Committee on Fire and Emergency Management

Good morning. Welcome to the Committee on Fire Emergency Management, Joint Web Hospitals. At this time, we ask that you please silence all electronics. If you wish to testify, please see one of the sergeant-at-arms in the back, and at no point, please do not approach the dais. Chair, you may begin.

Good morning. My name is Joanne Areola, and I am chair to the Fire and Emergency Management Committee. I would like to begin by acknowledging council members who are here today, Council Members Schulman and Palladino. I would also like to thank Chair Mercedes Narcisse for co-chairing today's hearing with me. Today, the Committee on Fire and Emergency Management, along with the Committee on Hospitals, will once again be holding an essential oversight hearing on ambulance response times and discussing Intro 990, a bill I introduced that would require NYC to alert New Yorkers through the Notify NYC system of extended wait times for an ambulance.

Over the summer, we saw 700 calls being held by EMS system because of a lack of staffing. This Minutes Matter bill would let New Yorkers know what that system is in the state of emergency, and if you— if you— you're called to 911 at the time, help is not moments away. The Fire Committee will also hear Introduction 990, sponsored by myself, which requires the city to issue emergency notifications each time the FDNY EMS has more than 25 pending ambulance dispatches at any given time.

As we all know, our first responders, notably our EMTs and paramedics, but also firefighters, are tasked with delivering critical emergency medical care throughout our city. These dedicated public servants routinely provide life-saving care and respond to more than 1.6 6 million medical calls each year. We are forever grateful for your service. At this time, we must acknowledge that the EMS workers undertake an immensely difficult job due to stressful work conditions, long hours, and challenging work.

Not only that, EMS workers, particularly employed by the FDNY, are vastly underpaid. for the vital jobs that they do. Yet despite these obstacles, each day thousands of ambulance workers strive tirelessly to serve the city and deliver timely emergency medical care to all New Yorkers. Despite a dedicated and talented workforce, it is apparent to anyone paying attention that our city has struggled to meet its obligations to provide timely emergency medical care to all New Yorkers.

Each year, the city publishes substantial amounts of data related to emergency response times, a key metric to monitor when seeking to evaluate and improve the delivery of pre-hospital emergency care. In fact, according to the FDNY, the department regularly reviews response times to life-threatening medical emergencies across the city and develops strategies and reallocates resources to reduce response times in communities with higher response times.

However, over the past decade, FDNY's response times to emergency medical incidences have consistently increased, a trend that is seen dramatically in responses to life-threatening medical incidences. The dire medical emergencies where prompt delivery of a medical— of emergency medical service and care is most vital. I'm extremely concerned that New Yorkers are facing negative health outcomes due to the delays of the delivery of emergency medical care, and the worry this instills a lack of public confidence in our city's ability to provide vital services when they are most needed.

As Chair of Fire and Emergency Management Committee, I expect to hear testimony from the Fire Department that will provide clarity to why we have seen dramatic increases in response times to medical emergencies, and learn more about the department's procedures related to dispatching, staffing, and the maintenance of ambulances. But also, I hope the department and administration is able to speak more broadly of the commitment of dedicating increased resources to the provision of prehospital emergency, and truly examine agency operations and interagency coordination to identify how the city can reverse this troubling trend of increasing emergency response times, because we cannot continue down this path.

I'd like to thank our committee staff, our committee counsel Josh Kingsley, our legal analyst Will Hongash, and my amazing chief of staff Phyllis Incirillo. I will now yield to Chair Narcisse for her opening remarks.

Good morning and thank you for being here. And I have to apologize for my 5 minutes or 7 minutes delay. Should not happen. Good morning again to all of you and for being here. I am Chair Mercedes Narcisse, Committee on Hospitals. I'm here actually for different aspect of my life being a registered nurse, and I'm so happy that we're having this hearing today.

Delayed ambulance response and prolonged emergency department wait times have become an increasingly emergent— urgent challenge in New York City. While many factors contribute to these delays, one of the most significant is the growing strain on our healthcare system. New York City is home to 49 hospital emergency departments, including 11 hospitals operated by NYC Health+ Hospitals, H+H. That's where I used to work, which served more than 8.5 million New Yorkers.

Reports indicate that between 2022 and 2025, patients at H+H hospitals waited an average of 12.8 hours to be transferred from the emergency department to inpatient bed. This prolonged wait can delay critical treatment, disrupt continuity of care, and contribute to overcrowded emergency rooms. As a registered nurse who works in triage at Elmhurst Hospital emergency department, I have witnessed these challenges firsthand.

Before first responders can return to the field, And answer the next emergency call, patients must be registered, assessed, and safely transferred into the care of hospital staff. When emergency departments are overcrowded and inpatient beds are not available on the floor, that process can take far longer than it should, creating ripple effects throughout the entire emergency response system.

Staffing shortage shortages, hospital closures, and increased barriers to accessing primary and preventive care due to recent federal Medicaid cuts we call HR one one big not beautiful we know where I'm going have further intensified these pressures as chair of the Committee on Hospitals. I am committed to examining the many factors driving prolonged ambulance response times and identifying meaningful long-term solutions rather than temporary fixes.

Temporary fixes are not going to help us in New York City. New Yorkers deserve confidence that when they call for help during a medical emergency— and we know what took place recently— They were waiting for so many minutes that the family forced to drive their own child to the hospital. That's not— that should not happen. Assistance will arrive as— emergency assistance will arrive as quickly as possible.

Every resident, regardless of zip code, income, race, gender, immigration status, or background deserves timely access to emergency care. Today we look forward to hearing from New York City Fire Department, New York City Emergency Management, and other representatives in the field of emergency management about the alarming state of ambulance response times across the city, including What changes have been made since the last City Council hearing on this topic in 2024, and other city-supported efforts.

We also seek their feedback on the legislation before the committee today. Together, we must work to ensure that our city ambulance services are efficient and trustworthy, and that they continue to serve our residents with the best. possible care. Like I always said, we call ourselves the capital of the world. We have to lead by example, and healthcare is a human right.

Without your health, you're nothing. And we each— everyone in this room can agree to that. Without your health, you're nothing. So we have that responsibility to address that. Before we begin, I'd like to thank committee staff, Senior Legislative Counsel Rhea Agarawala, Legislative Analyst Raina Lee, Policy Analyst Minor Butt, Financial Analyst Molly Howard, and Assistant Director Florentine Cabarro for their hard work in preparing on this hearing.

And I also like to thank my staff for their hard work. And as we continue to serve our constituents and the city as large. So we're all responsible to make sure this city is the best city. So I'll pass it on to my colleague, Chair Ayala.

Thank you, Chair. Before we swear in the panel, we are going to give a courtesy to Jennifer Daly. She's going to testify first this morning. Jennifer is the mother of Kevin, a 14-year-old boy who experienced a medical episode when he arrived at school on a late September morning. The school nurse called 911 3 times, but the ambulance never arrived.

Ms. Daly is joining us via Zoom to tell her story. Ms. Daly, can you hear us? Yes. Hi, how are you? Thank you for testifying. Oh, thank you for having me. You may begin.

Oh, okay. So, well, first I'd like to say thank you for having this hearing. It means a lot to me. So on September 28th, my son arrived at school. Um, around 8:15, um, and he was feeling fine. He arrived at school, and once he went into the building, he said he was feeling a little faint, a little weak, and his eye was, um, blurry a little bit.

So he immediately went over right to the nurse's office, and he told her. She sat him down, and she gave him water, and she gave me a phone call. Uh, that phone call was about 8:17. And I instantly said, I'll be right there. So I left Howard Beach and drove over to St. Francis Prep in Fresh Meadows.

And unfortunately, it was taking me a little longer than it normally does due to the morning commute traffic. And in the, in the interim of getting there, I had received another phone call from her, and she stated to me that she thinks that she needs to call the ambulance. So I said, please do whatever you have to do.

If the ambulance gets there before I do, you know, just tell me where you are. I will meet you there right away. Um, and then I was driving. Unfortunately, the traffic was building up a little bit longer, and, um, the nurse had called me again and said that she called the ambulance and she had his 2 sisters down there in the nurse's office with him, and his face looked, you know, a little, a little strange, like his eye was like, you know, Not drooping, but his eye was slanting down a little bit and looked a little weird.

So she was going to make another phone call. So she made another phone call to the 911. My daughters went there, and one of my daughters— they're both actually— one of my daughters is taking health and safety class, CPR training, first aid, and she looked at her brother and said, he looks like he's having a stroke. Because they are learning that in school.

