A recent meeting of the New York City Council rekindled hope among many New Yorkers and EMS professionals that the creation of an independent New York City EMS Department might finally become a reality [1].
For generations, EMS professionals and concerned citizens have imagined a department worthy of the city it serves: one that fully recognizes the capabilities, professionalism and potential of its workforce, while compensating them with professional salaries, and delivering 21st-century services to all New Yorkers.
| MORE: Should NYC split EMS from FDNY? Pay, staffing and patient care are on the line
For decades, EMS in NYC has operated with insufficient resources that limit its ability to evolve, innovate and adequately protect its workforce. The Council meeting acknowledged what EMS professionals have long known: pay parity and sufficient, sustained funding are essential. Equally critical is workforce safety, an issue that remains under addressed.
The dangers faced by EMS clinicians are not abstract and are indicative of systemic failures to address EMS risks. We all remember within the past decade, the two women who were brutally murdered while on duty for the NYC Fire Department (FDNY) EMS [2,3]. These tragedies shocked the city and our profession. Yet as devastating as they were, they represent only the most visible manifestations of a much broader occupational safety crisis that plays out daily, largely outside public view.
In 2022 alone, EMS professionals in New York City experienced 363 workplace assaults or violent threats [4]. Violence is only one of many hazards faced by these personnel. Each year, more than 1,500 FDNY EMS clinicians suffer service-connected injuries and illnesses, ranging from musculoskeletal trauma and vehicle collision injuries to communicable illnesses [5]. These are not isolated events; they are systemic indicators of a workforce operating under sustained risk.
Available evidence suggests that FDNY has not achieved meaningful reductions in these risks for its EMS workforce. Between 2016 and 2025, the number of injury cases per year among firefighters steadily declined, but over the same period, the annual number of injury cases among EMS professionals has remained essentially unchanged [5].
A similar pattern is seen in FDNY vehicle safety data: while collision rates involving fire apparatus have decreased, ambulance collision rates have increased [5]. These trends strongly suggest that safety investments and organizational attention have not been applied equitably across the department.
These stark disparities matter, not only for the health and safety of EMS professionals, but for the effectiveness of emergency care in NYC. Injured clinicians, high turnover and chronic under-staffing undermine response capacity, reduce institutional knowledge and impact morale. Safety and pay are likely the two leading reasons for the estimated 70% attrition rate among EMS professionals in FDNY [6]. Over time, these factors result in experience loss, onboarding costs and response delays, and weaken the system’s ability to meet community needs.
Fire prevention and structural fire response are rightly regarded as national success stories. Decades of investment in prevention, training, equipment and data-driven policy have produced dramatic reductions in fire-related deaths and injuries. There is no comparable success story for EMS in New York City, not because EMS professionals are less capable, but because the system has not been structured or resourced to succeed.
Risk prevention
In the three decades that FDNY has controlled EMS in NYC, the level of EMS service in the city has fallen far below the levels provided in other jurisdictions. In other jurisdictions, sufficiently resourced EMS agencies do more than wait to respond to emergencies. They actively work to prevent emergencies from occurring in the first place. In one U.S. county, EMS-led injury prevention initiatives reduced pediatric drownings by 50% [7].
Similar approaches have, for example, reduced falls among older adults [8]. These outcomes are not theoretical; they are documented results of modern, sufficiently-resourced, integrated EMS systems. New York City EMS professionals could achieve similar results.
Falls among older adults illustrate the consequences of a reactive EMS model. In NYC, 42,987 elderly patients were treated in emergency departments for fall-related injuries in 2023 alone [9]. For the elderly patients, these emergencies are disruptive, costly and often life-altering events. Many elderly patients are seen for conditions that could be prevented through targeted education, home safety interventions and community partnerships, precisely the kinds of strategies that modern EMS systems are designed to support.
Other jurisdictions have EMS clinicians with clinical master’s degrees who function at levels comparable to physicians assistants and are empowered with expanded treatment and decision-making options [10-13]. In other jurisdictions, elderly patients, for example, are not automatically transported to emergency departments to wait for hours in hospital hallways. Instead, these advanced-practice EMS clinicians can safely and effectively treat certain conditions in the home, coordinate follow-up with primary care providers and reduce unnecessary hospital visits.
| MORE: What do you do after the lift assist? Helping a fall patient back into bed, a chair or onto the ambulance cot should launch risk mitigation in the patient’s home to prevent future falls
In other jurisdictions, EMS is the agency that cares for patients with mental health emergencies [14-16]. In well-resourced EMS systems, EMS professionals are paid salaries comparable to nurses, police officers and firefighters [17]. EMS in NYC has fallen far behind these services that are operating 21st century systems in their jurisdictions.
Some people may believe that the upfront cost of building a 21st-century EMS department is a barrier to reform. Yet evidence from other jurisdictions demonstrates that such investments more than pay for themselves over time. Modern EMS systems reduce overall healthcare costs, decrease EMS call volume, limit unnecessary hospital transports, and improve population health outcomes [18-22]. A modern NYC EMS Department could also improve workforce safety and retention, critical factors in a city already facing EMS staffing shortages.
