View from the top: A career climb rooted in female empowerment

New York Fire Department EMS Chief Lillian Bonsignore credits the support and encouragement she received from the women in her life for her success in emergency medicine


It was a summer job that has spanned a lifetime.  

Nearly 29 years ago, in 1991, Lillian Bonsignore started her career as an EMT for the city of New York. In May, 2019, she was promoted to chief of EMS for the FDNY, the first female and openly gay person to hold the position.  

The now 4-star Bonsignore admits she didn’t know what EMS was, and in fact, intended to attend medical school, when her childhood pediatrician and mentor encouraged her to take an EMT class.  

FDNY EMS Chief Lillian Bonsignore started as an EMT in 1991, and is now the first female and openly gay person to head the department. (Photo/FDNY)
FDNY EMS Chief Lillian Bonsignore started as an EMT in 1991, and is now the first female and openly gay person to head the department. (Photo/FDNY)

“I trusted her, and I knew if she was telling me I should do that, it was a good idea,” Bonsignore said. “So, I took the course, and started working for an ambulance company, and then the city hired me. I ended up absolutely falling in love with the EMS profession.” 

Life in EMS 

For Bonsignore, the immediacy of the job and the ability to serve as a lifeline for people in their most desperate moments connected with her on an emotional level.  

“It was an amazing experience to be able to be out there and help people when they need it the most, and to be able to help them in their home, in their spaces where they were the most vulnerable,” she said. “I was able to be the person that shows up and offers a helping a hand, or life-saving medical care, or compassion, or whatever it is they needed at that point – I was able to do it.” 

It just “clicked.” 

“I felt like I was at home,” Bonsignore said. “I felt like I was exactly where I was supposed to be, and this profession is what I was supposed to be doing.” 

During the terrorist attacks on the World Trade Center in September 2001, Bonsignore was serving as an instructor in the CFR program, and joined a convoy of EMS members making their way down to Ground Zero. She spent several days working as part of the rescue and recovery efforts – her most memorable call in her nearly 30-year career.  

What else sticks out in Bonsignore’s mind when she runs through the catalogue of calls she’s responded to? Babies.  

“The first two years of my career, I complained that I had never delivered a baby,” she said. “I just thought that was the most incredible thing that could happen. Well, had I known what I know now, I would never, never have complained about that.” 

When she finally responded to a call involving a baby delivery, Bonsignore said everything that could go wrong, did.  

“Every problem that could ever exist during a birth was thrown at me at the same time,” she said. “I delivered twins; one was breach. They both needed to be resuscitated and I was in an abandoned building on the fifth floor with no electricity. It could not get worse.” 

The call cured her of her initial desire.  

“The twins were successfully resuscitated, but after that, I was not interested in delivering any more babies,” she laughed.  

Confronting the obstacles facing EMS 

In the seven months since she assumed the role, Bonsignore’s perception of the FDNY has changed.  

“I have a much broader view of our department now, and I’m way more impressed than I was when I started,” she said.  

As the head of the EMS division, Bonsignore is aware that one of most difficult challenges facing providers in the field are the increasing number of physical and verbal assaults, which she hopes to confront.  

“Being in this position, it’s certainly something that sits very heavily on my head, to know that there’s so many good people out there and that their wellbeing is at risk,” she said. “It’s unnerving to know that these folks are out there being assaulted at the rate they are.” 

Preparation and awareness of the possibility of violence is crucial, according to Bonsignore.  

“Some of the things that need to happen is communication about situational awareness, such as being able to identify aggressive body language, and retreating when we feel like things are getting heated or are going to get physical,” she said. “But, that’s not always possible. Sometimes you’re in the back of an ambulance and there’s just no way to get out.” 

For now, Bonsignore encourages safety in numbers and offers optimism that the threats will decrease.  

“It’s hard to understand why people would look to hurt the hand that is there to help them,” she said. “We prepare [providers] as best we can. We encourage them to stay together in teams and to communicate, and I hope someday we can overcome this problem.” 

In addition, Bonsignore also believes the industry must address the severe personnel shortage.  

“There are a lot of reasons cited as to why,” there’s a shortage, she said. “One, you’re almost guaranteed to be assaulted at some point in your career. Two, the money tends to be lower than all the other emergency services. Three, it takes a tremendous amount of mental strength to be able to make a career out of somebody else’s tragedy every single day.” 

Making people aware of the possibility of a career in EMS is one way to combat those retentions issues, Bonsignore said.  

“It’s not an easy thing to do, but there are wonderful people out there that may or may not know that a career like this is something that’s an option for them,” she said. “We need to make sure that we get the message out that this is a noble profession. You’re saving lives for a living.” 

FDNY EMS Chief Lillian Bonsignore in 1994. (Photo/FDNY)
FDNY EMS Chief Lillian Bonsignore in 1994. (Photo/FDNY)

Female encouragement in a world where it seems scarce 

The need for a lifeline is something Bonsignore can also relate to on a deeper level. According to her, it’s because of two women in her life – an educator and her childhood pediatrician – that she finds herself atop of the iconic FDNY, serving one of the country’s largest and most diverse cities.  

Bonsignore was a young single mother when she began her EMS career and says her mentors were there for her every step of the way. 

“They found me at a time when things were very difficult, and I was vulnerable,” she said. “They reached in and grabbed ahold of me, and things worked out. I’ve always wanted to do that for other people, as well.” 

Bonsignore says her supporters’ faith in her has never diminished, a testament to the importance and necessity of finding people in life who believe in you.  

“Young girls don’t always have a strong woman to look up to, and in a world where it’s already difficult to navigate as a woman as it is, having other women there to help you do that is just critical,” she said. “[They] took an interest in me and just never let go. No matter how bad things got, no matter what terrible decisions I made, they were always there, and they still are, 35 years later.” 

Bonsignore also has the encouragement of her wife of 18 years and her two grown daughters, all of whom she credits as her continuing sources of strength.  

“My wife has been an incredible support structure for me throughout my career, and my daughters are my biggest fans,” she said. “They are so proud of me, and I get a lot of my get-up-and-go when things are tough from them, because I know I have to be an example for them. I have to be their advocate. And I want them to see their own strength through how I operate.” 

It’s that kind of investment into other women that Bonsignore believes can change the world.  

“There are such strong women around us, and if they just took a moment to reach back, a moment to just offer the gift of their time, they could literally change somebody’s life forever,” she said.  

FDNY EMS Chief Lillian Bonsignore. (Photo/FDNY)
FDNY EMS Chief Lillian Bonsignore. (Photo/FDNY)

Using diversity to resonate with the community 

As the first openly gay EMS chief for the FDNY, Bonsignore also hopes that members of the LGBTQ community look to her and see a path they can forge themselves, despite the perception that the profession is male- and cisgender-oriented, she noted. 

“Don’t let anybody else define your ability,” Bonsignore said. “Just because there are fewer women in these careers, doesn’t mean that you won’t be successful. Just because you happen to love somebody of the same gender, doesn’t mean you don’t have these opportunities.”  

Encouraging people of different backgrounds, different experiences and different beliefs is a win for both the agency and city residents, Bonsignore believes.  

“Our strength is our diversity, and in a city like New York, we can basically communicate with just about anybody who is here,” she said. “For a young LGBTQ member, they see somebody like me sitting at the top of one of the most recognized fire departments in the world, with a job overseeing 4,000-plus EMS members, I think they see me as their possibility, and I’m proud to play that role.” 

Above all, Bonsignore says, “never let somebody else tell you what you can and cannot do.” 

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