She immediately called my husband, who is a retired fireman as well, and he was at work. And he— she told him Kevin's symptoms. And my husband said, well, give him aspirin. Luckily, I'm neurotic and my kids have, you know, aspirin and Tylenol and Motrin on them in case they need it. And she gave him the aspirin right there.

In the midst of that phone call with my daughter, with my husband, I get another phone call from the nurse. That she called the ambulance twice and that he does need to go. So I said, okay, I'm there. I will be there any second. So when I arrived, um, he was there. I saw him and he definitely 100% was having signs of a stroke.

You can tell it like almost immediately. Uh, he was slurring his words. His speech wasn't clear. He didn't really know what he was speaking about. He was mumbling his words. And, um, I called his cardiologist and I said, um, we have to get him over to, you know, the, the hospital. What do I do? She said, wait for the ambulance.

I said, I cannot wait for the ambulance. This is the— gonna be the 3rd time that PrEP made the phone call, and my husband made a phone call to them as well. And she said, okay, take him. She called over to New York Presbyterian in Queens, and I rushed him over there. with my, my twins from St.

Francis Prep. I think I got left Prep at like 9:30 something, 9:32, and I got to Presbyterian at 9:52, um, and my husband arrived as well. When we got there, he ran him in. They were great. They took him right away. They gave him all kinds of tests— EKG, ultrasound, CAT scan, MRI. And he had a stroke.

Then they transferred him over to, um, the hospital, uh, Morgan Stanley Children's Hospital on 165th Street in Manhattan. And then he stayed there for several days until he was released. That's basically it. That's my story.

Ms. Daly, thank you for sharing your story, and we're so thankful That you had the presence of mind to have your daughters prepared in case they did have any type of— you're not neurotic, you're just a great mom. And the fact that your husband had the medical knowledge to tell your daughter to administer the aspirin because it could be probably life-saving.

But thank you so much. Yes, I think it was. Oh, thank you. I appreciate it from the bottom. I want to cry from the bottom of my heart. Thank you. Okay. Thank you so much. Thank you. We have one— Chair Narciso, you have to say something. Thank you. I have a big thank you. No, no, don't go anywhere.

I want to say thank you to you. Okay. All right. I'm done. I'm done. Thank you. Thank you. You're welcome. For actually saving your child's life. You did it. And I'm thankful for your husband, FDNY, as well. And I have to let you know that the nurse could not give that medication because without a doctor present. Of course.

So that's the reason the call you made to have the medication, be able to call on your daughter, your family to do that, that's very much appreciated by us because you can save the life. And unfortunately, the nurse could not give the medication. So thank you. Yes, yes. You're welcome. Thank you. Yep. I would like to just note that we've been joined by Councilmembers Virginia Maloney— my gosh— Councilmember Wong and Brooks Powers.

Okay, we will now swear in our, our, our panel consists of Dr. Josh Motzquist from Health+ Hospital, Chief Paul Maiano from the FDNY, Chief John Esposito from the FDNY, and Chief Denise Werner from the FDNY. Thank you for joining us today. Hey everyone, can you just raise your right hand and affirm the following, that you affirm to tell the truth, the whole truth, and nothing but the truth, and answer honestly to councilmember questions?

Seeing you affirm, you may go ahead and testify. Thank you. Chief, you may begin.

Good morning, Chair Areola and members of the Fire and Emergency Management Committee. and Chair Narcisi, and the members of the Hospitals Committee. My name is John Esposito, and I am the Chief of Department of the New York City Fire Department. I am joined today by Paul Miano, Chief of EMS, and Denise Werner, Chief of EMS Dispatch. For members of FDNY EMS, reaching a patient experiencing an emergency quickly is paramount.

When lives are at stake, every second counts. As we have testified to this committee previously, the department is currently engaged in a challenging period of increasing response times. We know this is unacceptable, and we are working tirelessly to reverse this trend. I am grateful for the opportunity today to discuss some of the reasons for these increases and the steps that we are taking to fix it.

I want to state unequivocally. that addressing EMS response times is a top priority for myself, the Fire Commissioner, and for the Mayor. There are numerous reasons we are seeing increases in response time. One major factor is the number of in-service hours of ambulances in the 911 system. As you can see from the most recent Mayor's Management Report, the average ambulance in-service hours per day has trended lower over the most recent 5-year period, from 8,891 in fiscal year '22 to 8,572 in fiscal year '25 and 8,109 in fiscal year '26.

Meanwhile, the number of life-threatening medical calls has increased now compared to 5 years ago, from 564,412 calls in fiscal year '22 To a total of 610,771 calls in Fiscal Year '26. Put another way, when comparing these snapshots, we are responding to more calls with fewer ambulances. After years of seeing increases in call volume every year, the total number of calls was slightly down over the last year.

However, it remains a very high total number of calls, Many of which are low-acuity calls that may be more appropriate served— that may be more appropriately served by non-emergency medical services. If a person is not experiencing an emergency, an ambulance is not always the appropriate means of transport. A significant reason for the number of ambulance in-service hours— that the number of in-service hours have decreased is staffing changes.

We are in the midst of a promotion cycle in which 358 emergency medical technicians and 63 paramedics departed EMS to become firefighters in 2026. In 2025, 288 EMTs and 48 paramedics made this transition. It's a positive outcome for the city to have firefighters with EMS and paramedic level medical training, but it also has a severe impact on EMS staffing in the short term.

When a class of EMS members enters the Fire Academy, it means that EMS leadership has hundreds fewer members to staff ambulances. We have taken measures to mitigate this impact, including deliberately staffing up above headcount prior to the promotion cycle, but with so many members taking the firefighting exam in each cycle, the effect on EMS staffing continues to be significant.

There are also elements that influence response times that are unrelated to staffing. Since 2003, 19 hospitals in New York City have closed, with the most recent closure in 2025. That means fewer destinations for patients. With each closure, ambulances must travel further to get the patient to the emergency room, and further again to travel back to their assigned area.

Hospital closures also mean fewer hospitals contributing ambulances to respond in the 911 system. Currently, the 911 system is made up approximately 2/3 municipal units operated by FDNY members, and one-third hospital-run units that are staffed by the hospitals. We've also experienced hospitals reducing the number of units that they contribute to the 911 system. Each of those lost tours adds stress on the system.

We are pursuing numerous adjustments and innovations to address the ongoing challenges with response times. We know that building up EMS staffing is a key part of this issue. We need to replace the members who have left EMS to become firefighters and other EMS members who have left due to issues with wages, schedules, or for their own reasons.

Recruiting has become more difficult since the COVID-19 pandemic. The union that represents the department's EMTs is currently at the negotiating table with the City's Office of Labor Relations, and we are hopeful that a resolution to the next contract will provide a recruiting boost. Restoring staffing is a large piece of the puzzle, but it is not the only way we are attacking this problem.

We are also working internally with external partners to reexamine existing practices, streamline processes, and eliminate inefficiencies. We've already taken several steps to improve responses. Paramedic Response Units. We've set up PRUs to get additional paramedics into the field who can respond to patients faster to assess, provide treatment, and arrange transport. The Paramedic Response Unit brings paramedics to assignments classified as life-threatening.

However, if the assessment reveals that the patient does not require advanced life support, they are transferred to a basic life support unit, and the paramedics become available for the next high acuity assignment. We currently have 14 of these units operating across the city. The CRCC. We've created a centralized unit that assesses personnel across all divisions in real time with the aim of pairing up available members to get more ambulances into the field.

Our goal is to get as many units onto the street whenever possible to respond to calls and take the burden off of all the other units in the system. The borough-based command structure. Under this administration, EMS leadership has moved to a borough-based command structure. This enables staff chiefs to provide more oversight over smaller areas, so they can react quicker and more dynamically to evolving conditions in the field.

These chiefs develop better localized knowledge and are able to provide tailor-made solutions to operational issues, rather than a one-size-fits-all solution that may not be appropriate for a given geographical area. The Borough Resource Coordination Center. This unit was created to be the eyes and ears of the borough, Monitoring pertinent real-time information to provide— to prevent unnecessary off-service issues.

Ambulances cannot respond to calls when they are back in the station restocking medicine or equipment. So this unit observes resource levels in order to proactively restock when it is most efficient. This unit also monitors hospital trends and timing. communicating with hospital personnel to understand where delays are occurring, and resolving issues as they arise. As with all areas of emergency response, the more communication and coordination between partners, the better the outcome.

We've also been working with the Greater New York Hospital Association. We've asked our existing hospital partners who participate in the 911 system to add additional units. To date, 3 have agreed to provide additional assistance. We have also invoked our New York State Mutual Aid Agreement, and we continue to welcome units from the volunteer corps within the city to assist with 911 calls.

