EMERGENCY MEDICAL SERVICES POLITICAL ACTION COMMITTEE
EMS POLICY BRIEF NEW YORK CITY
WORKING DRAFT
INTRODUCTION
The Emergency Medical Services Political Action Committee (EMSPAC)-501(c)4 mobilizes NYC EMS to engage in political action around legislative issues that affect their workforce. There are 15,500 EMTs and Paramedics living, working, and voting in the five boroughs of New York City. We ask your office to review this short brief and schedule a time for your EMS constituents to address these issues with your office.
TABLE OF CONTENTS
TABLE OF AUTHORITIES……………………………………………………………………………………………………………………………………………….3
PRELIMINARY STATEMENT…………………………………………………………………………………………………………………………………………..4
STATEMENT OF FACTS…………………………………………………………………………………………………………………………………………………..5
STAKEHOLDERS……………………………………………………………………………………………………………………………..……………………..7
POLICY ARGUMENT……………………………………………………………………………………………………………………………………………………..8
I. [MENTAL HEALTH: THERE MUST BE A REASONABLE MUNICIPAL INVESTMENT IN THE MENTAL HEALTH OF THE EMS IN ALL SECTORS] …………………………………………………………………………………………………………………………………..8
II. [WORKPLACE SAFETY: THERE ARE NUMEROUS DANGERS AND SAFETY CONCERNS AFFECTING NYC EMS]………………………………………………………………………………………………………………………………………………………………………………….9
III. [WELLNESS: WELLNESS PROGRAMS FOR THE ONGOING WELL-BEING OF EMS PROFESSIONALS]…………………………………………………………………………………………………………………………………………………………10
CONCLUSION……………………………………………………………………………………………………………………………………………………………….10
TABLE OF AUTHORITIES
Work-Related Deaths Among New York City Ambulance Services Personnel: 1893-2022 (jems.com)
Mt Sinai EMT Stabbed in Ambulance on 7/19/23
NYC council wants more pay for EMS, but FDNYs hands are tied (nydailynews.com)
FDNY-Budget-Note.pdf (nyc.gov)
Rescue EMS from the FDNY: Reverse the merger from a quarter-century ago (nydailynews.com)
Queens councilwoman calls for EMS pay parity, slams Hochul for ‘unconscionable veto’ – QNS.com
COVID-19 fatalities among EMS clinicians (ems1.com)
PRELIMINARY STATEMENT
There are deep structural problems with the provision of Emergency Medical Services (EMS) in New York City. This is deeply rooted in the division of emergency services into 5 sectors with as many as 70 separate agencies providing ambulance services.
The subject of this policy brief is the mental health, safety, and general wellness of the 15,500 NYC EMS that manage over 1.6 million emergency calls per year.
We approach your office seeking to bring attention to a serious matter that concerns an essential service in the City of New York. Decades of mismanagement have placed the world’s busiest ambulance service under the control of a fire department that does not seek modernization, professionalization, or unification.
As a result, the FDNY EMS cannot manage over 66% of the 911 call volume. It cannot retain skilled personnel as 70% of the workforce resigns after or before 5 years. Importantly based on such prolonged attrition, the FDNY EMS has fractured the 911 system amid hospital-based units, private commercial units, volunteers, and poorly paid, poorly disciplined municipal service, third-class first responders within the FDNY where several hundred of the most physically fit “promote to fire” for higher wages and better conditions.
A rising number of assaults on EMS professionals, a steady wave of EMS suicides, and a total failure to protect the men and women protecting New York City are the focus of this brief.
STATEMENT OF FACTS
- The field of EMS is physically dangerous and mentally degenerative. As a result, most (70%) of FDNY EMS EMTs resign from their employment in under 4 years.
- Approximately 15,500 New Yorkers are employed in this industry which can be divided into five distinct; FDNY MUNICIPAL, HOSPITAL BASED VOLUNTARIES, PRIVATE SECTOR, PRIVATE SECTOR UNCONVENTIONAL, and 42 volunteer agencies the largest one Hatzalah as over 2,500 EMS providers.
- The sector distribution of operational EMS workers is approximately 4,100 in the FDNY EMS represented by Local 2507.
- Approx. 500 FDNY EMS Leitenatns and Captains are represented by Local 3621.
- Approx. 2,000 Hospital-based EMS; around 1,200 represented by SEIU1199, and approx. 6,000 largely non-911 EMS in the private sector although these personnel are being contracted out to a wide range of hospitals including St. Barnabas, Montefiore, Bronxcare, Mt. Sinai Beth Israel, Brooklyn Hospital, Interfaith, and Kingsbrook Jewish.
