Top Fire Department officials told a City Council committee Jan. 28 that the department’s policy of “promoting” Emergency Medical Technicians to become Firefighters, who are paid tens of thousands of dollars more a year, had produced a major gap in Emergency Medical Service staffing.
As a consequence, they conceded that even as the city continued to set records for EMS call volume, and response times for those calls were rising, there had been a decline in the number of ambulance crews available, a circumstance they said would take “a couple of years” to rectify.
The troubling admission came before the Council Committee on Fire and Emergency Management.
Lose 1,200 Every 4 Years
Administration officials cited a confluence of factors: the physical limitations of the FDNY’s Queens training facility at Fort Totten that’s slated for a multi-million-dollar upgrade; a national shortage of EMTs and Paramedics; and “a churn” of 1,200 EMS members into firefighting jobs every four years when the promotion exam was offered.
For years the unions representing EMS workers have argued that the vast pay-and-benefit disparity between their members and Firefighters meant a mass exodus by those who passed the Firefighter promotion exam, resulting in a less-experienced workforce, debilitating overtime for those who stayed and fewer ambulances on the street.
The testimony by the officials representing the FDNY and Mayor de Blasio confirmed most of those concerns were valid. The hearing came three weeks before the de Blasio administration and District Council 37’s EMS Local 2507 and EMS Officers Local 3621 open contract talks Feb. 18.
Both unions are in the process of suing the city for race- and gender-based pay discrimination because they claim their rank and files are predominantly made up of people of color and women whose pay is well below that of the other uniformed services. The most commonly cited disparity is that of Emergency Medical Technicians and Firefighters. After 5½ years, maximum EMT pay is $50,604, compared to a Firefighter maximum of $85,292.
The firefighting side of the FDNY is 78 percent white and 99 percent male. By contrast, a majority of EMS is made up of people of color, with 28 percent Hispanic, 21 percent black and 5 percent Asian. Close to a third are female.
Chief of EMS Lillian Bonsignore told the Council that 13 percent of her EMTs had less than one year on the job. In the years when there was no Firefighter promotion exam offered, she said the average on-the-job experience was 6.7 years for EMTs and 10 years for Paramedics.
“However, the years we have promotional exams and they are going to Fire, we have the average length of [EMT] service being 3.5 years, and 4.5 years for Paramedics,” she said.
Councilman Joseph Borelli, chair of the Fire and Emergency Management Committee, expressed concern about the decline in the average on-the-street experience of the EMS workforce.
“Does EMS experience directly translate in better outcome for patients?” he asked Ms. Bonsignore.
‘All Highly Trained’
She deflected the question by attesting to the qualifications and certifications of the entire EMS workforce.
“Every single person is trained to the highest level of training,” she said. “They would not be in the field if they were not qualified to be in the field.”
Mr. Borelli pressed on. “The fundamental question for the public is whether EMS experience translates in better outcomes for the patient. I understand that every single person we put on will have qualifications and certifications and be competent, but as a rule of thumb, does EMS experience translate into better [patient] outcomes?”
Ms. Bonsignore responded, “Outcomes are really patient dependent. So we are working under the same protocols. We have a set of protocols...and our assumption is, and always should be, that our members, no matter how long they are on the job, are following those treatment protocols, and outcomes of the patients are related to how that individual responds to that specific protocol that we are using.”
Mr. Borelli then cited a 2011 study conducted by the University of Pennsylvania’s Leonard Davis School of Health Economics that established a direct link between improved patient outcome and the level of experience of those who attended to them.
“And they found that experience and outcomes were correlated with Paramedics with over six years of service…The U Penn study basically says…that more experienced Paramedics lead to better health outcomes for the patients. Does the Fire Department have any internal data or studies to negate or refute the findings of the U of Penn study?” he asked.
“We don’t have any information or reason to dispute their findings,” Ms. Bonsignore conceded. “I am not disputing that experience is a good thing.”
Councilman Borelli noted that drops in the on-the-job experience were not the only risk he saw for the general public due to high EMS turnover.
“The Mayor’s Management Report says that despite the department’s aggressive efforts to hire additional EMTS and Paramedics, the peak number of ambulances in service per day dropped 2.5 percent, from 472 in FY 2018 to 460 in FY 2019, with a five-year average that was 444,” he said.
‘Can’t Always Use OT’
“So, we have a lot of [EMS] vacancies and as an ultimate result of those vacancies, you can’t always cover that with overtime, so as a result you have less tours,” responded Stephen Rush, the FDNY Deputy Commissioner for Budget and Finance. “Once we catch up in the headcount, which is going to take a couple of years, that should even out.”
He said that in addition to greatly increasing the FDNY’s EMS training program capacity, the department was taking a second look at its policy of letting EMS personnel take the Firefighter promotion test after only two years on the job.
“I think that is under review now, what [period] of service they have to remain in EMS, because that is a challenge we face, especially the training academy…and the churn of personnel that come in and out to become Firefighters,” he said.
“If the headcount increase is not working, is it possible to redirect the financial resources [committed] for increasing the headcount to something different like a ‘stick-around count’ through a raise [for EMS workers] for example?” Mr. Borelli suggested.
Have to Get Creative
Mr. Rush said that the EMS contract talks were getting underway after the de Blasio administration had established a collective-bargaining pattern with DC 37 and the United Federation of Teachers but the city remained open to “coming up with creative ways” to identify productivity improvements that would make it possible “to come up with additional compensation for the membership.”
The Committee on Fire and Emergency Management is considering legislation proposed by Councilman I. Daneek Miller, who chairs the Committee on Civil Service and Labor, to require that the FDNY closely track and publicly report on the EMS attrition rate.
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