These are partners who are already familiar with our system and who have participated in past times of need, Including during COVID We've been working with the hospitals to address persistent diversion issues. One challenge that creates longer response times is when hospitals go on diversion and refuse to accept patients. This is sometimes necessary for a variety of valid reasons, but we also experience hospitals that frequently go on diversion for certain types of patients which means that ambulances have longer trips to drop off patients and longer trips back to where they came from.

We continue to speak with hospitals where this practice creates persistent challenges to get them to go off diversion and become a destination for patients. One recent success is on Staten Island, where 2 hospitals that had consistently remained on diversion for mental health patients, This in turn required ambulances to drive across the island to reach a hospital that was accepting that type of patient, and then drive back across the island again to get back to the area it was serving.

By these hospitals agreeing to begin accepting mental health patients, ambulances no longer need to traverse the island in order to transport patients to receive appropriate care. We've also done and are doing a full review of EMS members who are working offline who may be returned to the field. We are currently reviewing all EMS members who do not work in frontline positions and redeploying to the field.

This includes emergency medical technicians, paramedics, and officers. A lot of EMS work happens in offline positions, including a lot of paperwork and analysis. However, during these times of lean staffing, we are transitioning as many members as possible back into operational roles. In particular, we have reassigned 2 Deputy Chiefs from offline positions to provide increased guidance and supervision to members in the field.

We also— we have also undertaken several long-term potential solutions. These are changes that require development before becoming fully operational, But they are steps that we are actively exploring or working on. We are updating the digitized EMS schedule. FDNY's Bureau of Enterprise Technology is currently working to improve the daily scheduling program that we use for staff scheduling. By replacing an off-the-shelf calendar program with a bespoke product that we've built ourselves, The new scheduling system will be a better fit for our unique needs and operational requirements, enabling the department to more efficiently deploy resources.

We optimize deployment decisions through better technology. We are testing ways that artificial intelligence technology can help us make more accurate decisions about deploying resources. While we currently make data-driven decisions to choose ambulance cross-street locations, We are exploring whether newer technology can be helpful with those decisions, and whether they can be used in a balanced, safe way to yield better outcomes and help us reach patients faster.

As this committee is aware, we continue working with the city's Office of Technology and Innovation to update the EMS CAD system. We expect that the new system will contain many tools that will improve the way we dispatch resources. There are a variety of alternate ways to treat patients outside of the traditional model of transporting them to an emergency department at a hospital.

We have piloted and tested different versions with varying levels of acceptance by the public. Programs like telemedicine, alternative transport, treat-in-place, and 911 to 988 provide models that would avoid lengthy transports. However, our experience has shown that the members of the public who call 911 are overwhelmingly expected to receive transport to a hospital. So it will likely take lengthy periods of education and outreach before these programs are used by significant numbers of callers.

We continue to explore the appropriate method of pursuing these alternatives. We know that we have a lot of work to do. Addressing this challenge is something we will be working literally night and day to improve. I know that rising response times is a concern for this committee as well, and I am appreciative of all of the attention that you've given to it.

Regarding Introduction 990, we understand and appreciate the intention of the bill. As written, we don't believe the bill We don't believe that the likely volume of notifications that would result would necessarily provide useful information to New Yorkers. However, we are open to further discussion and exploring ways to provide more real-time information to New Yorkers on this topic.

Before I conclude, I want to emphasize what a great job our members are doing to— despite this challenging environment. This year was an incredibly busy year for EMS. In addition to the regular demands of the 911 system, we operated in circumstances that included extended Code Blue cold periods, millions of visitors for the FIFA World Cup, numerous activities and events for the America 250 celebration and the International Naval Review, and we are preparing now for the holiday tourist season.

Our EMS members have risen to the challenge time after time, conducting themselves with professionalism, saving lives, and serving their fellow New Yorkers and visitors alike. I am proud of the effort they make every day, and I am proud of the great success that they achieve, even in these most challenging circumstances. Thank you. We would be happy to take your questions at this time.

Thank you, Chief. I just want to go and ask a few questions regarding the incident that took place at St. Francis Preparatory High School that, that Ms. Daly testified to. Going back to her testimony, Jennifer Daly noted that an ambulance never arrived for her child, was showing signs of a stroke. Can you explain why an ambulance did not arrive that day?

So before I defer to Chief Miano, we want to express our thoughts that it is unacceptable that we can't get an ambulance— we're not able to get an ambulance there in time. As a parent, the thought that your child goes to school, has a medical emergency, it's recognized, and they call for help, and It's unacceptable and we have to do better.

I'll pass it to Chief Miano and Chief Werner to describe the specific circumstances and what happened that day. Thank you. Echoing what Chief Esposito just said, this is a tragic incident that we want to try and stop from happening in the future. During the period of time where this call came in, EMD or the 911 system was experiencing an extreme number of calls, more than 100 calls than we normally receive during this period of time.

Our call takers, right, they don't just answer a phone and say, where's the address, and then dispatch out an ambulance. They spend a few minutes on the phone with each caller trying to ascertain exactly what is going on with that caller so we can dispatch the correct type of ambulance. Unfortunately, during this time when the call was received, again, there were a high number of calls that came in and our alarm receiving dispatches were on the phone with other callers.

That does not mean that this call was not dispatched. It was dispatched. It was sent from our NYPD dispatcher over to the EMS dispatch, and it was put into the system. It was classified as an unknown condition because we did not get to speak to the caller and triage the call ourselves. The call was dispatched out to an ambulance.

The ambulance did start traveling towards the call, but the ambulance was coming from a distance, and it did take beyond— the ambulance did arrive. They arrived, unfortunately, after the patient left to go to the hospital. At this point, I'm just going to pause questions because we've been joined by our speaker, Julie Menin, and she does have a statement that she would like to read.

Thank you so much, Chair Areola, and I really want to thank you and the committee for holding this incredibly important literally life-saving hearing today. So I really wanted to come by, first of all, to say that we all know in the city that we are truly facing a crisis regarding our EMS teams, who are obviously part of FDNY.

These teams save lives, yet they are understaffed and they are underpaid. And this City Council is very serious about this issue. These EMS These teams, I don't need to overstate this, are truly saving lives every single day. They're responding to 1.6 million calls compared to FDNY's 500,000, yet they're only staffed by 4,500 members compared to FDNY's 13,000.

The average length of service for an emergency medical technician is just under 3 years because the pay of $18 an hour for hard, long work is simply not enough. simply untenable. So we are hearing story after story of our EMS workers, many of whom after their job are going and living in a shelter because they literally cannot afford housing, or some are sleeping in their cars.

This is truly unacceptable. I don't know what kind of city we are that we are allowing this to continue. The lack of adequate pay has obviously led to both rising attrition and low recruitment. which of course perpetuates this understaffing issue. With fewer staff, there are fewer ambulances ready to go at a moment's notice, which is obviously deepening the delays.

And when New Yorkers cannot rely on the emergency medical services to quickly respond to an emergency, who can they rely on? Residents of my own district actually asked that very question recently, just a few days ago, when a 16-year-old was badly hurt during a basketball game. Despite 5 separate 911 calls, no EMS arrived. Despite a firehouse actually being next door, no EMS arrived. 30 minutes after the first call, the teenager's parent contacted a private ambulance service because he couldn't wait any longer.

Nearly 3 hours after the first call, the FDNY phoned back to ask if an ambulance was still needed. I think obviously we're all relieved that his life was not at stake, but this is totally unacceptable. What if his life had been at stake? This is just— this cannot continue. And there have been many cases where people's lives are literally on the line.

We've seen in the mayor's management report, the recent report came out, that the average response time is 13 minutes, 0.9 Seconds. This is totally and wholly unacceptable. So as we wait for wages to increase, response times are increasing to truly unacceptable levels. We know that brain cells begin to die after 4 minutes without oxygen. So the idea that we are now at an average response time of 13 minutes, 0.9 seconds is just wholly unconscionable.

We must act now to pay those who provide the lifesaving work. a living wage and to ensure that New Yorkers in crisis can truly get the care they need. So thank you, and I will now turn it over to Chair Areola for continued questioning.

Thank you so much, Speaker, and you make a very valid point, and it is the point that is at the crux of this issue, is the fact that they cannot retain an EMS worker because they do not make enough money to sustain themselves and have a family and support themselves. And yes, some live in shelters. Some live by the charity of family.

They cannot sustain themselves on $18 an hour and work 3 12-hour shifts and then work a second or third job just to make ends meet. So that's really the basis of the problem is you cannot retain and people will leave whether it's to go to the fire department to the DOT, to sanitation, or to a private hospital.

