Is a major occupational health issue for essential workers just being ignored?

By Bob Hennelly

For only the second time since the FDNY absorbed the city’s EMS workforce in 1996, the average response time for a city ambulance to answer a life-threatening emergency exceeded ten minutes. At 10:43, that response time was 36 seconds longer than the previous year, according to the Mayor’s Management Report [MMR] looking at fiscal year 2023 — and a 1:21 longer than what was reported four years ago.

The first time that critical response time exceeded the troubling ten-minute threshold was in FY 2020 when it hit 10:19. In a city where serious industrial accidents on construction sites are not uncommon, the deterioration of this vital service only adds to an already dangerous risk. 

“The American Heart Association's scientific position is that brain death and permanent death start to occur in 4–6 minutes after someone experiences cardiac arrest,” reports EMS World. “Cardiac arrest can be reversible if treated within a few minutes with an electric shock and ALS [advanced life support] intervention to restore a normal heartbeat. Verifying this standard are studies showing that a victim's chances of survival are reduced by 7 percent to 10 percent with every minute that passes without defibrillation and advanced life support intervention. Few attempts at resuscitation succeed after 10 minutes.”

The union leadership of the Uniformed Firefighters Association, Uniformed Fire Officers Association, DC 37 Local 2507 — which represent EMTs, paramedics and fire inspectors — as well as DC 37 Local 3621 — which represents FDNY EMS officers, told Work-Bites the latest data was alarming and depicted a system under significant stress and in no position to absorb additional budget cuts.

As first responders see it, the deteriorating response times are linked to a confluence of post-pandemic factors like additional traffic including increased vehicle and pedestrian volume as a significant percentage of New Yorkers continue to avoid the subway. Traffic congestion has also been made worse they say by the loss of vehicle roadway to bike lanes, pedestrian plazas, sidewalk sheds and building construction. 

On background, FDNY leadership doesn’t disagree.

Vincent Variale is president of DC 37’s Local 3621 which represents FDNY EMS officers said that between the FDNY’s inability to retain its current EMS workforce long term and its aging ambulance fleet “you could see those response times go to 15 to 20 minutes — and we know brain cell death kicks in at six minutes so even with these existing nine to ten minutes response times people are dying unnecessarily.”

“The Fire Department is committed to protecting life, and property, and is dedicated to responding as quickly as possible to all manner of emergency,” the FDNY wrote in response to a query from Work-Bites.

For FDNY EMS the aging of its ambulance fleet is clearly problematic with the daily peak average of rigs deployed on the street dropping to 466, down from 497 the previous year, and 516 the year before that.

According to the annual compendium of statistics which is required by the City Charter, the overall incidence of medical emergencies increased year over year, including a seven percent increase in life-threatening incidents. Of the 1.8 million FDNY runs, structural fires [23,901] and non-structural [12,594] fires accounted for a relatively small percentage of the agency’s daily call volume.

Civilian fire deaths were up significantly with 102 for the last fiscal year, compared to 92 the previous year and 53 four years earlier. The increase in civilian fire deaths came as residential blazes linked to lithium-ion batteries that power bikes used for transport and deliveries became more common with 17 deaths attributed to such fires.

In the latest MMR the percentage of cardiac patients revived was just 28 percent, down from 29 percent in the previous year, and several percentage points below the 35 percent survival rate in FY 2019. The survival rate data for witnessed cardiac arrests dropped from 43 percent to 38 percent over the same period.

When FDNY fire unit and ambulance unit response times to life threatening runs are combined, the average time is 9:50, 20 seconds slower than the previous year and almost a full minute-and-a-half slower than what was reported in FY 2019. Historically, fire units on scene reach times are quicker than what EMS units can clock.

“Well, these numbers show a very disturbing trend that if firefighters and EMS take longer to get to patients the survivability drops dramatically,” Uniformed Firefighter Association President Andy Ansbro told Work-Bites. “Five years ago, you had a 25 percent better chance of surviving a heart attack than you do today and that is due entirely to the city’s inability to control traffic and also keep units available due to the increased workload we have. These numbers are shocking.”

