New York City's Understaffed, Overwhelmed EMS Workers Strain to Meet Demand

The front door to EMS Station 40, known as “the Dragon’s Den,” in Sunset Park, Brooklyn. (Credit: Ana Castelain)

Lt. Anthony Almojera of the New York City Fire Department’s Emergency Medical Services was alone at EMS Station 40 in Brooklyn when the emergency call came in. A woman was suffering from respiratory distress in the nearby Bay Ridge neighborhood. The ambulance dispatched to come to her aid was in an accident and all other units were busy. Almojera jumped into his Chevy suburban and – upon reaching the woman – sat with the patient as she struggled to breathe for 20 minutes until an ambulance arrived.

“I gave her oxygen but that’s not enough,” Almojera said. “She’s got fluid in her lungs. She needs medication.”

The nearest available EMS unit had been reassigned from the other side of the borough, creating a delay that is becoming routine in the city’s understaffed and underfunded emergency medical system.

The reasons for these delays are numerous and interrelated: aging equipment with a reduction in ambulance capacity, lack of financial resources and a staffing shortage. As the city leaves these emergency needs unaddressed, response times will only increase. And adding new equipment will require additional staffing, such as paramedics and Emergency Medical Technicians (EMTs) who are the first responders to 911 calls.

New York’s emergency medical response service is the busiest in the world, handling more than 1.6 million calls in 2023. The city’s EMS workers are part of the fire department, or FDNY, which faces recruitment and retention challenges because its employees are among the lowest-paid public workers, according to the unions representing these workers. The EMS unions have been without a contract for three years and are suing the city for discriminatory pay. Current working conditions are taking a toll on EMS employees, putting additional strain on the workforce and leading to burnout for staff, according to the unions.

In December 2023, Nick Costello, 24, died of cardiac arrest in the Bronx after waiting 19 minutes for an ambulance. Several factors were to blame, including an out-of-date dispatch system, a staffing problem and a shortage of ambulances.

According to the Mayor’s Management Report published in January, ambulance response times for life-threatening emergencies increased to 8 minutes, 48 seconds in the latest period from about 7 minutes, 26 seconds, in 2022.

“We’ve seen a dramatic shift, an increase in the wait times for ambulances,” said Carmen De La Rosa, a City Council member who is chair of the Labor Committee. “This is due to the vacancies that exist.”

Between 2022 and 2024, the number of life-threatening medical emergency calls citywide increased by over 12%. While the FDNY’s budget has increased, EMS funding has held steady while the ambulance fleet shrunk.

“The problem is the call volume,” said Oren Barzilay, president of EMS Local 2507, which represents EMTs and paramedics. “They’re not adding additional resources to deal with it and it reflects on the response times because the units are tied up elsewhere.”

Staffing levels are an issue across the state. The number of active certified EMS responders in New York State declined 17.5 percent between 2019 and 2022, according to the Department of Health.

New York City’s 4,500 EMS workers handle about 4,400 emergencies per day. By comparison, the FDNY’s more than 10,000 firefighters respond to around 850 fire and non-fire emergencies per day. (Fire emergencies represent approximately 12% of the total.)

“Over the next year, I’m going to lose 1,500 people because they’re going to the Fire Station,” said Almojera, who is also vice president of the Local 3621 EMS Officers Union. “They keep pulling from EMS to solve their diversity issue.” The FDNY did not respond to interview requests.

“Our diversity is our strength,” said Lt. Tim Cusack, a 34-year EMS veteran assigned to Station 40 in Brooklyn’s Sunset Park neighborhood. “We represent the people that we serve.”

Lt. Anthony Almojera and Lt. Tim Cusack at EMS Station 40. (Credit: Ana Castelain)

The EMS staffing shortage is linked to pay, according to Almojera. “People aren’t coming to this job because they see there’s no money,” he said. “There’s no way to make a living and feed your family.”

The starting salary for an EMT is $39,999, reaching $59,000 after five years. Firefighters earn almost twice those amounts. “Me asking for equality shouldn’t be controversial,” Almojera said. “I just want the same, not one dollar more.”

EMS staff also lack the lifetime benefits and pay that firefighters receive for line-of-duty deaths.