An independent New York City EMS Department would not be a luxury. It would be a strategic investment in public safety, public health and fiscal responsibility. With appropriate resources, leadership and commitment, the New York City EMS Department could become a national success story in its own right: an agency fully equipped to meet the needs of New Yorkers, and one that matches the dedication, capabilities and expertise of the professionals who serve within it. The question is no longer whether New York City can afford an independent EMS Department, but whether it can afford not to build one.
It’s an age-old constant question — should EMS be its own agency, separate from fire? Why or why not?
EMS1 readers respond
“ FDNY/EMS should be its own department. Otherwise, EMS will always be a 2nd class service. ”
“ Yes. They should be separate. The only ones who benefit from a combined service are the municipalities that save money paying one person for the job of two. Or the departments gaining more to their budget. The first responders typically don’t want to do both, and the civilians receiving the care often suffer from watered down/burned out service providers. There is definitely room for crossover. But they do not need to be combined. ”
“ EMS in New York City should revert back to being its own entity. ”
“ While many advocate for EMS salaries to match those of firefighters, parity is unlikely due to the distinct nature of their roles. EMS professionals are medical providers, akin to LPNs, RNs and PAs, and their compensation should reflect this. Rather than comparing themselves to firefighters, EMS pay should be aligned with industry standards for medical professionals in similar positions, ensuring fair compensation for their expertise and responsibilities. Pay parity with firefighters isn’t the right comparison; EMS roles are distinct and deserve compensation reflecting their medical expertise. ”
“ It’s time the city recognizes EMS value. We have been disgustingly underpaid, underfunded, unappreciated. Working 80 hours a week just to stay afloat is asinine. Numbers showed EMS only gets approximately 18% of budget but 70% of work is done by EMS. It’s time to stop funding million dollar kitchens for fire houses and start giving parity to EMS. ”
“ I don’t know anything about FDNY and FDNY EMS. I am a firefighter/EMT with 29 years in a large metro city. I worked for a surrounding county EMS for 15 years, 12 as a paramedic. The problem nationwide is a failure of imagination, period. Regardless of who runs EMS, they fail to understand the problem that they are up against. In my experience, one of the largest problems within the overall problem, is the EMS deployment model. A variation on the definition of insanity is to continue to do the same thing you have always done but expect different results. EMS problems are not going to fix themselves. It takes visionary leadership. Leadership with imagination. ”
“ Everything depends on cost, not what makes people happy or the delivery of goods/patient care; it’s what the savings is; sad but true. ”
“ I consider the issue moot. Folks, this issue is more than 25 years old. Personally, the unions screwed over the workers. Do the union representatives still get compensation by the unions as well as NYC? ”
“ Splitting the agency would create redundancies and additional costs. They would still lose personnel to fire regardless. Fixing the pay disparity gives them a fighting chance at retention. ”
“ personnel to fire regardless. Fixing the pay disparity gives them a fighting chance at retention. ”
“ Splitting the agency would create redundancies and additional costs. They would still lose personnel to fire regardless. Fixing the pay disparity gives them a fighting chance at retention. ”
“ Absolutely, EMS is the new frontier and the need is outpacing fire service needs. ”
“ EMS was used to keep FDNY intact by raising response numbers and increasing diversity. Medicine was never a consideration. If EMS can’t be its own agency, it should be a division of NYCDOHMH. EMS is an important part of public health. Our EMS practitioners must be financially compensated so they can work one job and live in NYC. ”
“ Fire and EMS are 2 different jobs and SHOULD NOT be under one umbrella! ”
“ A combination department makes sense if the resources, personnel, and demands are all reasonably limited. New York City is not the place for that. FDNY has left EMS to wither away while they spend money on everything else a fire department has to do. ”
“ No, I always wanted to be an EMT and for the fire department. I don’t want to be a firefighter and never had the desire to be one. All I ever wanted is to be an EMT but if I can’t be a part of FDNY then I won’t be one. To me FDNY is a part of me and I as a 6 year veteran will not be a part of it if I’m not part of the FDNY family. ”
“ Yes, we are the stepchildren of the FDNY, and they treat us like 2nd-class citizens. We need pay parity for EMS members to stay and not have to work multiple jobs. The cost of living in NYC is out of control and is only getting worse. ”
“ Definitely split and equal pay is a must. Most FDs started EMS because of revenue and being bored most of the time. ”
“ Yes it should and the fire budgets need to be cut back and the money from the cut back of the fire department budget goes to EMS to staff properly! ”
“ Absolutely! Fire wants to play with hoses; that is their thing, not patient care and that often shows as less-than-optimal care from fire-based medics. For FDNY, they used EMS increased bargaining power for fire and threw EMS under the bus from the beginning. ”
“ The majority of hospital-based EMS agencies are running in the red! Partly because Medicaid and Medicare don’t pay the cost of prehospital care, the cost of medical equipment is outrageous and the cost and maintenance of vehicles is unsustainable! So what is going to change? The only thing that will change is the ease at which FDNY Fire was ‘promoting’ EMTs and paramedics, 300 at a time! This is what devastated FDNY EMS, poor leadership on both sides! ”
“ I think EMS should definitely be its own entity. Double the budget for EMS! ”
“ I think it’s much better for EMS to be with fire. I’ve worked in two agencies, one with fire and one in a separate location. Being in the same location, fire support is incredible and amazing and always there! When you’re separated sometimes you have fire support and sometimes you don’t. ”
REFERENCES
- New York City Council. Council hearing debates plan to split EMS from FDNY as sponsors call for pay parity. November 14, 2025. Available at: https://citizenportal.ai/articles/6857701/New-York/Council-hearing-debates-plan-to-split-EMS-from-FDNY-as-sponsors-call-for-pay-parity. Accessed: December 20, 2025.
