The pandemic ushered in a reckoning among New York’s healthcare workers: Just this year nurses struck and won raises and better staffing standards, and trainee doctors, who are stepping up union organizing efforts, walked off the job for the first time in 30 years.
But one segment of New York’s frontline medical workforce has continued to fight the same battles for equity and better pay for more than 20 years.
The emergency medical technicians (EMTs) and paramedics who provide New York’s emergency medical services remain in a state of emergency, because they receive the lowest pay among first responders and face unrelenting job demands, according to workers and union leaders. As public workers, they are forbidden by law from going on strike.
They take on additional jobs — moonlighting as CPR instructors, Uber drivers and supermarket cashiers — to supplement their income. Alcoholism and other substance abuse are common.
And workers routinely put in 10 to 20 hours of overtime a week — either to boost their meager pay, which starts at the equivalent of $18.94 an hour — or because they are called on to supplement staffing at emergency services stations that have a high volume of calls.
The city’s medical service is “fundamentally understaffed and inadequate” to meet the needs of both workers and the public, said Anthony Almojera, a lieutenant paramedic and vice president of Uniformed Emergency Medical Services Officer Local 3621, which represents emergency medical services lieutenants.
Now, long-standing strains over staffing levels could be compounded if the City Council approves a proposed one-time exception that will make it easier for hundreds of emergency medical services (EMS) workers to become higher-paid firefighters: The EMS workforce could be further weakened.
In a statement to THE CITY, a Fire Department spokesperson acknowledged that the city struggles to recruit and retain EMS workers, reflecting a national trend, even as the service’s vacancy rate currently sits at 1%, according to data from the city Comptroller.
“Our staffing level is a moving number across the board, but we are always hiring,” said spokesperson Amanda Farinacci. “Recruitment and retention of EMTs and paramedics is a struggle nationally, and the FDNY and New York City are not alone in dealing with this issue.”
Why Not Us?
Most recently, EMTs watched from the sidelines as FDNY firefighters and other uniformed colleagues in law enforcement won a $4 billion tentative agreement with Mayor Eric Adams’ administration that guarantees 17.5% raises over the next five years. Meanwhile, EMTs expect yet another contract where they will remain much lower-paid civilian workers, despite their first responder duties.
The FDNY, Almojera said, “in an EMS agency that occasionally puts out fires.”
Entry-level EMTs earn about $4,000 less annually than their peers fighting fires in the FDNY, but the gap widens to about $26,000 after five years, according to a 2022 class-action lawsuit and agency job postings.
The gaps continue to widen over the course of the different careers. EMS chiefs and commanders — who oversee all EMS stations within a borough and are responsible for responding to mass casualty events — earn $135,000 annually, while their firefighter colleagues earn $235,000 a year. The gaps for these two roles persist, according to the lawsuit, despite both performing “substantially equal work in skill, effort, responsibility, and working conditions.”
Angie Alburquerque, a paramedic who lives and works in Brooklyn, said that in her 14 years in the department, she’s never seen morale as low as it is now.
Alburquerque, 32, works three additional jobs and as much overtime as she can pack into her schedule to afford to rent her one-bedroom apartment and take the occasional vacation.
She loves being a paramedic, even with her backbreaking schedule, she said. But after many years of watching her colleagues struggle with bills, housing, broken marriages, alcoholism and depression, she believes the department is due for a complete overhaul.
“We’re overworked and underpaid. Like if the paycheck was worth it, we’d go home and we didn’t have to think about where we’re gonna get our next meal or how we’re going to pay our rent or I have to miss paying this bill because this was more important,” said Alburquerque, a member of FDNY EMS Local 2507, which represents paramedics and EMTs. “You know, like, if we had that option. I think our stress level would be lower.”
Forced Overtime
Even with the pandemic in the rearview mirror, paramedics and EMTs continue to respond to four times the number of calls than do their peers at FDNY.
An analysis of 911 data by THE CITY found that EMS handles an average of 20,000 incidents each week — a number that’s held relatively steady since 2014 — compared to FDNY firefighters, who handle about 5,000 weekly.