- There are 42 volunteer EMS agencies, the largest being Hatzalah with over 2,500 EMS. The majority of these VACs are inoperable and not staffing daily units.
- The estimated salary range of an EMT is $18.00-24.00, these units are called BASIC LIFE SUPPORT (BLS). The majority of City ambulances are BLS.
- The estimated salary range of a Paramedic is $30.00-$45.00, these units are called ADVANCED LIFE SUPPORT. These units perform above the level of RN in the field doing intravenous medication administration, endotracheal intubation, as well as cardiopulmonary resuscitation with electrotherapy.
- There are staffing shortages for both types of EMS workers particularly in the FDNY EMS divisions, where low wages and high attrition rates cause 70% of the ambulance service to resign before their 4th year on the job.
- There are over 5,000 911 EMS calls a day divided into 7 response segments.
- Several thousand more calls of lesser acuity are managed outside the 911 system by private EMS units and volunteers.
- The system inefficiently utilizes a combination of municipal, hospital-based, and private-sector units under the command and control of the FDNY. This system is the result of the deliberate defunding of Municipal EMS in the years since the 1996 merger of the HHC Ambulance Service with the FDNY.
- 1.6 million calls per year managed by municipal, private, and hospital-based EMS units under the dispatch command and control of the FDNY.
- The Municipal FDNY-based service responds to ⅔ the 911 call volume with the remaining ⅓ being handled by hospital-based units.
- The 911 system of the City of New York is supported by four sectors of EMS providers; ⅔ of the approx. 5000+ daily calls are handled by FDNY EMS.
- At the root of this are long hours worked, constant exposure to death and dying, as well as high-stress intervals where there is front-line exposure to critical trauma and medical events.
- There have been over 500 documented assaults on EMS in 2022. The number unreported is easily double that.
- These instances of assault and battery on EMS members take many forms and contexts; verbal threats, physical attacks, spitting, biting, and kicking, and numerous cases have resulted in long-term disability and permanent disfiguration.
- Since 2020 more than 128 EMS workers have died, mostly while off duty from cumulative stress and illness.
- Notable among these incidents are the line-of-duty murder of EMT Yadira Arroyo, the on-duty shooting of an RUMC EMT Rich McMahon, the stabbing murder death of FDNY Lt. Alison Russo, as well as Mt. SINAI EMS Julia Fatum who was stabbed 6 times in August of 2023.
- There are at least 4 assaults on EMS workers daily largely concentrated in Manhattan (Divisions 1 & 6) and the Bronx (Divisions 2 & 7).
- The majority of documented suicides are in the FDNY EMS.
- There is on average 1 suicide, drug overdose, or attempted suicide per month.
- In the period of 2022-2023, there have been at least 10 EMS suicides.
- There is no universal safety net, critical incident stress management system, hotline, or unified efforts to promote EMS wellness and prevent self-harm.
STAKEHOLDERS
MUNICIPAL EMS UNIONS
- Local 2507 (4,100 FDNY EMTs and Paramedics)
- Local 3621 (500 FDNY EMS Lts and Cpts)
- FDNY EMS Superior Officers Association (40 FDNY EMS Chiefs/ Deputy Chiefs)
HOSPITAL-BASED UNIONS
- 1199 SEIU Technical Professional Division (1,200 Hospital EMTs and Paramedics)
CHARITABLE BODIES
- EMS FDNY HELP FUND 501(c)3 (FDNY EMS only)
- REMSCO PEER SUPPORT PROGRAM (All EMS Sectors)
- EMSPAC 501(c)3 (All EMS Sectors)
VOLUNTEER BODIES
- NYSVARA(40 VACs/ all except Hatzalah)
- United Hatzalah(2,500 Hatzalah EMS Volutneers in 11 Divisions/ 6 entities)
This proposal necessitates the formation of an EMS General Coordinating Committee (GCC) body to manage and distribute the funding for Mental Health, Safety, and Wellness measures to all sectors based on numbers and needs.
- The GCC would become a standing Committee of NYC REMSCO.
- The initial confidence-building mechanism of the EMS GCC would be data sharing around hardships, crashes, and assaults.
- The secondary task would be an annual dispersal of grant money. Municipal funding specifically into EMS Hardship Help services.
- The EMS GCC will appoint one reporter per stakeholder group to approximate the number of data points agreed to aggregate per sector.
- The GCC would have one rep per stakeholder group and an executive of 1 per sector: MUNICIPAL (FDNY), HOSPITAL (1199), PRIVATE, and VOLUNTEERS.