So that's where we have to say that the mayor's office has to deal honestly and competitively with this contract that they are negotiating now with the unions and not just kick the can down the road like previous administrations have. They may not have caused this particular situation, but they certainly can end it. And that's what we're looking forward to.

So thank you for bringing that up, Speaker. That is really the crux of the problem. And I'd like to note that we've been joined by Councilmember Epstein. And to the Speaker's point of what happened with that particular incident in her district, I know that we've had conversation about that. I'd like you to share the reason why an ambulance didn't come and then called 3 hours later to see if an ambulance came.

So before I give this to Chief Miano, again, and this was a different reason than at St. Francis Prep, but the idea that somebody, one of our children, can be hurt at a school and not get an ambulance in an acceptable amount of time. But I've sat in front of this committee several times with Fire Commissioner Bonignore and before her, Fire Commissioner Tucker, where we have said that the EMS system is in crisis, and unfortunately, we're still in crisis, and we are working to improve this.

So for the specifics of that day, I'll pass it to Chief. Okay, I just want to say, with all due respect, yes, you're saying it's in crisis, but you really are the only people who can solve the crisis. I mean, let's be clear, you've got a City Council that wants to raise the wages. You all are the only people, the administration is the only people that can actually solve this crisis.

And I just, I don't understand how we can like keep perpetuating this when people's lives are literally at risk. Thank you. So for that incident, that particular incident, there were— that was called. We did speak to the caller. We did triage that call. That call was classified as an injury, which is a Segment 5 category, and that is not considered a life-threatening emergency.

An ambulance was dispatched. Several ambulances actually were dispatched to respond to that call. But while en route to that call, they were preempted and redirected to life-threatening emergencies that they were the closest ambulance to while they were responding to that assignment. But when there's a firehouse next door, shouldn't there have been— I mean, I don't really understand where the breakdown in communication went in this situation where you've got 3 hours that this family is waiting.

So ambulances do not come out of firehouses. I understand that, but when you've got a situation where the ambulances are being rerouted, Couldn't there have been an on-the-spot calculation to just check on this young boy? So the fire engines are known as certified first responders, and there are certain call types that they respond to, and those are life-threatening emergencies like cardiac arrest, difficulty breathing, cardiacs with difficulty breathing.

They are not dispatched to injuries. Okay. So just— I will continue then with my questioning. So you said that you were holding 100 more— going back to Ms. Daley and her son Kevin and his issue. So you were holding more than 100 calls and it was put in as an unknown condition. How often are you holding more than 100 calls?

And how often do calls go into the system as unknown, especially when they are as critical As Kevin Daly's condition was? So I'll defer to Chief Warner to speak about how it's dispatched, why it was classified an unknown, and that process. But as far as how many calls, how many times that we're holding calls, that many calls, unfortunately that has risen over the last few years.

Our call volume is up, as Chief Esposito stated, and our headcount is down, which means that we have less ambulances on the street to respond To those calls. However, our life-threatening, our most serious calls, our segment 1 through 3 assignments— cardiac arrest, difficulty breathing, shortness of breath, cardiaques— those do not hold. Those calls are immediately dispatched out as soon as an ambulance is available.

Those are our most highest priority calls, and that is why the lower priority calls oftentimes, while ambulances are responding to lower priority calls, are redirected into higher priority calls because they are the closest ambulance. And we do not want to have a situation where somebody who is in cardiac arrest is not receiving an ambulance. So I'm going to turn over to Chief Werner to explain the call typing process and why it was designated as an unknown.

So this call was processed by the overflow position, so we did not triage it. So the person that's categorizing it giving it a call type is relying on the information that PD obtained and relying on the code that they made it. So this call was designated as a 54Q, which translates in the EMS code to an unknown condition.

And I would, I would understand that if it was just the school nurse that was calling or the boy's mom, but a trained FDNY, retired FDNY member called 911 and stated clearly what was happening. So what would a suspected stroke be, a segment 1, 3? What does that categorize as? Had this call been triaged, it would have been categorized as a priority 3.

Why wasn't it triaged? There were no call takers available at the time that this call came in. So you also have a low headcount for your EMS dispatchers as well? So when we discuss EMS headcount, we're talking about every EMS employee that we have in the service, and that includes members who ride on ambulances, it includes the members who are in emergency medical dispatch, it includes our instructors that are at training, it also includes, you know, our people who work in Office of Medical Affairs.

That includes Every single EMT, paramedic, lieutenant, and officer that we have. There is no specific headcount for EMD, for the field, for training. Our headcount is our headcount. Okay, so you're telling me that a segment 1, I'm going to expect a stroke to be a segment 1, and I'm assuming a broken bone for you? Okay, so segment 3, maybe?

segment too. But neither of them were responded to. At least that parent got a callback. Ms. Daly did not get a callback from EMS. This is why I had introduced Intro 990, which you testified to, Chief, that you're not— that you're open to further discussion, but you don't believe that likely volume notifications would result necessarily and provide useful information to New Yorkers.

I believe that if, if the Speaker's constituent's parents were aware that an ambulance was not coming right away, they would have chosen a different route earlier and called a private ambulance sooner. And also the dailies would have done the same thing. So that's why we have to do something so the public is aware, whether it's the bill, the intro as it stands, Or if we work towards an amendment, but the public needs to know whether or not help is coming.

And I think we should continue discussion. We just don't think that, that, that the NISM notification system is the correct way. Our concern is that the public might be confused or fearful and then not call an ambulance when they really need one. And in that situation, for those life-threatening calls, even if we're holding calls, they get an ambulance while the lower acuity calls— in the case of the child at Wagner Middle School, that is not a life-threatening segment 1, 2, or 3 call.

So that's why they got preempted, those ambulances were preempted and went to a life-threatening call. Correct. the parents knew ahead of time, they would not have waited as long as they did. And I don't know how long they waited, but certainly I'm sure the hospital— I mean, overall, it was an unacceptable wait time. I think the chair makes an excellent, you know, argument in this regard, is that families need to know if help is not coming.

Because if families knew help is not coming, and we're going to be honest with you that you're not going to get an ambulance, then they would make other arrangements if they could, either private ambulance or if someone is able to drive them to the hospital, but just letting them sit there waiting and becoming, you know, more fearful and anxious and stressed and angry.

Quite honestly, they're angry, and they have every right to be angry. We understand that, and we should work together to come up with a way to make sure that they are aware of that. I just— we just don't think that that NISIM alerting system is the correct way. It's the correct way to alert everyone for everything. So I don't know why it wouldn't pertain here.

But we are also open to discussion on it.

So how often are— how often and what are the number of EMS call takers that EMS call takers are available? So EMS call takers are scheduled in a staggered— they come, they report in a staggered manner throughout the day based on historical call call volume highs and lows. So at our peak time, we are staffed with the peak amount of call takers that we have.

In our off-peak times, we stagger, we work on staggering up and staggering down, but I will defer to Chief Werner for more clarification. Our baseline schedule is a 3 8.5-hour shifts around the clock, and then I stagger the 12-hour members. throughout the day into the evening when our call volume increases. Okay, so for lack of a better word, what, in your opinion, is the safe amount of calls to be on hold that the system can handle in the current staffing state?

Could you just repeat that one more time? Sorry. What do you believe is a safe amount of calls to be on hold in the system that can handle— that the system now can handle in its current staffing state? 200 calls? 100 calls? Like, if you get an average of 100 calls in a day, and I'm making that number up, and now you've got 200 calls that day, at what— what's the breaking point?

So I think it's— It's much more dynamic than it being so black and white to be able to just come out with a number, right? 38% of the calls that we receive every day are what we consider to be high acuity or life-threatening. So that means the other 62% calls that come in are not considered life-threatening or high priority.

So we do not want our life-threatening assignments to hold at all. And that is why the system is designed where if we are responding to a low acuity assignment and ambulance is redirected to a higher acuity assignment. So there is no number, right? There's no exact number that I could give you that would make any sense because it varies so much, not just day to day, but hour to hour and literally moment to moment.

Like I mentioned to the speaker, we had several ambulances responding to the constituent's injury, but they were redirected because someone else called and they were having what What is the average number of calls on hold? Again, it's not that I don't have it, it's just that it varies, literally varies from moment to moment. If we have high acuity calls coming in, they're not holding, right?

But if we have an enormous amount of high acuity calls coming in and at the same time low acuity calls, we need to ensure the high acuity life-threatening emergencies are responded to and we may need to hold someone who is called up because they have an illness or an injury that does not meet the life-threatening criteria. Okay, so, but Kevin Daly was a life-threatening call, and 4 calls were placed, and he went into unknown condition.

