FDNY safety improvements leave EMS professionals behind

The New York City Mayor’s office has made data available that permits a direct comparison of occupational risks between firefighters and the EMS professionals employed by the fire department.

The data from 2016 to 2025 show that although the number of cases of service-related injuries is decreasing for firefighters, the number of cases per year has remained flat for EMS professionals. In addition, the number of fire apparatus collisions has been decreasing while the number of ambulance collisions has been increasing. These data indicate that safety investments and organizational attention have not been applied equitably across the department.

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Introduction

A growing body of evidence shows that EMS professionals do one of the most dangerous jobs in the U.S. The EMS occupational fatality rate is comparable to the rates for firefighters and police officers, and eight times higher than for other healthcare personnel [1-2]. The rate of non-fatal injuries is higher for EMS professionals than for fire and police, and four times higher than the rate for all workers in the U.S. [3,4]. A 2020 study of FDNY data showed that the fatality rate was higher for EMS professionals compared to firefighters in the same department [5].⁵ In 2022, the 100th EMS professional died as a result of the September 11 terrorist attack on the city [6].

For violence-related injuries, EMS professionals have an injury rate that is six times higher than the national average for all workers and seven times higher than the rate for firefighters [4]. Most of the perpetrators are patients [4]. In 2022 alone, EMS professionals in New York City experienced 363 workplace assaults or violent threats [8].

EMS professionals also face high risks of transportation-related injury. About 75% of occupational fatalities among EMS professionals are transportation-related [2]. Their risk of non-fatal transportation-related injuries are about four times higher than the national average for all workers [4].

On March 17, 1996, the New York City Fire Department (FDNY) took control of the city’s EMS service [9]. Since then, the NYC EMS professionals have become acutely aware of their risks [10].⁰ However, although the U.S. Occupational Safety and Health Administration has taken steps to address the high occupational risks faced by EMS, no publicly available reports were identified describing department-wide initiatives specifically aimed at reducing occupational risks for EMS professionals in the almost three decades that FDNY has run the service.

Methods

This is an examination of data posted by the NYC Mayor’s Office of Operations, titled: Dynamic Mayor’s Management Report [12]. The data are arranged by various departments and city services, and cover the fiscal years 2016 to 2025. The data examined for this report were posted under the Fire Department.

Results

Under the Fire Department, there are various indicators that can be searched. Only two categories of data have comparable information for both firefighters and EMS; they are “service-connected injuries” and “collisions.”

Service-connected injuries

The following data were found when selecting “Firefighters/fire officers who sustained service-connected injuries” and “EMS workers/officers who sustained service-connected injuries.” Table 1 below shows that the number of injuries for EMS professionals is consistently over 1,500 per year.

Table 1. Number of service-connected injuries for EMS professionals and firefighters in FDNY 2016 to 2025. NYC Mayor’s Office of Operations. Dynamic Mayor’s Management Report. 2025. Available at: https://dmmr.nyc.gov/.

Figure 1 below shows that, although the trend line in the number of cases per year for firefighters is decreasing, the number of cases per year for EMS professionals is essentially unchanged over the 10-year period.

Collisions

Vehicle collisions represent one of the most serious occupational hazards in EMS. Figure 2 below shows that the ambulance collision rate is higher than the collision rate for fire apparatus. The average rate over the 9-year period is 8.5 for ambulances and 3.6 for fire. In addition, the trend lines show that the rate of collisions is decreasing for fire and increasing for ambulances.

Discussion

Between 2016 and 2025, the number of injury cases per year among firefighters steadily declined. Over the same period, the annual number of injury cases among EMS professionals has remained essentially unchanged. A similar pattern is seen in FDNY vehicle safety data: while the rates of collisions involving fire apparatus have decreased, ambulance collision rates have increased.

“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” [13]. The Mayor’s data shows that while the Fire Department has achieved success with reducing risks for firefighters, it has not reduced occupational risks for its EMS workforce.

Limitations

An ideal comparison would have been to evaluate the rate of occupational injuries for fire and EMS. However, although the fire department does post the rate of injuries for firefighters, it does not post the rate of injuries for EMS professionals. A comparison of rates might have shown that the injury rates are higher for EMS compared to firefighters.

The available data do not include a way to compare occupational fatalities. Other research has found that the rate of occupational fatalities is higher for EMS professionals employed in FDNY compared to FDNY firefighters [5].

Conclusions

The 10 years of data from the NYC Mayor show that while the number of service-connected injuries among firefighters is decreasing, the number of cases per year has remained essentially the same for EMS professionals. These trends strongly suggest that safety investments and organizational attention have not been applied equitably across the department.

These findings warrant further investigation and should inform future policy decisions regarding EMS governance, funding, and workforce safety in New York City.

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REFERENCES

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