The EMS headcount numbers around 4,500, while firefighters total more than 10,000, according to data from the city comptroller’s office.
Many workers claim the service is so understaffed that workers are frequently called to far-flung jobs in other boroughs, or forced into mandatory overtime, which requires working four additional hours if someone calls out or doesn’t show up for the next shift. Ambulances are required to be staffed by four people at all times.
Overall, EMS response times — the duration between a call for help and the arrival of the unit — have edged up in recent years, fluctuating from an average of under nine minutes in 2016 to nearly 11 minutes in 2023.
That trend holds up for calls categorized as “life-threatening medical emergencies,” THE CITY’s analysis of data from the 911 call system showed. The response times for such calls rose above nine minutes in 2023, the slowest response in the 10 years for which data was available.
An EMT in Brooklyn, who declined to be named out of fear of retaliation from the FDNY, said he gets called to jobs in Queens from his station in Sunset Park, Brooklyn up to three times a week. Another worker at the same station said it’s not unheard of to be sent to The Bronx for certain calls.
Nicole, a Local 2507 member who works as a paramedic in Brooklyn, used to be called to do mandatory overtime three times a week when she worked at a larger station elsewhere in the borough before she transferred to Sunset Park. Now, she said in a phone interview, that happens about once or twice a month.
A lieutenant paramedic who recently submitted his resignation said his colleagues generally work two overtime shifts a month at minimum — and can only get out of it if they volunteer for overtime. “You can’t avoid the mandatory overtime,” he said, adding that he is leaving to work for the city hospital system as a registered nurse.
Alburquerque volunteers about 10 to 20 overtime hours a week on top of her side jobs. “It’s a lot,” she said. “If I have a day off, I will crash the entire day. Like, I will sleep all day long.”
A Series of Suicides
All of those pressures have further squeezed a population of workers already doing extremely high pressure work tending to survivors of car crashes, shootings, stabbings, medical crises and more, as well as to people who don’t make it out alive.
In the depths of the pandemic, three city EMS workers died by suicide in a matter of weeks, including Lt. Matthew Keene, a former work partner of Alburquerque’s. Leaders of both EMS unions say that between 2020 and 2021, during the height of COVID, a total of eight workers died by suicide.
“It was evident of how impactful and damaging it all [was]. All that we had to deal with had an impact on the people,” said Oren Barzilay, president of FDNY EMS Local 2507. “They just couldn’t bear it.”
The city provides some support services to members, though one worker said these are not enough. The FDNY partially funds the Counseling Support Unit, a volunteer corps of rank-and-file and retired FDNY personnel trained to drop into stations to talk to workers, their families, and others who need it any time of the day, any day of the week.
During the pandemic, the FDNY stepped up its efforts, training and dispatching 90 EMS members to stations across the city, as part of a strategic response to aid workers at the COVID frontlines. According to the FDNY, each volunteer averages 100 visits a month, providing support for 1,200 people on a monthly basis.
Data from January 2021 through June 2022, the most recent information provided by the FDNY, says that counseling volunteers met with 18,332 people, which includes EMS, fire and civilian workers and retirees and their families.
Though the Counseling Support Unit continues to operate, the increased visits provided during the pandemic were never meant to be permanent. EMS workers say visits are now fewer and farther between — and they are feeling the absence. Nicole, the Brooklyn paramedic, could not recall the last time a counseling volunteer visited her station.
Another paramedic at the same station, who declined to be named out of fear of retaliation from the FDNY, said he called the support hotline and never heard back.
The FDNY said it continues to support the mental health of EMTs.
“Our Counseling Services Unit is instrumental in maintaining a healthy workforce. The services offered have contributed to saving lives and improving the mental health of our FDNY family,” Farinacci, the FDNY spokesperson, said in a statement. “Any member who needs help can contact the Counseling Unit 24/7 and speak with a counselor, and no one will be turned away.”
Even with these tools in place, emergency medical services are shrouded in a culture — common among first responders and healthcare workers — that makes them fear speaking out. Generally, workers are concerned that speaking out to a peer counselor about their mental health issues, or even a particular crisis call that affected them emotionally, means they will be perceived as weak or mentally unfit to work.