So how can we prevent an incident like that from happening in the future? So what you just stated was 100% correct, and we are not disputing that. So what Chief Werner, and again, Chief Werner, I'll defer to her to speak on it, but as soon as this came to our attention, we painstakingly went through every single line of the assignment, minute to minute to minute, all the calls that were made, all of the interactions between the police dispatchers and the EMS dispatchers, and then our radio dispatchers to see, was there a unit available?

Where were they responding from? And we are working on improving improving our communications between NYPD and EMS. Chief Werner? That's very accurate. We are looking to improve the communications between PD and EMS to make sure that we get vital information. I'm sorry, what was the second part of the question? How can we make it better? How can we ensure that incidents like this don't happen in the future?

Currently, I'm utilizing— I have offline members as well. Doing other functions such as QA and training. So during periods of high call volume, I am putting them offline and bringing them— taking them offline and bringing them to the call-taking floor to increase our capacity. So what is the current status of the supplemental tours via mutual aid? In your testimony, you said you're utilizing.

So how often are you utilizing? Only when needed, or are they available at all times? So we put a request out to all the volunteer agencies that operate in New York City, and they are volunteers. So they don't commit to us on certain dates and times, but when they are able to log in and put a unit into the system, we log them into the system and they help us.

We do have some volunteer agencies that are tremendous and are consistently running units, like our Central Park volunteers. We very consistently can count on Central Park volunteers to be in service and available and handling calls that occur within that Central Park area.

Okay, and in what circumstances can a hospital divert certain types of ambulance patients? So when a hospital requests a diversion, we send an EMS officer over to evaluate what is going on over at the hospital and the reason why they need to do it, and there are many reasons why a hospital can ask for a diversion. It could be a utilities or infrastructure issue such as power outage, computer, IT issues.

It could also be that there are certain types of monitoring that needs to be done on certain types of patients. So they could divert for cardiac patients because they have no more beds that have monitors. Perhaps they can divert for a stroke patient because their CAT scan is not working. So we work, as soon as a hospital advises us that they need to go on a diversion, we send an officer to evaluate what's going on and we speak with the administrator on duty.

We also involve our Office of Medical Affairs to determine how long that this diversion and whether it needs to be a complete and total diversion, or do we just need to divert certain areas or certain patients that we are taking to the hospital? Because maybe the general emergency room is open and operating, but L&D is having an issue.

So we would keep the hospital open for general emergency, but we wouldn't transport someone who is having a baby. Okay, and the speaker noted that there was an engine company right next door to the school. So in what circumstances are engine companies dispatched to a medical emergency? So our engine companies, the firefighters there are certified first responders with defibrillation capability.

They are assigned in Segment 1, 2, and 3 calls. All of our medical calls, when they hit the emergency medical dispatcher, get triaged and get a segment. So if it's a segment 1, 2, or 3, which we see as the life-threatening calls, that CFR engine, if available, will be assigned. In the case that the speaker was talking about, that was a segment 4 or 5, and the CFR engine is not— which cannot transport— is not assigned to those.

Okay. Has the FDNY ever explored the utility of having certain members of fire companies undergo training as EMTs and paramedics, those who did not come into the fire department through that pipeline? I guess in years past, there were things that the possibility was looked at. We've had thousands of our members over the last 25 or 30 years that that came from EMS that were either EMTs or paramedics.

But the way we look at it now is that the EMTs and paramedics are on, you know, are on the ambulances. Which is not optimal, right? We want ambulances to go to ambulance calls. So what is the process of getting an engine company back in service After responding to a medical call, and does the company have to wait until an ambulance arrives?

Yes. Once that CFR engine makes patient contact, they are required to wait for an ambulance. And we've had times where that engine, because it winds up being a lower acuity call, could wait an hour or 2 with the patient waiting for an ambulance. The engine is not able to transport And they are not able to leave the patient.

They cannot abandon that patient regardless of the level of illness or injury. And what happens if a fire call comes in while the engine company is at the scene of a medical call? That fire call would be handled by other fire companies. That fire company cannot leave. So what we're seeing is when a fire company fire engine has to respond, there's gaps for possible fires that are happening in their district, in the area that they cover, their catchment area.

Then they have to call in another fire engine company, and that leaves another gap. So you see what's happening here. It's just— it puts more people in danger, and it creates more of a public safety issue.

I just want to mention also we've been joined by Councilmembers Gal Brewer and Lincoln Ressler. I just have a couple more questions and then I will defer to Chair Narcisse. Just for those who don't understand, could you please explain the roles of personnel on ALS and BLS ambulances? So an ALS ambulance is advanced life support that's staffed by paramedics, and BLS ambulances are staffed by EMTs, which is— BLS stands for basic life support.

Okay. So paramedics, I'm sorry, so I'll expand a little more, right? Paramedics can provide advanced cardiac life support. They can provide medications that basic life support cannot. They can provide advanced airway maneuvers like endotracheal intubation to secure somebody's airway who's not breathing. So the paramedics are an advanced level of care that provide additional medications almost, We're an emergency room on wheels, right?

We we bring the emergency room to your home, to the scene that you call, or whether it's on the street, in your home, and and and our medics, our paramedics, and the paramedics that operate in the 911 system, whether FDNY or anyone who operates in the 911 system, they they are. I'm sorry, but it goes with the name.

We're New York City's best, right? And and when they come out. and they assess a situation and they acknowledge the fact that this is a life-threatening situation, they go to work. And they're— this is the only emergency agency whose primary goal, their only goal, is life. Yes. Right? And that is what they do every single day. And they put their own lives on the line to ensure that other people can reunite with their families, and go home and not just save lives, but bring lives into the world.

There's no better feeling than going from a cardiac arrest save to a couple hours later delivering a baby. Who gets to experience and do that in the same day? Only the members of New York City's EMS system. And that is what we— that is why we have to Do everything that you've stated up here, that you've stated in your opening testimony, that the Chief of Department has stated, that the Speaker has stated.

We have to take care of New York City's best. Yes, in many ways. And I will say it again, it begins with a living wage for EMS and paramedics, because then we will not have a retention problem. We will not have a nutrition problem, and they will be getting paid to compensate them for the job that they do because they are saving lives.

They don't even have— and most people don't know this— they don't even have uniformed first responder status. They're categorized as civilians. So we need to really sit and we will hear from the unions later. But I know that I've asked for FDNY to leave someone behind, and I know that the mayor's office is here, a representative, because that is an area where really, if we can fix that, we can then work on all the other problems, and we need to do that right away.

Does the fire department believe that 2 paramedics are needed for ALS, and if so, who's driving the ambulance? So 2 paramedics are needed to provide effective advanced life support care. In our training, right, we train as a team. We don't train as individuals. You know, as an RN, as a nurse, you know that prior to the delivery of medication, I don't just look at that medication.

My partner has to look at that medication, confirm I'm giving the correct medication, confirm the dose is correct, confirm the route is correct. Right, so that is why 2 people with the same level of care need to be in the back of an ambulance and treating patients with life-threatening emergencies. So in situations where both paramedics need to be in the back of an ambulance, a BLS ambulance does respond and they drive that vehicle, both vehicles, while the 2 paramedics are operating in the back.

Okay, and just to round out, would 1 EMT and 1 paramedic be able to provide the needed care? Does the FDNY believe that fire companies should stay on scene for non-acute calls? I'll take the first part of it. There are extreme situations where we have multiple patients on the scene and we need to split up. We need to divide and conquer.

We do duplicate the amount of equipment on an ambulance so 2 paramedics can handle 2 patients. And, you know, in those situations, or in a fire or a bad car accident, or even an incident maybe it's a carbon monoxide incident in a home where there's multiple patients who are unresponsive, we will divide both of those 2 paramedics up so they can operate.

But it is not optimal to operate as a sole paramedic in the back of an ambulance. But with staffing so low, I think that's something that you should do since it was done during COVID and it can be done. We are in a state of emergency right now with ambulances, and that's why we spoke about We had a meeting with the Mayor's Office about mutual aid, about bringing everybody off the desk and into the ambulances.

So in a state of emergency, I think that that might be something you'd want to look at. Chair, respectfully, I don't know who advised that we did that during COVID but we didn't. That was not a step that we took during COVID It may have been on our list of considerations, but it was not something that we transitioned to during COVID Okay, thank you for the clarification, Chief.