In 2019, workers filed a discrimination complaint, leading to a 2021 finding of discrimination by the U.S. Equal Employment Opportunity Commission. In 2022, Unions and FDNY EMS workers filed a suit against the city stating discriminatory pay practices. The suit was certified to move forward as a class-action lawsuit in 2024, which the city sought to dismiss.

“We’ve been looking at the pay inequities as a real root cause of why we can’t retain the workforce,” De La Rosa said. “There’s a lot of concerns about the way that the bargaining for the contracts have happened.” She said the situation is tied up in collective bargaining, which leaves the lowest rung of city workers with slim increases each year.

“This is one of the lowest paid workforces in the city of New York and a workforce that is critical,” De La Rosa said. “You never want to be on the other side of needing an ambulance and not having that workforce available.”

Firefighters are paid more than EMS workers because the former group are considered non-civilian and must go through an academy with specific training, De La Rosa said.

EMS workers won uniform status in the late 2000s, so they refuse to give in to the contract the city is offering them, which is the civilian pattern at 16% and not the uniform pattern at 18%, Almojera said. “We’ve had to fight them on this all the time,” he said.

Every city worker “has an honorable job,” said Barzilay, the EMS Local 2507 president. “But nobody has a job that’s as risky as ours,” he said. “And they (the city) don’t want to acknowledge that.”

Prospective firefighters must pass two exams and an 18-week training program to join the FDNY. The city’s paramedics must have prior experience as an EMT, which can involve up to two years of training through a specific academy.

“It’s the same thing for EMS,” Barzilay said. “Ours is just more medical school.”

“Firefighters respond to fire; EMS responds to a sick person,” De La Rosa said. “We need both of those things to work hand in hand.”

The pay disparity creates a revolving door in the ranks. Despite campaign promises, Mayor Eric Adams has yet to address the issue. In 2023, app-based delivery workers earned $1.02 per hour more than an EMT’s starting pay.

Adams and Justin Brannan, a City Council member who represents Bay Ridge and other parts of Brooklyn, addressed pay disparities between the EMS staff and firefighters in an op-ed under the headline “New York City needs to treat EMS workers so much better,” published in 2021 in AMNY.

“There’s no other way to say it: The way New York City treats our EMS workers is shameful, if not borderline discriminatory,” Adams and Brannan wrote. They said “the goal was that workers from both agencies would eventually reach pay parity.”

Many EMS employees work multiple jobs to make ends meet. Almojera holds down three jobs. Nationally, 60% of EMS respondents work two or more jobs. Others suffer from burnout, PTSD and mental exhaustion.

Citywide, there have been 12 suicides among FDNY EMS workers since 2020, according to Almojera. Ten EMS staffers died of COVID, he said.

“These are first responders that are called to the scene of gunshot wounds, called to the scene of murders. Everything that is happening across our city, they are first responders,” said De La Rosa. “Between the morale of the workforce and the pay, we’re seeing a drastic decline.”

EMS Lt. Anthony Almojera inside Station 40. (Credit: Ana Castelain)

Even veterans struggle. “If I take one day a month for mental health or get really sick, I’m off payroll,” said Cusack of EMS Station 40. Sick leave benefits are subject to arbitration.

In 2017, the EMS FDNY Help Fund was created after the death of EMT Yadira Arroyo in the line of duty to provide assistance to EMS workers in need. The non-profit was founded by EMS workers for $2 a paycheck.

“If I’m an EMT, I can give $2 a paycheck, and it’s like self-insurance,” said Danielle Gustafson, executive director of FDNY EMS Help Fund.

After the pandemic, the organization also started to provide mental health assistance.

“We have something called the counseling service unit in the fire department. Useless,” Almojera said. “The EMS Fund is the only support.”

As experienced EMS workers leave, life-saving expertise vanishes.

“The real skills to save lives develop by year six,” Gustafson said. “If everyone leaves by year five, you’ve got a brain drain.The people that are most equipped to save lives, especially with heart attacks and things like that, they can’t afford to stay.”

Almojera acknowledges that compensation for EMS workers might not be top of mind for city residents.

“Me saying I want to have extra money, they don’t get it,” he said. “I’m not the priority until you call 911. And then you get mad when you are waiting 20 minutes for an ambulance.”