“They just ask, ‘Are you OK?’ – of course they’re gonna tell you that they’re OK,” said Barzilay. “Nobody wants to admit that they’re traumatized, or feel embarrassed, or admit that there’s a problem, to be automatically placed off-service and get checked out.”
Workers also fear that speaking out may put them at risk of retaliation by the FDNY, which earlier this year settled a lawsuit brought by four EMS workers who were punished in 2020 for speaking to the media about their brutal experiences during the pandemic. Each plaintiff reportedly received $29,999 in damages.
EMS advocates say the issues may be more widespread than the public realizes.
The EMS FDNY Help Fund was created in 2017 after the on-the-job murder in The Bronx of EMT Yadira Arroyo, with the goal of providing monetary assistance to families and other survivors of workers who die in the line of duty. But since the pandemic, more workers have reached out directly to request cash assistance to cover the costs of rent, food and personal debts, said Danielle Gustafson, the executive director of the nonprofit Help Fund.
Gustafson said workers are seeking assistance for housing, and her group helped many secure relief money to rehabilitate their flooded homes after Hurricane Ida. Also, she said more people are seeking information on alcohol and substance abuse programs.
“Really, this is a form of self-medication — dealing with trauma, without having the support and coping that they need,” she said. “And obviously I don’t think they have enough support in coping, and so it’s our goal to provide more.”
No Bargaining
Current and former EMS workers say the city should invest more into mental health resources for the rank and file, such as having licensed therapists, in addition to peer support, to meet their needs.
Many are quick to point out, however, that many workers’ issues could be relieved with competitive raises, benefits and better staffing.
Workers and their union leaders cast blame on the city Fire Department and past mayoral administrations, which for decades have classified EMS staffers — most of them people of color, and nearly half of them women — as civilian staff.
Accordingly, EMS workers were excluded from the tentative agreements that 11 unions representing the city’s uniformed workforce, from firefighters to correctional officers, reached with the Adams administration this month.
The two unions representing the city’s EMTs and paramedic have yet to hold or even schedule a bargaining session with the city.
At a June 15 press conference announcing the tentative agreement for the uniformed unions, city Office of Labor Relations Commissioner Renee Campion said that talks with unions representing EMS workers haven’t started yet.
“We will be bargaining with them and I look forward to those conversations,” Campion said.
The salary and benefits gap between EMS and firefighters is so wide that in December 2021 federal watchdogs determined that the city discriminated against FDNY EMS on the basis of race and sex and urged the city to remediate the issue. That investigation by the Equal Employment Opportunity Commission was the basis of the class-action lawsuit against the city and the FDNY filed in January by several unions representing EMS workers.
The result is a workforce that increasingly sees itself as a springboard for other jobs. It’s an open secret among EMS that many rookies get out “the back door,” biding their time in the department until they qualify for a promotional exam to become firefighters.
The City Council is currently weighing whether to grant a one-time exception that would allow aged-out workers who were not able to take the promotional exam in 2020 to do so later this year.
Unions representing EMS are divided on support for the legislation, which could hemorrhage about 324 EMTs to firefighting, an estimate that excludes other eligible titles like officers and paramedics, according to estimates by the city Department of Citywide Administrative Services (DCAS).
The Adams administration has yet to say where it stands on the proposal.
“We fully understand the impact this opportunity could have for many of the frontline workers who served our city bravely throughout the pandemic,” said DCAS spokesperson Anessa Hodgson. “We are exploring how this matter can be addressed consistent with applicable law.”
The former lieutenant paramedic said he’d been plotting his path to become a registered nurse “for several years,” noting that it’s a common transition for medics who hit their ceiling within EMS.
Both Almojera and Barzilay say 10 to 15 people resign each week, either to other first-responder jobs or leaving the profession entirely, working in retail or parcel delivery.
“We go to the same calls as NYPD, the same calls as FDNY, we go to correctional facilities, we go to all sorts of calls yet they pay us basically, minimum wage to start here,” Barzilay said. “This is about equality.”
If you or someone you know needs help, call or text 988 for the 988 Suicide & Crisis Lifeline. You can also reach those services by visiting 988lifeline.org.