And to your question about the point of fire companies staying with the patient, we believe that when there's a patient that needs an ambulance, we have to stay with them to ensure that they don't get any worse. Thank you. I yield now to Chair Narcisse.

Thank you, Chair. I heard about the engine, like, that was next to where the school knocked So what are the steps someone can take, like, in a case of an emergency? Like, you can't— the engine cannot call and say, this is an emergency. Let's say if there's a rotation, they can call and say that there is an emergency here, one of us got to run with the child.

Is that possible? In that case where Engine 44 is, if they— because it's not a life-threatening call, The engine doesn't get assigned. If once we was to send them there, even to confirm, but then they would be tied to that scene, and they're not able to transport that. That child needed needed transportation to the hospital. The engine's not able to do that, right?

So so they would just be you know be waiting there, and that's why we reserve them for the serious life-threatening calls. So they can provide life-saving care until that ambulance gets there. There's not much that engine could have done for, you know, for that boy with the broken leg. Got it.

I'm in agreement with the chair. Retention is a problem. And when I spoke, I was at Garrison Beach, the fire department ceremony installment. And one of the things is just the pay. If the pay is not right, people are not going to stay. They're going to go to nursing. They're going to go do something else. And we have to look into that seriously.

And another thing, which I want to introduce a bill on that, it's calling 911. We are in the habit everywhere we go. Even police department people in the meeting will tell you, oh, emergency, call 911. We're not detailing anything, and that is a problem. And another problem that we're facing right now, it's folks losing their insurance and they end up in the emergency room, and they will call 911 because they know they can get in faster.

And as a nurse, I'm going to tell you, I know that for a fact. Some of them will tell you they have respiratory problem, just to get in an ambulance and to get to the hospital. All those culture we have to be in together. I hope people are hearing me. Stop calling 911 if you don't have to.

You can actually get in the hospital because sometimes the ambulance come waiting and by the time I do a triage, I realize that patient is not an emergency. There is no reason that patient should be calling 911. But how do you say that? You just have to be patient because they told people. if you have any problem.

The person have a chronic illness, emphysema, and they're still calling 911 even though they have medication. So that's a problem that we have to work on our own culture in the City of New York to try to decrease it. But retention is a must.

Now going to H&H. What are the current average emergency department wait times for H&H citywide? And How do we compare to the past 2 years? Thank you, Chair Narcisse. It's good to see you again, and I appreciate all you do for hospitals and helping us. The current median arrival time to seeing the first provider is 29 minutes in health and hospitals overall, which is an improvement from previous years of 33 minutes.

How long does it take on average for a patient to be transferred? From the emergency department to the inpatient hospital bed? So that's a great question. One of the measures we try to track is after the decision is made to admit the patient, how long it takes to get out of the emergency department to a bed upstairs.

To the bed? Right. And right now that time is on average about 270 minutes. 70? 270 minutes. 200. I was hoping for 70. We would all hope for 70. I'm just hopeful. What do you think is the problem? I think it's a complex situation. It depends on, you know, what the capacity of the facility is at the time of day, you know, what time of day it is, what resources are available.

It depends how many patients are coming in, how many are being admitted. Also, getting patients home is also a challenge sometimes, getting patients out the door. There's a lot of different variables that kind of contribute. I know there's a lot of different factors. Can you give me the top one? The top one? I don't have the top one in front of me.

I'm happy to get that back to you, but a combination of, you know, getting patients out of the hospital and getting patients upstairs all contribute to the overcrowding nature. Do wait times vary by hospital? If so, which hospital reports the highest and the lowest wait times? I don't have the wait times of all the hospitals in the city with us here today.

You know, I could say that— Not in the city, H&H, I'm always trying to get at least— I don't know if I have the H&H data, but I can get that for you. I could say that it depends on several factors. You know, time of day matters a big difference, right? Sometimes people people come in. Depends on whether a mass casualty incident occurs, as the chief had mentioned earlier.

It depends on the seasonality as well. You know, as flu season comes through, people get sicker with different illnesses. There's lots of different variables that contribute to it, and we try to staff to demand to meet those expectations. There's a lot of variables, but what I'm getting to, trying to, is to see what are the top ones and what's the plan to make it better, because right now we're in a crisis.

It is a real crisis for us. Which HNH hospital currently experiences the longest emergency department wait times, and what factors are driving those delays? I don't have the number of the longest in front of me, but I can say a certain facility like Lincoln sees about 37 patients per hour arriving at any given moment at its peak.

And so when, you know, a patient's arriving literally more than one every 2 minutes, it's a lot of volume coming in for them to manage, and we have to increase staffing and increase our resources to meet those needs. How are we doing with staffing in the ER? Because ER is important. If you don't get the patient to be seen, then they're not going to go anywhere.

I hope there's no shortage there. You know, we could always use more resources, but staffing is important, and it's variable. We have, you know, physicians, nurses, patient care techs. I'm only naming just a few of the needs of our emergency departments. As you know, we're a complex like a Formula One team. We all have different roles and responsibilities to address a patient in crisis.

And when a critically ill patient comes in, mass casualty, we have a lot of trauma centers. A trauma patient comes in, a whole lot of resources have to get consumed on that patient for quite some time sometimes to stabilize and save that person's life. H&H previously reported that provider in triage models reduced time to provider at Lincoln Hospital by approximately 20 minutes.

Have those improvements been sustained, and have similar models been implemented successfully at other facilities? Some of our facilities use a provider-in-triage model, and what that does is allow the physician or physician associate to see the patient sooner and start the care sooner. It doesn't necessarily always improve the throughput of the case there, and so we have to kind of vary and see what the value is of putting provider up front versus being there throughout the entire patient experience.

Where are patients awaiting transfer from the emergency department to inpatient bed typically held? I'm sorry, what was that question? Where the patient usually— where you keep the patient after you finish in the ER to transfer to go upstairs. I think that's a very facility-specific question and depends. Some facilities try to designate a separate space in the emergency Some use a scattered approach.

And so it's very facility dependent on how they manage those operations. Some is constrained by building construction and resource availability. And so I wouldn't be able to answer that question off the top of my cuff. How are we doing with the space-wise? Because one of the problems that we face in many ERs, that we don't have no space at all.

We end up putting a bunch of folks in the hallway and become more chaotic. Are we doing well in that setting? I mean, that's a hard question to answer, right? So ideally, we never put any patients in the hallway. Ideally, you would never have that need, but we will always see patients when they come in. We try to see them as soon as possible, and we'll use any available resource we have available for that, including hallway spaces and other areas.

Because that delays the process too, you know that, right? What was that? I said that delays the process when you have people overcrowded ER. Absolutely. It makes it more challenging. What impact do prolonged emergency department and inpatient bed wait times have on patient outcomes, quality of care, and hospital operations? I'm sorry, can you one more time, please?

I apologize. What impact do prolonged emergency department and inpatient bed wait times have on patients' outcomes, quality of care, and hospital operations? I've seen some mixed studies on that. I think overall we feel that the sooner the patient gets up to an inpatient bed, it's better for the patient. I think it's more humane and private and decent for them to be there, and the resources are better served.

And so we strive in our limited resource environment to do the best possible we can with the resources we have. The reason I've been asking all these questions, you know, I lived it. And one of the things, the patient get aggravated for staying in the ER, in the hallway for a long period of time. And that actually get them frustrated.

Thank you. And that when you stress, you know, your quality of care, the things that in your mind, the confidence that you have in, you know, the trust Everything just— it becomes a ripple effect. So I think we have to assess our emergency space as well. Absolutely. Patients might get the impression they're not being cared for, for example, but they are being cared for even in those situations.

We've seen episodes of violence increase in the emergency department. We've seen nurses attacked, physicians attacked, EMS attacked. People afraid because when you're in this environment where you're ill and you're not getting better and you're stressed and breached, it's very complicated and very challenging for them. Absolutely. And that's why sometimes they sign against the medical advice and they walk out.

How many, by example, if— how many of our patients actually get in the emergency room and did not finish getting care and sign against medical advice? Do you have that data? I don't have the AMA data with us, and I'm happy to get it for you. I know that our left without being seen data is around 2% in general.

How about 2%? Yes. What are the most common reasons people visit emergency rooms? Do you track them to assess the need to continue improving services? Yes, and every facility is going to have little differences, right, a little different nuances to what their patient population comes to. In general, patients come in for chest pain, come in for belly pain, come in for, you know, shortness of breath.

Under EMTALA, we take care of any patients that come in. Right. And so what an individual layperson might perceive to be an emergency, we're here to help them and figure out whether it is a true life-threatening emergency or not and try to care for them as best of our ability. Because we track it in the ER. We ask people why they come after the triage nurse finishes.

