Last month, 318 providers of Emergency Medical Services for the New York City Fire Department were “promoted” to be Firefighters.
This is about 7 percent of the current FDNY EMS workforce and includes 40 Paramedics. No one can fault this group for wanting to pursue a noble profession and seeking greater financial security (this group is now eligible for 29 percent to 60 percent higher pay over the next few years compared to a career in EMS). But why is changing roles from EMS to firefighting a “promotion?” Isn’t being an Emergency Medical Technician (EMT) or a Paramedic just as noble? And what effect does this disparity in how we value these two different types of public service have on the care provided to patients in our city?
As a quick refresher, EMTs have about three months of medical training prior to joining FDNY and are the primary responders to major trauma, including gunshot wounds, stabbings and stroke patients. They assist Paramedics in the care of patients in cardiac arrest. Paramedics have 12 to 15 months of formal medical training and possess deep knowledge of complex emergency-medical conditions such as heart attacks and congestive heart failure, and they can perform very advanced skills such as placing airway tubes, intravenous catheters and administration of a pretty broad range of medications.
Odds Are It’s Medical
This extremely valuable EMS labor force responds to more than 1.4 million 911 calls that are categorized as medical emergencies. Fire and non-medical emergencies account for approximately 300,000 calls and less than 18 percent of FDNY’s total volume. The number of fires, both structural and non-structural, is around 40,000. As the Citizens Budget Commission pointed out in its report in 2015, when you see a firetruck racing down the street with its lights flashing, the odds are about 4 in 5 that it is actually responding to a medical call.
Despite this disproportionate share of medical-call volume, the labor force is greatly skewed toward fire suppression and not medical care. There are 218 firehouses compared to 37 EMS stations. There are more than 11,000 uniformed firefighters compared to about 4,500 EMS providers. The CBC estimated that only 13 percent of the FDNY budget is allocated toward EMS.
While the identity and soul of the FDNY is and may always be its heroic Firefighter, it is high time that the public, our civic leaders, and most of all, our budgets, begin to come to grips with a reality that FDNY is primarily a provider of medical care in New York City.
Another tragedy of the “promotion” is that all that medical training is effectively lost. Unlike other cities, FDNY paramedics who transition to becoming firefighters can operate no higher than the level of a “certified first responder.” This level represents about 80 hours of training and primarily allows for the provision of CPR and use of an automated defibrillator.
Imagine what a negative impact all of this attrition has on the morale of our city’s EMTs and paramedics. Oren Barzilay, head of Local 2507, the EMS provider union, predicts that by this time next year, 20 percent to 30 percent of the EMS workforce will have abandoned the EMS profession, and all their medical training, to become firefighters. What does this do to the level of effort and job satisfaction of the EMS instructor training the new recruits? What does this do to the level of effort put into studying new protocols or practicing skills for the paramedic who has a Firefighter exam coming up in a few weeks?
None of this is meant to disparage firefighters or their role. Nor is it meant to disparage the EMT or Paramedic who wants to transition to being a firefighter. Everyone is entitled both to pursue the career they want, and to improve themselves financially. But doesn’t the Paramedic, a senior-level healthcare provider and backbone of both the public-health and public-safety infrastructure of our city, deserve to be economically valued at a similar level to a Firefighter? Shouldn’t the transition from Paramedic to Firefighter be considered a lateral move to a new profession, as opposed to a “promotion”?
Paramedics are not running into burning buildings, but they are running into our homes, our schools, our communities and providing high-quality, sophisticated medical care. They are operating with a significant degree of autonomy, and their lives are no less at risk. Running into disaster situations or domestic-violence situations is fraught with unknown danger. A 2011 study found that the annual line-of-duty death rate for EMS providers was 7.0 per 100,000 full-time equivalents compared to 6.1 for firefighters and 4.0 for workers overall.
The currently inadequate monetary value we place on the EMS workforce contributes to high turnover and attrition as many EMTs and Paramedics find themselves unable to support themselves or their families on current wages. They don’t just leave EMS to become firefighters. They leave to pursue any number of other careers where there is higher pay. Not having a stable workforce makes it difficult for EMS to invest in quality improvement. In addition, low wages make it difficult to raise the bar for entry into the profession or to increase educational standards.
Why can’t we as a society create greater career-advancement opportunities for our EMS providers? Why can’t we place more value on these individuals who help us when we need it most? If you suddenly experience a medical emergency, wouldn’t you want the EMT or Paramedic caring for you to be passionate and committed to a career in EMS, not someone passing the time until the next Firefighter “promotion” exam?