In this episode of EMS One-Stop, host Rob Lawrence welcomes back FDNY Chief of Department John Esposito for a candid conversation about the challenges and opportunities facing emergency medical services in New York City.
Following a recent city council hearing examining ambulance response times, staffing shortages and EMS compensation, Esposito discusses the realities of operating one of the world’s busiest emergency response systems.
With approximately 4,500 EMS calls each weekday, a nearly 10% staffing vacancy rate and mounting pressure to improve response times, he explains why the challenge is not a shortage of ambulances, but a shortage of people to staff them. Central to his vision is making FDNY EMS a career destination, rather than a steppingstone to other public safety professions.
The conversation also highlights Esposito’s commitment to strengthening the relationship between fire and EMS within one unified department. From assigning rescue paramedics to FDNY rescue companies and deploying non-transport paramedic response units, to improving hospital turnaround times, Esposito outlines practical initiatives to increase operational efficiency and patient care.
He also discusses the importance of public education, alternative care pathways and FDNY’s planned next-generation EMS computer-aided dispatch system, expected in November 2027. The episode concludes with a reflection on leadership, the professionalism of FDNY personnel, and the lasting impact EMTs and paramedics make on the patients and families they serve.
Key quotes
- “We have a budgeted headcount in FDNY EMS of 4,500 people, and we have slightly over 4,000 — almost a 10% vacancy.” — Chief John Esposito
- “And that results in in less ambulances. We have plenty of physical ambulances in service ... we just don’t have the people to put in them.” — Chief John Esposito
- “One of our goals — one of my goals — is to make EMS here a career, make EMS the destination that you get people that come here for that.” — Chief John Esposito
- “But the people that they had those interactions with — those people’s houses and apartments and homes that they went into to save somebody’s life to make a difference — they will remember them probably forever.” — Chief John Esposito
Episode timeline
- 00:49 – Welcome and reflections on the 9/11 remembrance
- 03:47 – Building a unified fire and EMS department
- 05:34 – Rescue paramedics embedded with rescue companies
- 07:35 – Making EMS a career destination
- 12:10 – Compensation, resources and response times
- 13:39 – Non-transport paramedic response units
- 15:41 – The unique challenges of responding in New York City
- 17:42 – Bystander CPR and the role of hospital ambulance partners
- 20:42 – City Council oversight and public accountability
- 23:24 – Staffing vacancies and rising ambulance response times
- 27:07 – Improving field staffing and response classification
- 30:00 – Daily call volume and alternative care pathways
- 33:52 – Hospital turnaround times and ambulance availability
- 36:38 – FDNY’s operational priorities
- 38:11 – New EMS CAD, predictive technology and AI
- 39:30 – Leadership, professionalism and the lasting impact of EMS
- 41:31 – Closing reflections
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