We have data that we enter in to say why that person is here. So that data should be easy to gain because the nurses have to tell you why, from the triage nurse, why that person was here specifically. What was the Yes, and each facility has slightly different chief complaints that are their priority. I don't have the data in front of me, but we can break it down for you if you'd like us to.

What are you assuring New Yorkers with mental health needs are being taken to the correct facilities instead of the emergency room? How can we streamline this process? That is a A complicated question I'm not sure I'm prepared to answer today. Health, you know, mental health crises are really important. I know that the 911 system is central to the Bee Herds operation that we're working with, and that we are continuing to work closely with both FDNY and NYPD to address any operational challenges for the mental health crisis system and improving call triage, working with agency partners to drive mental health calls to 988, as an example.

Other behavioral health services can reduce unnecessary strain on emergency resources to make sure that New Yorkers who are experiencing mental health crises receive the most appropriate response. So you doing some kind of education too as well for those patients? Let's say a patient come in and they have mental health, like it's not really an emergency to be in emergency room.

So do we use that opportunity? I used to, to tell the patient these are the information and kind of guide the patient through the next step. Yeah, we try to provide patients with Appropriate resources to help them get the care they need. Thank you. No problem. And you talk very kind of low volume. I apologize for that.

I want everybody to be able to hear the answer. Challenges that we have. Have H&H hospitals experienced an overall increase in emergency department volume? Or hospital admission in recent years? Yes. Let me just get the data, please. The overall emergency volume has been increasing since 2020. Our volume is— I apologize, I don't have the data. Our 2025 ED encounters were over 1 million patients.

What was that? Over 1 million emergency department patients across our facilities, 1.1 million in 2025. The biggest increase for us has also been in the higher acuity cases. So we try to rank our patients by severity index. You might be familiar with the ESI scoring, if you remember back in the day, the Emergency Service Index. And so 1 through 5, 1 tends to be a sicker patient, 5 tends to be a less sick patient, and our overall increase in the 1s and 2s have significantly increased over time.

Most of the questions Sure, no problem. Yeah. Most of the questions that I'm asking is just, I think it has to do with a lot of education. We have to educate people wherever we can get them and then to decrease for people to have a better understanding and to focus on preventive care. So you have a lot of clinics, different places that we can redirect people.

And I think engagement with the community— how involved are you in the community to help decrease those processes? Because wherever you can get people, you have to meet them where they are. And are we doing that in the hospital? That's absolutely true. As a practicing emergency physician, I spend a lot of my day with my patients just educating them about their disease, but also how to take care of the disease, how to find the right resources, how to get the care they need.

And where the most appropriate place for that care is. A lot of my day is spent connecting those dots and really just encouraging them to take good care and prevent this illness from occurring. I had a recent case where a woman was very ill from sepsis, and because she didn't understand how to get to the doctor in time to get the antibiotics in time to get the care, what resources were available, and she waited too long before she came to see me.

And it was very sad and very tragic. And so I think a large part of our care is connecting the dots of the resources, which are sometimes complicated and complex for patients to navigate. And we do the very best to try to provide those resources to our patients. Are you closing any clinics? I'm not aware. Outpatient clinics?

Do we have— are we— because if folks don't have insurances, I'm concerned that they will get, you know, toward the ER. So are we doing— because we're not talking about preventive care. This is Part of the plan of preventive care. Yeah, I mean, as Health+ Hospitals, our goal is to strive to help— Preventative is the best, right?

Absolutely. We strive to help every New Yorker regardless of means, ability, etc. And so our goal is to take care of anyone who comes for care. And I'm not aware of any clinics being closed. I can find out if that's the case or not. But we have, you know, in the ED example, financial counselors who enroll our patients in New York City Care to help get them preventive medicine, primary care.

We have a virtual Express Care is an example where we connect patients online through telephonic, through video calls to give them care on the spot. Within the last several years, have patient needs become more acute or complex, and has that affected emergency department throughout in the wait times? I would say over the course of my career, I've seen a lot of complexities of care.

The drugs are changing, the pathology is changing, our knowledge is changing, and And so all of it's becoming more difficult to navigate. Connecting patients to resources is always challenging. And I think the more options and the more needs will always make that more difficult. What are the primary operational challenges contributing to prolonged emergency department wait times? I'm coming back to that again.

Yeah, I know. Yeah, I mean, when you think about a patient who comes in the emergency department, there's so many needs they have. Right? So whether that patient needs laboratory assessment, whether they need radiographic assessment, whether they need medication administration, all those things take time. Time it takes to draw blood, send it to a lab, get results back.

All these things add up, and depending on the complexity, they keep multiplying, right? It's not just a 1+1 scenario. And you add that with the fact that, like, a facility that gets 37 patients an hour, trying to accommodate that many patients at once also makes it more complicated and complex. Have you thought about exploring having those clinics closer to the hospital where you see the emergencies coming all the time that don't need— because I know you have the data, you just have to go back to triage to see what's going on.

So if all the— like, let's say if it's mental, so maybe we can anticipate partnering or having a place where you're not putting it and then you can move people out of the emergency room a little faster. Absolutely. I mean, part of the issue is— You don't need transportation because we already have problems with transport, I mean, EMS, you know, to come and get those patients.

Yeah. So, I mean, part of it is we do have clinics in our facilities as well. But under the federal EMTALA laws, we have to do an emergency treatment and screening exam for all patients that present, right? And a lot of times in some of these lower acuity patients, by the time I'm done with my EMTALA screening exam, I can pretty much diagnose you and send you on the way.

And so simply diverting them to another clinic isn't always the right answer, but educating them on the opportunities available next time instead of presenting to the emergency department might give that option. And so, as I said before, a lot of my time is educating the public on what options do exist, how to search for help, how to ask for help, and what other resources might exist for healthcare besides the emergency department.

I'm going to ask one more question and I'm going to try to get it back to Chair because I have a lot of questions more that we— because today is about What can we do together that we can decrease the wait time in the ER and how fast our EMS can get to the patient? FDNY is helping us.

We're just looking for solutions to the problem we're facing, and that's the reason I'm going to come back for more questions. I'll ask you the last one and I'll come back again. What specific strategies is H&H pursuing to reduce overcrowding improve patient flow and shorten wait times? Yeah, so one of the strategies we have done and we've partnered with FDNY on is Virtual Express Care, as an example.

And so we will see patients virtually over phone or video. And so some 911 calls are being transferred to our Virtual Express Care calls and allowing us to treat on the spot right there and sometimes divert an ambulance from even being dispatched to that facility, to that person as well. So you have your mobile units, My understanding is just, let's say, if a patient— because one of the things that we lack of doing, telling the patient, open visit, in the clinics as well as in the hospital, do not call 911, this is the step you need to take.

And I think that's one of the bills I'm looking to see how shaping. We started already to see what can we do to help those folks. in terms of education, not pressure, because sometimes it's a simple education you give people, they can do better. If we keep reinforcing it, if we just say it and then you move on, people forget.

Maybe we can see, like, if we can get, you know, advertisement somewhere, a spot, something going on and using social media, educating people, because we need to educate people and reinforce it so at least we can decrease the flow of people. And then we don't want to lose lives in New York City. So I'm going to pass it on by my chair and then probably opening up for some colleagues' questions, and I'll come back.

Thank you. Thank you. Can I just say, Chair, thank you so much for that. I mean, the emergency department is the safety net of this country, right, and of the city. Yeah. And patients know they can always come to us, be seen. We will never turn you away. And that's why I love my job and I love doing the work that I do, is because we will always take care of patients who show up.

But the challenge is exactly what you discussed. And so I think there might be opportunity for us to discuss later Look forward to seeing that bill. Where can we decrease or redirect patients to find the most appropriate care they need? I really believe in preventative care, and that's what I've been preaching, and it seems like it's in slow motion right now.

And I need— we need to sit down and collaborate, whatever we can do here with my colleagues to structure it to help and make it happen. I look forward to the opportunity. Thank you.

Thank you, Chair. Yes, we will yield now to Councilmember Can I yield to, um, Palladino because she has to leave? Most certainly. Okay, thank you.

Good morning, everybody. Uh, first off, let me say this. We have fought very hard. for pay parity for the EMS workers. It was one of our top priorities for the fiscal budget of '27. We raised this issue repeatedly during the delegation meetings, formally submitted it as part of our budget priorities, and pleaded with the Finance Department to address the compensation disparity.

