NEW YORK — A debate over whether New York City’s Emergency Medical Service should separate from the FDNY has reignited after a veteran FDNY EMS lieutenant and union leader is calling on the city to break its emergency medical service away from the fire department and create a stand-alone “third 911 service.”
In an article for The Chief Leader, FDNY EMS Lt. Anthony Almojera, vice president of Local 3621 and author of “Riding the Lightning: A Year in the Life of a NYC Paramedic,” argued that paramedics and EMTs “may show up to the same scene, risk the same dangers and respond to the same calls,” yet earn roughly half a firefighter’s salary and receive fewer benefits. The pay gap, he said, “leads to massive attrition” and tells young providers “they are second-class responders.”
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“We’re asking to be seen not as an appendage of the Fire Department, but as what we are,” Almojera said. “Healthcare professionals delivering critical services in some of the most dangerous and high-pressure situations imaginable.”
Almojera argues that EMS belongs firmly in the healthcare realm, not in fire suppression or policing. Its core job, he says, is to assess, treat, stabilize, and transport patients and to advocate for them both at the scene and in the hospital. But inside the FDNY, EMS still answers to fire-focused leaders trained in fire science, which limits medics’ career growth and suppresses new ideas in pre-hospital care.
Almojera says an independent EMS agency, run by medical professionals, could update care protocols, launch community paramedicine programs and tackle modern public-health needs.
A stand-alone EMS agency would be nimbler, more accountable, tightly linked to hospitals and mental health partners, and better equipped to deliver patient-centered care.
“We aren’t looking for special favors, only fair treatment,” Almojera said. “See us not as a fire department add-on but as healthcare professionals who provide critical care in the most dangerous, high-pressure situations.”
What’s your take? Should New York City spin EMS off into a third service, or does keeping it under the FDNY make more sense? Share your frontline experiences, concerns about pay and staffing, or ideas for improving pre-hospital care.
FireRescue1 readers respond:
- As part of FDNY, EMS will always be a side dish while the fire service is the main course. EMS deserves to be an equal and independent third service with pay, benefits, and retirement parity with fire and police. But adequate funding is key. NYC EMS was drastically underfunded before the FDNY takeover, and that mistake should not be repeated.
- I disagree. Granted, I work out of a much smaller area that doesn’t even compare to N.Y., but as an EMT, I couldn’t do my job nearly as well as I do without the rest of the crew that rides with us. In our small town, all of our firefighters are EMTs, and vice versa. It’s our minimum high requirements and enables us all to start out at the same pay rate.
- They were a standalone agency under HHS before the fire department took them over. They weren’t happy then either. But let them go. Leave the Haz Tec medics, though. Those people are kind of firefighters.
- I see this as part of a larger discussion about the role of ambulances in society. Less than 1 in 20 patients transported by ambulance to the hospital will receive immediate care, per CDC statistics. Yet, there continues to be a culture that is more about speed than healthcare. Moving the ambulances to an independent agency, led by health experts, would probably lead to more evidence-based care. The great pay disparity in the current system also raises suspicions of sexism.
- It is funny how members of an organization forget where they came from. New York City had a separate EMS agency at one point that was dysfunctional and delivered substandard services. It was moved under the FDNY for the purpose of command, control, accountability and efficiency. Separating would create another bureaucracy that would most likely lack accountability and efficiency.
- The NYC system is broken beyond repair. This isn’t a BAD idea, but there’s so much more to be done.
- Keep it as one FDNY, but close the pay gap and make significant management changes. The notion that this is just a pay parity problem is incorrect. EMS has many internal issues unrelated to money. It’s about the disrespect shown to EMTs and paramedics by upper management, not to mention the politics. EMS is heading for a downfall — 70% of medics and EMTs are in nursing school or other training, moving away from an agency that keeps stress levels at an all-time high. EMS problems go much deeper than just pay.
- I know FDNY and FDNY EMS have had a long, sometimes adversarial relationship. In such a large system, with both fire and EMS stretched by constant calls, crowded ERs and staffing shortages, the idea of a separate service may now be feasible. I come from a fire-based EMS system and am a “spawn” of the 1970s show “Emergency!” However, what I have witnessed over the years is what appears to be an increasingly unsustainable delivery model. Both disciplines have perishable skillsets if not refined and practiced on a regular basis. We are fortunate here in Los Angeles County to have very dedicated fire leadership who have taken their turns on the paramedic squad at one time. But how sustainable is that?? We too have seen increased EMS call loads and in the West, protracted deployments for ever-increasing major wildfires that the fire-based EMS of the 1970’s never had to contend with. So even as biased as I am for fire-based EMS, the “numbers” don’t lie. And for a major city fire department to continue to be forward-leaning and progressive, the idea of a third service might be more than past its time of deep consideration.
- As a past employee of NYC EMS, I agree that separating EMS from FDNY makes sense. These are two different agencies working under one umbrella. They are two different jobs, requiring different job skills. Under FDNY, the primary concern is firefighting and technical rescue. EMS should truly be a third service. Why is there such a large pay disparity between an EMS employee and a firefighter with the same time on the job?
- The problem is EMS isn’t fully integrated into FDNY. They don’t work out of the same stations, nor do they get the same pay and benefits. Going back to a third service or remaining only works with adequate resources, pay and benefits. There has to be a resolution to make them equal as a partner of FDNY or as a third service, or not much will change.
- I was one of the first paramedics and flight medics in SW Ohio back in the 70s. I saw massive pushback to EMS advancement, especially ALS. Some departments used EMS as punishment, and old firefighters said the fire department had no business playing doctor. Unfortunately, that mentality still exists. EMS has become far more stressful and dangerous, and the pay and benefits have not kept up with the reality. It’s time for departments and communities to have a “come to Jesus” moment. Either EMS/ALS is important enough to pay for properly, or walk away. Something for nothing is no longer a viable option, and truth be told, it hasn’t been for many years.
- New York City should absolutely spin EMS off into a third service. Provided that it doesn’t affect the FD resource needs. It must be managed by competent, progressive leadership to succeed. Then there’s the issue of who medics are actually responsible to — the officer in the firehouse or the EMS officers.
