Everything old is new again, is a phrase that I’ve heard for years and years. It’s also the title of a song I’ve never heard of. It was in the film “All That Jazz” which I never saw. Where it originally came from, I have no idea.

That phrase was the first thing that came into my mind when I saw this article on EMS 1.

Time to let FDNY EMS stand on its own

The idea of a third service is not radical. Across the country, many cities recognize EMS as a distinct and vital public safety entity alongside police and fire. New York, ironically the city that never sleeps, remains asleep on this issue — keeping EMS under the shadow of the Fire Department. But the challenges EMS faces today aren’t just a result of budgetary neglect or political inertia — they’re rooted in a structural problem. You cannot fix a broken system while keeping EMS trapped in someone else’s house.

For a long time my former agency and the union that represents EMTs and Paramedics there had a very close relationship with the EMS system in New York City. We attended their events, they attended our events. That started back before the agency was assimilated by the fire department in New York City.

Lieutenant Anthony Almojera doesn’t seem to know that once upon a time EMS in New York City was indeed a third service system. It was a subsidiary of the New York City Health & Hospitals Corporation. That agency ran the ambulance service and the city owned hospitals.

In 1996, by order of them Mayor Rudy Giuliani NYC*EMS was “merged” with FNDY to create a combined agency. Most of the people who worked for the former third service are retired, and sadly many that I knew have died over the years.

Ironically, FDNY didn’t want to perform EMS, they just wanted to control is. At the time there a lot of comparisons to EMS being assimilated just like the Borg on Star Trek assimilated planets and societies. The merger was not smooth as the people who were now in charge didn’t understand anything about running an EMS system. They decided that running it like a fire department would be ideal. It wasn’t. They tried putting paramedics in squad like vehicles and staffing ambulances with just EMTs. That didn’t work. Eventually they went back to something like the EMS model that had been used before. That worked fairly well and is used to this day.

Of course EMS providers were treated like second class employees. On good days, that is. There was path of sorts to become a fire fighter. It was considered a “promotion” to be selected to go to the fire academy.

FDNY EMS is staffed primarily by EMTs and paramedics — workers who are highly trained, deeply experienced and often the first healthcare providers a person will ever encounter. Yet they are the lowest paid and most overworked of the city’s emergency responders. An FDNY firefighter and an EMS paramedic  may show up to the same scene, risk the same dangers and respond to the same calls. But one makes nearly double the salary of the other and receives far more comprehensive benefits. Why? Because one wears bunker gear and the other wears an EMS patch. This is not the fault of the firefighters themselves. The fault lies solely on the management of New York City and FDNY.

In this regard, nothing has changed. I will also say that EMS being a third service is not a magic solution to a nationwide problem.

Where I worked EMS calls far outstripped fire calls. In order to fix that, fire units were added to medical calls. This was a trick to accomplish two things. One was to make response times look better as the clock stopped when the first anything arrived on scene. The second was to keep from having to lay off firefighters as smoke detectors, better building codes, and sprinkler systems cut the number of deaths from fire year after year.

That wasn’t just in New York or where I worked, it was nation wide. In the late 1980s into the end of the 1990s there was a wave of takeovers of third service EMS agencies by fire departments eager to keep run numbers up and prevent layoffs.

I wish Lieutenant Almojera luck in his quest, but I fear that like Don Quixote his is The Impossible Dream.

Here is an article with a brief history of NYC*EMS. It’s from JEMS in 2022, so take it with a bit of salt even though the state that the content is that of the contributors not JEMS itself.

A Short History of New York City’s Emergency Ambulance Services