- Long C. FDNY EMT killed by hijacked ambulance known as matriarch of station. FireRescue1. 2017. Available at: https://www.firerescue1.com/fdny/articles/fdny-emt-killed-by-hijacked-ambulance-known-as-matriarch-of-station-88IFrKEm936V5TfF/#:~:text=%22I’m%20innocent.,accused%20of%20killing%2C%20Yadira%20Arroyo. Accessed: 30 Jan 22.
- Kilgannon C. Slain Paramedic, ‘Mother of the Station,’ Was Near Retirement. New York Times. September 30, 2022. Available at: https://www.nytimes.com/2022/09/30/nyregion/alison-russo-fdny-emt-stabbing.html?searchResultPosition=1. Accessed: October 3, 2022.
- Calder R. ‘Spit show’: Attacks on NYC EMS workers are through the roof. NY Post. February 24, 2024. Available at: https://nypost.com/2024/02/24/us-news/attacks-on-nyc-ems-workers-are-through-the-roof/. Accessed: February 27, 2025.
- Maguire BJ. What do FDNY data reveal about occupational risks among EMS professionals? EMS1 - draft. 2025.
- Campanile C. NYC response times for ‘life-threatening’ emergencies surge in troubling trend. September 17, 2025. Available at: https://nypost.com/2025/09/17/us-news/nyc-response-times-for-life-threatening-emergencies-surge-in-troubling-trend/. Accessed: December 22, 2025.
- Harrawood D, Gunderson MR, Fravel S, Cartwright K, Ryan JL. Drowning prevention. A case study in EMS epidemiology. J Emerg Med Serv. 1994; 19(6):34.
- Bonner M, Capsey M, Batey J. A paramedic’s role in reducing number of falls and fall-related emergency service use by over 65s: a systematic review. British paramedic journal. 2021; 6(1):46-52.
- New York City. Falls among older adults. Available at: https://a816-dohbesp.nyc.gov/IndicatorPublic/data-explorer/falls-among-older-adults/?id=2135#display=summary. Accessed: December 22, 2025.
- London Ambulance Service. Advanced Paramedic Practitioners. Available at: https://www.londonambulance.nhs.uk/calling-us/who-will-treat-you/advanced-paramedic-practitioners/. Accessed: December 21, 2025.
- Australia National Boards. New paramedic model to boost access to healthcare. 2025. Available at: https://www.ahpra.gov.au/News/2025-04-23-New-paramedic-model-to-boost-healthcare-access.aspx. Accessed: December 21, 2025.
- Australian Institute of Paramedic Practitioners (AIPP). What is a Paramedic Practitioner? Available at: https://www.acpp.net.au/what-is-a-paramedic-practitioner. Accessed: December 21, 2025.
- Northern Ireland Ambulance Service. Advanced Critical Care Programme initiated at NIAS. Available at: https://nias.hscni.net/advanced-critical-care-programme-initiated-at-nias/. Accessed: December 21, 2025.
- Florida R, Murphy ME. Rockland County, N.Y.’s Innovative Response Team Works to Treat Mental and Physical Health Issues in the Community. Journal of Emergency Medical Services. April 30, 2016. Available at: https://www.jems.com/patient-care/rockland-county-n-y-s-innovative-response-team-works-to-treat-mental-and-physical-health-issues-in-the-community/. Accessed: December 22, 2025.
- Emond K, O’Meara P, Bish M. Paramedic management of mental health related presentations: a scoping review. Journal of Mental Health. 2019; 28(1):89-96.
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- Maguire BJ, Phelps S, Maniscalco PM, et al. Paramedicine Strategic Planning: Preparing the ‘far forward’ front lines for the second COVID-19 wave. Journal of Emergency Medical Services. May 14, 2020. Available at: https://www.jems.com/2020/05/14/paramedicine-strategic-planning/. Accessed: May 14, 2020.
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- Gregg A, Tutek J, Leatherwood MD, et al. Systematic review of community paramedicine and EMS mobile integrated health care interventions in the United States. Population health management. 2019; 22(3):213-222.
- U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Evidence of Impact for Community Paramedicine. 2022. Available at: https://hdsbpc.cdc.gov/s/article/Evidence-of-Impact-for-Community-Paramedicine. Accessed: December 22, 2025.
