Mike Greco was worried. In early March 2020, New York City had confirmed its first case of Covid-19, and the vice president of Local 2507, the union representing employees of the city’s emergency medical services (EMS), knew how overworked and exhausted EMS workers already were. At a special City Council hearing on March 5, he testified that EMS was already handling 1.5 million calls a year. “If you were to have another half million calls in a pandemic, you would overwhelm the system,” he said.
Weeks later, the city’s 911 system was inundated. On March 30, it received more than 6,500 calls, its busiest day ever, surpassing September 11, 2001. Response times lagged, and families waited in agony for ambulances. Greco spent months working from 7 am to midnight, making sure Emergency Medical Technicians (EMTs) and paramedics had access to personal protective equipment.
Last spring, hundreds of EMTs and paramedics employed by the Fire Department of New York (FDNY) fell sick with Covid-19, and the city relied on reinforcements from around the country. By the end of 2020, five EMTs and paramedics in the FDNY had died of Covid-19. Another three died by suicide.
“The treatment of EMS left the city wholly unprepared,” Greco, a 13-year veteran of EMS in New York City, told me recently. “This March 5 prophecy wasn’t much of a prophecy. We’ve been screaming from the rooftops for many, many years that the city should be prepared for the worst event.”
NYC EMTs have been protesting low pay and what they see as disrespect from the city government since the 1980s. Mayors from Ed Koch to Bill de Blasio have said that EMS work is “different” from policing or firefighting, implying that the pay gap is the result of skill level or dangers faced on the job. But in the minds of EMTs and paramedics, the past year should have erased any notion that their work is less valuable or less perilous than other first responders’.
Today’s EMTs and paramedics say low wages are driving them out of the job. The EMS collective bargaining agreement expired in 2018, and negotiations, which were put on hold because of the pandemic, have begun again. Workers say that if the new contract does not raise pay and improve conditions, the city’s emergency medical system will be left more vulnerable than ever.
After five years, EMTs earn just $50,604 and paramedics $65,226. For comparison, after that same time period, firefighters take home $85,292, and they can earn an additional $25,631 in overtime and holiday pay and have better pension plans and unlimited sick days. The union says the disparity is also an issue of racial equity: Fifty-nine percent of the EMS workforce are people of color, while 77 percent of New York City firefighters are white.
Greco said that his local often pays for hotel rooms for EMTs and paramedics who are living out of their cars or sleeping at their stations because they cannot afford rent. “They can’t afford to live in the city that they serve,” he said. “Nobody who saves lives for a living should be worried where their next meal is coming from.”
In March 1988, New York City’s EMTs and paramedics were angry and frustrated. Their contract had expired. Slow ambulance response times and understaffing were making headlines. Many quit the job because of low pay. Then Mayor Ed Koch allegedly remarked at an EMS graduation ceremony that they did not deserve equal pay with firefighters and police.
EMTs and paramedics had heard enough. Hundreds of union members voted to take part in an unauthorized sick-out, defying the Taylor Law, which prohibits municipal employees from striking. Almost half the force’s EMTs and paramedics didn’t show up for work. Forty-five provisional employees were later fired. But the tactic put pressure on the city, and the new EMS contract, signed in July 1988, included a 5 percent pay raise.
In the 1980s, EMS was affiliated with the Health and Hospitals department. In New York City, early ambulance workers were hospital orderlies who rode along with doctors. Gradually, the work began to require more complex skills and certifications, but the pay remained low.
“To suggest that what we did as EMTs and later as paramedics was not dangerous is one of the most ludicrous arguments of all,” said Bruce Wolk, a former EMT and paramedic in Manhattan in the 1980s. “We constantly, routinely put ourselves in harm’s way.”
Wolk, who is now a writer and lives in Colorado, said he loved the job but that the pay was too low to stick with it. “I was living in Manhattan, and even in those ancient times, with what they were paying us, it was ridiculous.”
EMS also trailed other first responders in benefits like paid time off for workplace injuries and illnesses, an issue that came to the fore in 1990. On August 13, Correction Officers (COs) blocked the bridge to Rikers Island as part of a work slowdown following a series of conflicts with incarcerated people. When EMS arrived to provide medical care, COs prevented the ambulances from retrieving the patients and injured eight EMTs and paramedics. (“Two Days of Jail Guards Against Everyone,” read the New York Times headline)
“The tempers were so high that we basically had the leverage at that point,” said labor organizer Alan Saly, a former assistant to the president of Local 2507. “We said we were going to call a strike, and we didn’t care what the penalties will be.”
The city was forced to negotiate. By September, it had agreed to pay out up to 18 months of full salary for those injured on the job.
The next big changes to EMS came in March 1996, under Mayor Rudi Giuliani, when the service merged with the FDNY. This followed a trend across the country, as the number of fires declined and fire departments sought to maintain their budgets and workforces. The merger did increase the number of EMS workers, which relieved some of the pressures of the short staffing and brought down response times. But being part of the fire department did not lead to pay parity.
“A lot of people thought that after the merger they would gain these benefits by osmosis,” said Saly. “But it didn’t turn out that way.”
The merger opened a path for EMTs and paramedics to become firefighters, but many EMS workers rejected the idea of being “promoted” to firefighting.
“Most of the rank and file did not want to be absorbed into the fire department,” Wolk said. “We wanted to maintain our independence. That way, we could have expanded our professionalism and find [related] career paths.”
