A short history to set up the main part of the article, On March 17, 1996, NYC*EMS was assimilated merged with the Fired Department of New York City (FDNY) by order of then Mayor Rudolph Giuliani. As Mayor Giuliani did some very good things for the residents and visitors to New York City. This wasn’t one of them. It the joining together of two different agencies with two different missions, two different cultures, two different shift schedules, different uniforms, and two different salary structures. Oh, and two different unions, but that’s a whole other story.

To say that there was a period of adjustment would be perhaps the understatement of the 21st Century. It merger was fractious for several years, but as time passed and the “old guard” on both sides of the merger retired or moved on to other jobs, the new normal began.

Some things improved, some stayed the same, arguably some got worse. EMS and fire suppression still seem to operate as two different agencies, which makes sense.

Perhaps the biggest disparity then and now was salary. I don’t know if it’s still true, but for a long time while I followed these festivities and EMT getting hired by the fire suppression part of the operation was considered a “promotion” not a hiring.

To be sure, this is not unusual in EMS at all. After San Francisco merged it’s EMS system with the fire department, there were three different salary scales for paramedics. The lowest pay scale was for single role paramedics who were not cross trained as fire fighters. Next up on the scale was for cross trained paramedics who still were only allowed to work on ambulances. The highest paid paramedics were fire fighters who didn’t work on ambulances or provide more than BLS care at scenes.

Hmmm. I could go on and on, but will only mention that there are still fire based systems that are looking at hiring single role paramedics to work on their ambulances. For less pay, fewer benefits, more work. That’s an incentive, right? Right?

All of this has been compounded by a nationwide shortage of people who want to become paramedics or EMTs and work on ambulances. That was starting to happen before COVID, but since then has become a crisis in most parts of the country. Private, third service, fire based, it doesn’t matter. EVERYONE is having problems finding people to work. I am presuming that the problem is as bad for volunteer services, but can’t swear to it.

I won’t go into the various plans being implemented to change that other than to say that some will help the problem, some won’t, some will lower standards for medical care, some will not. At least I hope they won’t.

One to our main story. After Twenty Nine years of pretending that there is no pay disparity at FDNY EMS, the New York City Council has decided that there is a “Salary Emergency.”

This article is from “The Chief” which bills itself as “A Voice For Workers.” Note that most of the content is behind a paywall, but they put this in front of it. The article is short, so I’m only going to post what I think is the key point.

Salary Emergency

The historically out-of-kilter EMS wages mean it’s increasingly harder for the city to recruit and retain medically trained and experienced first responders. In 2024, city EMS personnel responded to more than 600,000 calls for life-threatening medical emergencies, the kind that can kill.  But on a recent day, just 70 percent of the city’s target for EMS ambulances were in service, while the number of fire trucks in service was over 90 percent. Soon, hundreds will be moving from the EMS to the firefighting side.

Imagine that, people want to leave a lower paying job with better benefits and a lighter work load for one that is, in a word, better.

Keep in mind that FDNY ambulances are supplemented by a combination of hospital based (voluntary), private, and even volunteer ambulance services. The article doesn’t tell us if the 70% is just city ambulances are all 9-1-1 ambulances.

The Fire Commissioner has sounded the alarm over the situation, Harry Siegel: Fire commish sounds alarm: EMS about to collapse.

Note that I typed my preamble before I read this article,

The job comes with a limited number of use-them-or-lose-them sick days, a big pay disparity with other uniformed service workers, a culture that’s nearly as isolated as a firehouse is intimate and a rapidly churning workforce mostly there because it’s a four-year backdoor to becoming a firefighter.

By the way, the term “backdoor” is usually used as an insult, but Harry Siegel is probably too dumb to know that.

In a phone conversation on Thursday, he elaborated about “what’s been sort of the tale of two cities” inside the FDNY between fire operations and EMS operations: “They’ve never adequately been merged. They wear the same patch, but they hardly operate under anywhere near the same conditions,” Tucker said, adding that EMS members “still do a phenomenal job despite the setup.”

Commissioner Tucker understands the problem, but has about no capacity to fix any of it unless the Mayor and City Council are willing to spend a lot of money. I won’t be surprised if someone, probably on the City Council proposes that New York City just contract the whole mess out to some private ambulance company. Which, of course, will make things a lot worse, but it will be cheaper. Or something.

Here is one last link for your reading pleasure. It’s also from “The Chief” and is also in front of their paywall. It’s from 2024 where the Mayor says he wants to fix the inequities at EMS. Oddly, he’s done nothing about it since then.

Adams, Kavanagh express support for EMS pay parity

Note that the Commissioner last year is not the Commissioner this year. Apparently the tenure at that job is measured with a stop watch, not a calendar.

I’ll close by saying that the problems in New York City may be extreme, but it’s not the only such case. I’ll even say that it’s not uncommon. Can think of several large city EMS systems, not fire based, that have similar problems. In those agencies it’s common for EMTs or paramedics to work for a couple of years and then try to get hired by fire departments. Back to better pay, better benefits, better schedules, better retirement, and so on.

Private services are even worse.

I don’t know if or when the situation will get better.