The tragic death of 24-year-old Nicholas Costello from the Bronx, who suffered cardiac arrest and waited nearly 20 minutes for an ambulance in December 2023 starkly exposes the dire state of New York City’s Emergency Medical Services.
Costello’s death is not an isolated incident but a symptom of a systemic ailment plaguing this city’s emergency medical services. Just last month, FDNY Commissioner Robert Tucker, the man currently in charge of New York City’s ambulance system, sounded the alarm. He declared NYC’s EMS system to be in “critical condition,” struggling under the strain of a record 1.6 million calls last year and suffering from chronic underfunding, systemic bigotry and political neglect.
Commissioner Tucker’s distress was palpable. “When I tell people I don’t sleep at night, this is why. …Our EMS system has operated on an unsustainable model for years and without immediate attention and proper investment it could soon collapse.”
The tragic and needless death of Nicholas Costello is a direct consequence of the city’s inadequate emergency response infrastructure, but he is only one of the many New Yorkers who suffer from the deteriorating state of this city’s public health system. On that fateful night, the delay in getting help to Nicholas was ultimately not caused by traffic or technical glitches, but by a simple yet devastating reality: there were not enough ambulances or staff available.
The most recent data available reveals a distressing trend: average ambulance response times have surged from seven minutes and 26 seconds to nearly nine minutes over recent years, a far cry from the FDNY’s target of under seven minutes. Each delay increases the risk of preventable fatalities and long-term disability for New Yorkers.
The root causes of these delays are deep-seated. This city’s EMS workforce is plagued by high turnover and low pay. According to Anthony Almojera, Vice President of AFSCME DC37 Local 3621, one of the city’s EMS unions, “75% of the service has less than 5 years on the job.” Almojera explained in a recent message to fellow union members, “We have lost approximately 3,100 members of service since 2020 (out of a workforce of 4,400) through attrition, retirement and other means.”
NYC EMS workers face a grueling job with not just low pay and high risks, but also discrimination. There is a stark contrast in compensation and access to resources within the FDNY between predominantly white male firefighters and the diverse EMS workforce, which is primarily composed of women and people of color.
There are over 11,000 firefighters and about 4,400 EMS workers. In 2024, NYC firefighters responded to 2,158 serious fires and emergencies, while NYC EMTs and paramedics answered 627,599 life-threatening emergency calls with less than half of the staff of the fireside. After five-and-a-half years, the yearly base pay of these two “first responders” within the FDNY is almost $36,000 apart. A firefighter’s base pay is $86,000 a year while an EMT’s is $50,000.
With only 11 public hospitals for 8.7 million people and nearly 7% of the population uninsured, the underfunded public health system mirrors the deficiencies seen in EMS.