Other EMS workers say that the skill set of an EMT or paramedic is distinct from a firefighter’s. Carl Gandolfo, the current recording secretary of Local 2507, said that he has coworkers who left EMS to become firefighters but that they miss the patient contact integral to medicine. “They really don’t like the job on that side all that much,” he said. “They love EMS, but they were forced to go over to fire because of the pay.”
Gandolfo said that the EMS merger had additional benefits for the FDNY, which has long been hounded by racial and gender discrimination lawsuits. Multiple legal orders have forced the department to hire more women and people of color. The merger with EMS improved the FDNY’s overall diversity numbers, while the firefighting workforce remained largely white and male.
“They can exploit the fact that we have majority of women and people of color,” Gandolfo said. “It’s a sad state of affairs that you have a mayor that preaches diversity, and then actually violates every turn when it comes to our working members here.”
An FDNY spokesperson said the department does not combine the diversity numbers of EMS and fire, and added, “The Department had conducted extensive recruitment campaigns over the last decade to diversify the firefighter ranks.”
In early 2020, as the threat of the coronavirus loomed, Mayor Bill de Blasio reassured New Yorkers that the city had “the best emergency response teams in the nation.” But as the wail of ambulance sirens began to fill the streets, his administration did little to support the workers rushing to people’s aid.
Al is a paramedic in Brooklyn who, for fear of reprisal, asked to use just his first name. (In 2020, the fire department suspended or placed on restricted duty four EMTs and paramedics for violating operational procedures, shortly after they spoke to reporters.) Al said he spent months facing the risk of coronavirus transmission, and as more EMTs and paramedics contracted the virus and the station became short-staffed, he often had to work 16-hour shifts. He also told me he cannot support his family on a paramedic’s salary and that he supplements his income delivering pizzas. “There is no future here. There is no future at all,” he said. “I would not recommend the job to my son, or my daughter.”
In early April, as EMTs and paramedics like Al responded to coronavirus calls, de Blasio answered a question about pay parity by saying, “It’s not the time to, you know, make something up on the fly in the middle of a crisis.”
Al described the city’s indifference to the EMTs and paramedics as “a slap in the face.”
Despite being celebrated as heroes, rookies are still living at the poverty line, and experienced paramedics have quit, broke and burnt out. Ambulance workers have told news outlets that working through the pandemic and then processing George Floyd’s killing and other acts of violence against Black people has pushed them to a breaking point. In June, an EMT at the private ambulance company Senior Care was suspended after supporting Black Lives Matter protesters while in uniform.
Low EMS pay was in the news in December 2020, when the New York Post published an article about Lauren Kaitlyn Kwei, a paramedic using an OnlyFans page to supplement her income. Instead of bowing to pressure, Kwei took to social media and spoke about the exploitative conditions facing EMS workers.
Kwei, who works for a private ambulance company, wrote that many of her coworkers must take second or third jobs. She spoke for many in her profession when she wrote, “I LOVE my job and I love taking care of people.… I want to serve the city of New York.”
New York City is now facing its biggest budget shortfall in decades. FDNY is a public ambulance service, but it relies on revenue from patients’ insurance companies. When it comes to EMS, the city acts like a private company, trying to keep labor expenses low while maintaining revenue from transport fees.
“This presents a problem that inevitably lands on the backs of EMTs or paramedics,” said Josh Seim, a sociologist at the University of Southern California and author of Bandage, Sort, and Hustle, based on research with ambulance crews in California. “You maximize revenue by trying to intensify the exploitation of workers.”
With the public heeding requests to avoid non-urgent 911 calls, market demand decreased for ambulance services. The FDNY switched EMT and paramedic shifts from eight to 12 hours with little warning. In December, the FDNY raised how much it charges for ambulance transports. An FDNY spokesperson told me that services fees are increased periodically, and even so, “EMS revenue does not come close to covering the full cost of operating EMS.”
EMTs and paramedics at private ambulance companies feel the squeeze even more. Seim said that the profit motive translates into longer shifts, short and informal breaks, and burnout.
Seim found that during the height of the pandemic in New York City, some ambulance companies in other parts of the country were cutting hours and threatening layoffs.
“It shows what happens when you have capitalist medicine that runs on a commodified system,” Seim said. “It’s going to respond not to the needs of people but the conditions of the market.”
Greco, the local 2507 vice president, told me, “Lord knows that if it wasn’t for unions, management would have no incentive to actually do the right thing. It becomes about numbers, just the bottom line.”
The city says it must keep costs down, but EMS labor leaders point out that increasing their pay would be a drop in the bucket compared to expenditures on police and fire salaries. “This past year has shown the value of having a strong EMS agency,” Greco said.
While EMS pay is low in many cities, New York City has an especially high cost of living. And in Boston and the District of Columbia, EMTs start at $57,000 and $48,731, respectively—higher than New York City’s $35,254.
Boston, said Saly, is “a good example of how political circumstances can change the situation for the workforce.… EMS was championed by the mayors in Boston.”
EMS’s is one of the few unions in New York City working under an expired collective bargaining agreement. The city labor commissioner has argued that because pay in the private sector for EMS is comparable, the FDNY does not need to increase compensation.
The New York City Office of Labor Relations (OLR) is now back at the negotiating table. The outcome will reveal how much the city values the first responders who risked their lives to provide medical care during the pandemic. The OLR declined to comment for this article, and the mayor’s office did not respond to requests to comment.
“This is the time to fix 30 years’ worth of unfair pay practices and finally pull EMS into the 21st century,” said Greco. “If the city doesn’t step up and make this right after the pandemic, they’ve completely lost EMS as a service.”