the overwhelming majority of emergencies across the city well over 6,000 calls for EMS.

EMS workers warn that the consequences of continued neglect are already visible. Ambulance response times are realistically above 18 minutes to patient contact, experienced EMTs and paramedics continue leaving the profession, and response delays are affecting communities in every borough. When you invest in special interests before fixing the service handling 85 percent of 911 calls, eventually the chickens come home to roost.

That's a polite way of saying that while various politicians are 100 percent ready to get their firefighter votes and campaign contributions; you and your family will be screaming and tearing your hair when you can't get an ambulance to your loved one because there aren't any available. Because the city invested its resources in something that was already fully staffed and has been for years.

If you'd like to send a message to the entire ambulance service you want us to walk off the job, by all means, fund a fifth firefighter before you fund FDNY EMS parity.

But 6,000 calls a day are not for fires, they are for medical emergencies.