- The GCC would be granted funding in proportion to the number of EMS members per sector.
POLICY ARGUMENT
- EMS Mental Health Legislation
The field of EMS is both physically and mentally demanding. Long hours, and constant exposure to death, dying, and human suffering take a largely ignored physical and mental toll on the mind and body of the EMS provider. This manifests as weight gain, depression, insomnia, alcohol/ substance abuse, risk-taking behavior, and difficulty in maintaining civilian relationships.
The segmentation of EMS response into numerous different agencies and sectors all but ensures a total lack of uniformity in response and more importantly a lack of uniform support for EMS providers seeking help.
The EMS as a service requires a broad-based support system to be established for all EMS workers no matter what their sector.
There is currently no unified critical incident stress debriefing system.
REMSCO PEER SUPPORT is completely underfunded and FDNY CSU is stigmatized and geared toward the firefighters. There are no EMS-specific support groups.
What we are asking funding for:
We are seeking City and State funding for a wide range of measures to support EMS Wellness, Health, and Safety.
We are seeking the following programs and policies to be framed as municipal law and budget allocations. These funds will come out of the budgets for FDNY, and HHC, and will be mandated spending programs for the hospitals and private agencies supplying 911 units to the system.
- ALL-AGENCY/SECTOR EMS PEER MENTORSHIP PROGRAM JOINTLY MANAGED BY REMSCO, FDNY, and HHC. THIS PROGRAM SHOULD ENABLE THE TRAINING AND PER DEIM HIRING OF SEVERAL HUNDRED EMS ADVOCATE/ PEER SUPPORT MENTORS TO ENSURE A MAXIMUM DIVERSITY OF TALENT AND AVAILABILITY.
- A system of crisis debriefing and monthly support groups for EMS members in all boroughs.
- A well-staffed crisis line and drop-in center in each borough.
The specific program costs are estimated to be:
INSERT LINE ITEM BUDGET
II. [WORKPLACE SAFETY LEGISLATION: MITIGATING DANGERS AFFECTING NYC EMS PROFESSIONALS]
EMS is a dangerous job with many well-documented risks to the body and mind of the EMS provider. These include but are not limited to:
- Chronic Depression
- PTSD
- Alcoholism
- Weight gain
- Risk-taking behavior
- Drug use
- Sleep disorders
- Loss of civilian friends
- Divorce and domestic violence
- Lowered life span to age to 55 year range
We are requesting support and funding for:
- Adequate and acceptable de-escalation training.
- Individually issued, standardized PPE, helmets, and respiratory masks.
- Bulletproof vests are available to all 911 units on request.
- Mandation of building in EVOC/ CEVO training to all EMS Academies as a standard for graduating EMTs.
- Mandation of 2 keys per unit.
- Providing ongoing martial arts training to all active duty EMS.
- Providing ongoing de-escalation training to all active-duty EMS.
- End the usage of lights and sirens by private EMS for non-emergency transports.
- End the usage of private-sector EMS in the 911 system.
The specific program costs are estimated to be:
INSERT
III. [WELLNESS SUPPORT LEGISLATION: FUNDING THE ONGOING WELL-BEING OF OUR EMS PROFESSIONALS]
The most serious issue affecting NYC EMS in all sectors is cumulative stress, PTSD, and poor health resulting from long work hours and ongoing exposure to illness and trauma. Having an all agency Support system is a vital part of helping our members deal with this high-stress essential profession on the front line of supporting our fellow New Yorkers.
We are requesting support and funding for:
- Mandation of built-in Critical Incident Stress days to be activated after serious calls.
- Sponsorship of monthly EMS Debrief and Support drop-in groups in all boroughs.
- Uniform annual physical tracking for all EMS professionals
- Subsidized therapy as needed paid for by the employing agency
- Subsidized gym membership
- Mandatory out-of-service lunch breaks for all units
The specific program costs are estimated to be:
INSERT LINE ITEM BUDGET
CONCLUSION
We seek proper funding for support groups, hotlines, and psychological support for CISM. We are seeking adequate PPE, bulletproof vests, and standardization of all equipment in the 911 sector across all agencies. We seek EVOC, martial arts, and de-escalation built into all EMT training programs. We seek to end all private EMS companies using lights and sirens to expedite non-emergency calls. We are seeking an end to all private sector agencies in the 911 system.
THE INITIAL PROJECTED EXPENDITURE FOR THESE POLICIES WILL BE CALCULATED AND ATTACHED AS AN ADDENDUM.
Version 1.0: November 1st
Public Version Nov. 1st