The city could more wisely spend the $1.1 billion it costs to provide emergency medical services, a budget watchdog group says, in part by reducing the role fire engines play in responding to 911 calls — and then considering whether it really needs all of its engine companies.
In a new report, the Citizens Budget Commission recommends ultimately reducing the number of engine companies, which for years has been a political nonstarter.
The suggestion comes as the fire department, which is responsible for responding to medical emergencies, has seen a steady uptick in the number of calls — responding to 1.5 million in 2017, up 36% since 2000. At the same time, the number of fires in the city has decreased. But while EMS work makes up 84% of the department’s workload, it accounts for just 30% of its budget, the report’s author, Mariana Alexander, a research associate at the Citizens Budget Commission, said.
“The fire department has adequate resources to do its job, and it’s about reassessing how those resources are allocated to match its workload,” she said.
Fire engines are only supposed to be dispatched to the most serious medical calls, when time is of the essence — because they can often arrive faster than ambulances. But that quick arrival doesn’t always translate into much help.
While the engines can reduce response time, firefighters can’t provide the same level of care as an ambulance crew can. And the engines are much more expensive to staff — with “5 or 6 people on a fire truck, and they’re all paid a lot more than your average EMT or paramedic.”
“Sending a fire engine doesn’t necessarily reduce your workload, because the ambulance is still needed to transport,” Alexander added.
Staffing each fire engine costs the city an average of $7.2 million a year — compared to $2.2 million a year on average for an ambulance to make three tours a day.
“If you closed one fire engine company you could fund 10 additional ambulance tours each day,” she said.
But closing fire engine companies has been a political third rail for years — Mayor de Blasio even got himself arrested protesting the idea under his predecessor’s mayoralty.
“It would politically be a very heavy lift for the fire department to do,” Alexander acknowledged.
FDNY spokesman Frank Gribbon said the engines are dispatched to life-threatening calls such as cardiac arrest, an unconscious person, or someone choking, in addition to responding to fires.
“Engines also respond to fires and other emergencies, and we do not advocate nor support closing any of them, as the report seems to suggest,” Gribbon said.
Reducing the role of fire engine companies isn’t the CBC’s only suggestion — it also called for mounting public campaigns to reduce unnecessary requests for ambulances and reducing the focus on response time for minor issues while beefing up the ability to quickly respond to more serious ones.
“Many of the incidents that the fire department are responding to are not genuine emergencies. These are incidents that either medical care is not needed at all or urgent medical care is not needed,” Alexander said.
The FDNY said it has been working with other city agencies to try to steer people to other forms of medical treatment when appropriate.
“We share the CBC’s concern about unnecessary or inappropriate requests for ambulances — and have been working closely with NYC Health & Hospitals, Greater NY Hospitals Association. and the city health care networks that are participating in the Medicaid DSRIP program to ID appropriate alternative pathways for these patients to receive care,” Gribbon said.
The CBC also takes to task the focus of city officials on response times for all medical calls — arguing that while a quick response is vital in emergencies like cardiac arrest, it is less important for other medical issues.
“They adopted this kind of cardiac arrest model of responding to medical incidents where time really matters, you have to get there as soon as possible. But that’s not really the case if you sprain your ankle. It doesn’t really matter if they get there in 20 minutes,” Alexander said.
The city should instead focus on prioritizing lower response times for its Advanced Life Support ambulances — staffed with paramedics — who can provide medicine and have more training. While the number of life-threatening calls have increased, there are fewer Advanced Life Support ambulances and more Basic Life Support ambulances, worked by emergency medical technicians. .Alexander posited that was due to the focus on lowering all-around response times.
“The City Council has been concerned about response times to all incidents not just the most critical ones,” she said. “There’s no evidence that response time matters for those less critical incidents, where as they really really do matter for the most critical ones.”
One way to increase the number of Advanced Life Support ambulances — and their response times — would be to change the way they are staffed. Currently, the ambulances have two paramedics on board. The CBC suggests changing that to one paramedic and one EMT, which would both lower the cost and, spread out more paramedics, who are in short supply, over more Advanced Life Support ambulances.
Gribbon noted the department has sought to change staffing in the past but was met with roadblocks in Albany.
“We need state approval to change our Advanced Life Support (ALS) ambulance staffing (currently staffed by two paramedics) to a combination of one paramedic and one EMT,” he said. “We have requested making this change in the past but have been denied.”
Vincent Variale, president of the Uniformed EMS Officers Union, Local 3621, opposes the idea.
“I think that’s dangerous,” he said. “I think with the amount of call volume New York City EMS deals with, you need two medics there.”
The paramedics need to be able to consult with one another and provide a continuity of care, he said.