“Those are very concerning numbers and certainly trending in the wrong direction,” FDNY Deputy Chief Jim Brosi, president of the UFOA, told Work-Bites. "Unfortunately, with the ever-changing traffic patterns, the narrowing of the streets, and the increase in population on the street it’s hard to believe that we will trend in the right direction...with all medical emergencies and fires the faster we get there, the faster we intervene, the better the outcome."

Ansbro suggested that the FDNY revisit its long-standing policy of taking units out of service when firefighters are required to undergo their annual medicals or supplemental training sessions. “You are taking about ten to 12 companies out of service on any given day and even though it’s a small percentage, over time there’s no question it would impact response times,” he said.

Almost a third of the city’s 911 calls are handled by so-called “voluntaries” — private, non-civil service people who are paid, state certified EMTs working for various city hospitals. Earlier this month, the New York Post reported that Queens based Northwell Health, the largest private provider of 911 EMS services was cutting back its EMS role which would now be absorbed by the already stretched FDNY.

Back in 2016, New York City lost dozens of EMS units when TransCare, a Bronx based EMS provider went bankrupt without warning.

“This reliance on these privates has always been a vulnerability, whether it was the sudden overnight departure of TransCare up in the Bronx that covered ten percent of the city we then had to cover, or Northwell’s planned scaling down where we had a warning — anytime you put privates in a municipal 911 system it’s always a real concern,” Mike Grecco, vice president of DC 37’s Local 2507, told Work-Bites.

FDNY EMS union officials said that on the same day that the FDNY committed to using overtime to cover Northwell’s workload another letter came out that the agency, in response to calls for budget cuts from City Hall, would have to cut agency overtime.

Grecco added that the deteriorating response times and cardiac survival data coincided with an ongoing churn among his 4,000-member rank and file — mostly female and people of color who are often drawn to the much higher paying firefighter job title that also comes with unlimited sick time for workplace-related illness or injury. 

The FDNY EMS unions have ongoing litigation related to alleged gender and race-based pay disparity between EMS and the firefighting side of the department.

Under their 2021 deal an EMTs' top pay at $53,437 — earned after 5 1/2 years of service — went to $68,700 — with the top rate now reached after five years, with longevity differentials bringing 20-year veterans to $74,100. Paramedics saw their top pay go from $65,000 to $86,379 — with five years' service and 20-year vets getting $91,779 a year.

Far less dramatic was the treatment of a starting salary for EMTs which went from $35,254 to $39,386.

Glenn Corbett, an assistant professor of Fire Science at John Jay College of Criminal Justice, believes the time for parity for the EMS workforce is long overdue. “You are talking about the substantial risks involved for them when they are encountering people on the street in very bad conditions,” he said in a phone interview back in 2017. “It’s one thing to be in a hospital setting with security guards all around, but it’s very different encountering people on the street in what can be very dynamic situations.”

“We are underpaid, understaffed, and underappreciated and you wonder why the results of that are negative?” Grecco asked rhetorically. The EMS union vice president said that most of his members had five years or less on the job.

A multi-year study by medical researchers at the University of Pennsylvania looked at ambulance runs in Mississippi from 1991 to 2005 and included 120,000 heart-related EMS runs and flagged six years as the sweet spot for street medics. They concluded that “paramedic tenure and cumulative experience is associated with better EMS performance."

They noted that the more experienced EMTs were, the quicker they stabilized patients in the field, which “reduced total out-of-hospital time and on-scene time…furthermore, the experience was more strongly associated with performance among paramedics with more than six years of service.”

EMS union officials told Work-Bites they were concerned about pending City Council legislation to retroactively extend the chance to 324 FDNY EMS members who in 2020 were not permitted to take the firefighter exam because it was canceled and they subsequently aged out of the FDNY’s 29-year-old age limit.

Council Member Joann Ariola (R-Dist. 32 Queens) is chair of the Committee on Fire and Emergency Management and supports the measure she said corrects the “disenfranchisement” of the FDNY EMS members that were aged out of the crucial exam that can mean much higher pay and superior benefits.

But Ariola agreed with the EMS union leadership that the time was long overdue for pay parity between the FDNY’s firefighters and EMS workforce.

“It is only right — yet as it is now, they are unable to support a family just on an EMS salary and it is below all of the other members of our other emergency services,” Ariola told Work-Bites. “They should have pay parity so that it can become a career choice because many of them would remain EMTs or paramedics but it’s this income issue that pushes them to the firefighter test.”