A modest proposal for EMS reform

Bryony Gilbey is an award-winning writer and documentary filmmaker. George Molé is a retired NYPD captain and former member of NYC EMS.

They respond to emergencies large and small — cardiac arrests, shootings and other violence, contagious illnesses and mental-health crises. They employ Narcan for overdoses and defibrillators for cardiac arrests, administer life-saving medication and CPR, carry patients out of cramped apartments and down long flights of stairs, and sometimes confront mass casualty events.

But increasingly, as The Chief and other media have reported, the men and women of FDNY’s Emergency Medical Service are burning out, jeopardizing the health of the entire EMS system.

Compared with police officers and firefighters — who are paid significantly more, receive better benefits, and are recognized as uniformed first responders — EMS has been left behind, working without a contract with negotiations at a standstill. This disparity in compensation and recognition has led to recruitment and retention issues that endanger anyone calling 911 for a medical emergency or serious injury.

We can confirm the extent of the crisis. Over the last year we interviewed a variety of EMS professionals and found a sense of discontent and alarm both wide and deep.

“The question for many drawn to EMS is … how can one properly pay the rent and feed one’s family while doing this?” said Walter Adler, co-founder and president of the nonprofit Emergency Medical Services Public Advocacy Council (EMSPAC). “The answer is to either do it twice as much as most average workers work, in effect working 60 to 80 hours. Or, like the majority, to leave the job.”

“Every day we’re losing people,” Anthony Almojera, an FDNY EMS lieutenant and vice president of the Uniformed EMS Officers Union Local 3621, told us. “Morale is the worst I’ve ever seen.” 

Almojera has spoken out about Mayor Eric Adams’ failure to keep his campaign pledge to give EMS parity with police and fire.

“The mayor promised he’d come in with a purse in his hand for us,” said Lieutenant Roy David, the most senior active member of FDNY EMS, with more than 50 years of service. “It never happened.”

Douglas M. Wolfberg, of Page, Wolfberg & Wirth, a national law firm specializing in EMS law, posed a key question: “Why would the city not address the wholesale dissatisfaction of a workforce on whom New Yorkers depend?”

But the upcoming mayoral election provides a perfect opportunity to make things better — and for the candidates to demonstrate their ability to agree on a non-partisan issue.

We call on the three remaining major candidates — Zohran Mamdani, Curtis Sliwa and Andrew Cuomo — to commit to the following common-sense program of EMS reform:

1) Bring FDNY EMS salaries and benefits in line with those of their firefighter and police officer colleagues (with a reasonable differential between EMTs and paramedics to reflect the difference in training).

EMS providers work side by side with other first responders and their jobs are just as dangerous. Pay parity will enable them to build middle-class lives, complete full careers rather than having to seek other professions, and provide the public with experienced and seasoned clinicians.

2) End FDNY’s system of “promotion” from EMT or paramedic to firefighter, which turns EMS from a respected career in its own right to a mere apprenticeship for another job.

This program is a significant source of EMS’s staffing issues, drawing candidates to EMS who have little interest in the work and no intention of staying past the time it takes to transition to firefighter.

3) Educate the public on proper use of the 911 system and encourage alternate forms of medical care and transportation for non-emergency health concerns. The overuse and abuse of 911 is a primary cause of the system’s overload and often results in delayed response to true emergencies.

4) Lastly, vastly improve the city-run EMS system by removing it from FDNY control and creating an independent Department of Emergency Medical Services.

Placing a smaller agency under a larger agency with differing organizational culture and functions invites problems. Since 1996, when New York City EMS was folded into FDNY, there have been many, including several successful claims of FLSA violations and one ongoing class-action lawsuit. An independent EMS could focus on its primary function without having its priorities and needs subordinated to those of the Fire Department.

The plight of EMS poses a severe threat to public safety. Our city deserves a reliable and competent EMS service, provided by proud and happy professionals who are treated well and paid fairly for their vital work. This election season is the right time to demand change.