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Anthony Almojera is an FDNY EMS lieutenant, vice president of Local 3621, the Uniformed EMS Officers Union and author of “Riding the Lightning: A Year in the Life of a NYC Paramedic.”
When New Yorkers dial 911, they expect help — fast, skilled and lifesaving. Whether it’s a fire, a shooting, a cardiac arrest or a mental health crisis, lives often hang in the balance of seconds. Yet for too long, the city’s emergency medical services — FDNY EMS — have been treated like a side note instead of a pillar of the city’s emergency response infrastructure. It’s time to change that. It’s time for EMS to separate from the FDNY and become its own independent agency: a true third 911 service.
The idea of a third service is not radical. Across the country, many cities recognize EMS as a distinct and vital public safety entity alongside police and fire. New York, ironically the city that never sleeps, remains asleep on this issue — keeping EMS under the shadow of the Fire Department. But the challenges EMS faces today aren’t just a result of budgetary neglect or political inertia — they’re rooted in a structural problem. You cannot fix a broken system while keeping EMS trapped in someone else’s house.
FDNY EMS is staffed primarily by EMTs and paramedics — workers who are highly trained, deeply experienced and often the first healthcare providers a person will ever encounter. Yet they are the lowest paid and most overworked of the city’s emergency responders. An FDNY firefighter and an EMS paramedic may show up to the same scene, risk the same dangers and respond to the same calls. But one makes nearly double the salary of the other and receives far more comprehensive benefits. Why? Because one wears bunker gear and the other wears an EMS patch. This is not the fault of the firefighters themselves. The fault lies solely on the management of New York City and FDNY.
This disparity is not just unfair — it’s dangerous. It leads to massive attrition. It breaks morale. It tells every young EMT or paramedic in New York City that they are second-class responders. And in a city where medical calls vastly outnumber fires, that message undermines the very fabric of public health and safety.
EMS is healthcare. It is not fire suppression. It is not law enforcement. The mission of EMS is unique: assess, treat, stabilize, transport and also advocate for patients and their families not only on scene but at the hospitals we deliver them to. But under the FDNY, EMS is often viewed through the lens of firehouse priorities. This has created a system where operational decisions are made by leadership trained in fire science, not emergency medicine. Where career advancement for EMS professionals is capped. Where innovation in pre-hospital care is stifled by a culture that doesn’t fully understand or value it.
Creating a stand-alone EMS agency would allow for a leadership structure that reflects EMS’s mission — led by medics, clinicians and administrators who understand the science and practice of emergency care. It would empower EMS to modernize its protocols, pursue community para-medicine programs and engage in public health initiatives that align with 21st-century needs.
Every New Yorker should care about this. Because when EMS is underfunded, understaffed and undervalued, response times rise. Quality of care suffers. And people — especially in marginalized communities where EMS call volumes are highest — pay the price. An independent EMS agency would be more nimble, more accountable and more focused on delivering patient-centered care. It could better partner with hospitals, mental health services and public health departments. It could build a more resilient, responsive system from the ground up.
We’re not asking for special treatment — we’re asking for fair treatment. We’re asking to be seen not as an appendage of the Fire Department, but as what we are: healthcare professionals delivering critical services in some of the most dangerous and high-pressure situations imaginable.
The pandemic laid bare what EMS has always been: frontline, essential and heroic. But heroism without structure is not sustainable. The only way to fix the cracks in this system is to build a new foundation. Let FDNY EMS stand on its own. Let it be the third 911 service New York City so desperately needs. Our lives — and yours — depend on it.
4 comments on this item Please log in to comment by clicking here
JohnMurray
Always love reading your work, Anthony.
Thursday, August 21 Report this
lgm718
Unfortunately, I don’t see any convincing argument made here for separating the two agencies. NYC EMS was once a separate agency under HHS - and it still suffered the same problems with pay and retention that it does today. Maybe the real problem lies in union leadership that has consistently failed to deliver any meaningful increases in compensation or help pass any bills in the state legislature to address benefits or civil service aspects of the job? Barzilay has been on the board of 2507 for nearly two decades, and Variale has been for 15 years. What have they done during that time except point fingers?
Thursday, August 21 Report this
Getomedic
Great insight and analysis of a situation which has been ignored for to long. You are medical professionals and should be part of NYC’s health care infrastructure as its own entity. A change such as this may bring with it a better bargaining status as well.
Thank you Tony for this enlightening article.
Thursday, August 21 Report this
Nursejohn66
Unfortunately the distortion that union leaders love to portray are not the facts you are not risking your life. You don't go into burning buildings The educational requirements are a hs diploma or a GED.the city will train you to become a medic you are not the same as firefighters or police or sanitation workers if the private ambulance companies offered these high wages you feel deserve then there would be great compition for this career path but they don't. And as for leadership of FDNY ems I guess the chief of ems and all his deputies are puppets of the firemen and no advancement means the no one gets promoted then how come none of the FDNY.ems officers aren't firemen. I could go on
C
Friday, August 22 Report this