We warned that if EMS workers were not paid the wages that they deserve, the city would continue to lose experienced personnel to better-paying jobs, making it increasingly difficult to maintain adequate staffing and timely emergency responses. Unfortunately, we are now seeing the consequences of those concerns. EMS workers are being overwhelmed by call volume, and response times are increasing.

Thank you. This is not simply a workforce issue. It is a public safety issue. New Yorkers are calling 911. Should they not wonder whether or not an ambulance will arrive when they need it? Our EMS workers will— our EMS workers provide life-saving care every day, often under extraordinary demanding conditions. They deserve fair compensation. And the city must treat EMS staffing and pay parity as a public safety priority that they indeed are.

You know, we're listening to you guys get kind of crucified here at the whys and how comes and what fors. When you receive the amount of calls that you receive every single day and you do not have the amount of emergency vehicles that you need to respond, nor do you have the personnel That you need to respond to these calls.

Everybody's sitting here and wondering why, how come? Well, we need more people. We need to hire the people to do these jobs. They're moving on because their pay is not significant. The speaker came in and that's the first thing she rattled off, and she's 100% right.

I'd like to know, on an average, How many ambulance tours are out of service at any time? What are the reasons that the ambulance might be out of service? So in a 24-hour period, we're averaging over 90 ambulances off service per day, and that is overwhelmingly due to staffing. Staffing. Again, staffing. Not enough people to sit in the cars, in the emergency vehicles, and take them where they're needed.

So would you say that at least 85% of what you heard here today, had this budget been met to your needs and you were funded as you should have been funded, would you say some of these problems would not even be existing today? Because you would be able to get to point A to point B to point C in a timely fashion.

We believe that Solving the pay issue is the first step to getting everything back on track. 100%. So this $126 billion budget that this city passed, none of it went to you and what you guys actually need to do your jobs so that the people— that young kid at St. Francis Prep, and, uh, to the, to the speaker's point, the emergency that she faced Your ambulances would have been able to get there in a timely fashion had they been staffed properly and if these people were paid properly.

Is that correct? We could never make a guarantee, but we would not— we don't think we'd be holding calls as frequently as we are now.

So once again, I call upon New York City's Budget Committee and New York City's mayor, and I want to know why the funds are not appropriated as to where they should be appropriated to. You are— we are facing a public safety issue here, and you guys are on the front line, and you're sitting here at a dais today asking— being asked all these questions that basically can be fixed.

You know, there's problems, but there's solutions to every single problem that this city is facing. And all we need to do is put the money where the money belongs. Thank you very much. That's all I have to say.

Thank you. Councilmember Schulman, the gracious Councilmember Schulman. Thank you. Thank you very much.

First of all, I want to say that I am the only member of the City Council that used to work for the Emergency Medical Service on the leadership side. I know a lot of the people that are sitting here in the audience today. The issue of pay parity has been a longstanding issue. And I was there many, many years ago.

And I— so, you know, so I have some questions. One is, so, Chief, you said in your remarks that you're in the midst of a promotional cycle. That promotional cycle has so many EMTs in it because of the pay issue, and— or a large part of it is the pay issue. And I've heard this anecdotally from people on the street and who are working in EMS and everything.

So again, I'm going to reiterate what the speaker said, what the chair said, what all of my colleagues are going to say about that we have to get the pay up for EMTs and paramedics. So that's one. The other— so I have some questions as well. One is, when you talk about response time, is that still point-to-point, like when they get to the address or they get upstairs?

So response time is calculated from when the call is made to 911 until we get on the scene of the assignment. On the scene, so that's in the street. So I just want to point out to everybody that there's more— this response time is higher because you got to get up to the patient. So that doesn't include getting up to the patient.

So I just, I want to make that clear. So that extends it. That's number one. The other is that I want to ask you, I'm very close to the firehouse. By the way, EMS and fire does a spectacular job, and I actually participated in Community Day this past weekend, but the firefighters are telling me that they're responding to— in fact, when I was sitting there, they had to respond to an EMS call.

So my question is, how many EMS calls are routed to FDNY during any particular tour? Our fire companies routinely on doing about 1,000 CFR medical emergency runs each 24-hour period each day. So some, some companies might be doing 10 or 12 while other companies might only have 1 or 2. Does that depend what's in the queue? Like if there's a backlog, they'll go out or— They do not go out on the backlog.

It's simply if it's a segment 1, 2, or 3, and then that if that engine is available.

So I appreciate that. And the other thing too is that I want to mention, you know, the city is in a position now where we're building a lot of affordable housing and doing a lot of construction, everything else. So you're going to have a lot more people living in different places. And so I presume that the system will be inundated with more With more 911 calls because you're going to have more people living in all different parts of the city.

Are you planning for that separate from the problems that exist now? As I had mentioned earlier in my testimony about trying to use technology and AI to best tell us where we should move and put resources, it is something that we are looking at. And I'm also going to say, whatever you— and by the way, I've given funding for equipment for AFIDNY.

I've given money for equipment for UMass. So I just, you know, we're big supporters here. You got to let us know what you need so we can push, and the speaker and everybody is behind this. And I, like I said, I appreciate everything that you do, and let's figure out how to resolve this. Thank you. And thank you.

And we do thank the the council for— we know that you've supported us with driving simulators and conditions vehicles and response vehicles. So thank you very much. Thank you.

Now Councilmember Brooks Powers. Thank you, chairs, and thank you to the agencies represented today. At last month's hearing on the Rockaways, FDNY testified that EMS response times on the peninsula are below the citywide average, but response time stops the moment the ambulance arrives, as it was just indicated again. For a resident of the Rockaways or another isolated community, the clock that matters runs until they reach a hospital that they can receive treatment.

Can the FDNY provide these communities— excuse me, these committees with the full-time From the 911 call to the hospital arrival by council district? Right now, I cannot, but it is something that we will— I will look when we get back. We'll look for it and provide you what we have. I appreciate that. Queens saw the biggest drop of any borough this year in calls reached within 10 minutes.

Can you share why this is, especially with a And just a follow-up right before you answer that, is FDNY currently monitoring how often areas are affected by not having sufficient ambulance coverage, and does that lack of coverage contribute to delayed calls? So I'll do your first— your last question first. We actively monitor 24 hours a day call volume throughout the city and our CRCC, which is our Central Coordination Resource Center, that redeploys ambulances from one area of the city to another, areas that have a lower call volume and higher availability into areas that have a higher call volume and lower availability.

So we are constantly monitoring that and moving units around. You know, the NY in FDNY truly stands for An ambulance that starts its day in one part of a borough may end up in another part of a borough to assist and help anywhere that we have deficiencies in coverage. As far as call volume goes, we've already responded to 1.2 million calls this year, and over 480,000 of those calls have been of Segment 1 through 3 or life-threatening. opening emergency calls.

So our call volume remains high, and if you can just— I don't remember the whole question you asked first, sorry. The one right before that one was just talking about Queens as a borough seeing a drop, the biggest drop of any borough this year in calls reached within 10 minutes, I think it was said, but we wanted to understand better as to why, considering that there's been a decreased number of calls overall.

I don't think the call volume decrease has been substantial enough. Like I said, we are at the middle of October, towards the end of October, and we've already responded to 1.2 million calls, so I think we are right on on par with where we've been over the last few years. And my last question is in respect to the Chair's Bill 990, Intro 990, and the ambulance delays.

Right now, if your ambulance is delayed or your area does not have an ambulance immediately available, no one tells you that information. Are 911 callers told how soon they should expect help when a call is made? I know when I've called 911, I've been told that someone's on the way, but I don't recall ever being told necessarily like the window of time.

And this is what I think we can work on, because the person answering the phone that you're speaking to doesn't know the status of the ambulances or what's available or what part might not be available. That's on the dispatcher's part. So we should work together to figure out how we can share that information. So if there is not an ambulance coming soon, that they would know.

Thank you.

Thank you, Chairs. Councilmember Epstein.

Thank you, Chair. Thank you for all being here. So it sounds like there's consensus that we need to pay our EMSs more. It sounds like there's some opportunity to be working on that in the either this year through negotiations or next year in the budget. But I think we're trying to look at what's happening, the public-facing aspect of it, and we're trying to ensure the public has good, accurate information so they can be able to make informed choices about waiting a half hour or getting into a cab or making other choices about maybe not the high-priority emergencies.

What system— are all the EMS vehicles GPS-tracked? Yes. So there's the current system to monitor where those vehicles are and where they're going, right? Yes. And that's how we determine which, aside from acuity, whether it needs an ALS or a BLS ambulance, that's how we determine which ambulance is closest to respond to that call. And none of that is publicly facing, right?

None of that information's publicly facing. Meaning that someone can log in and see where ambulances are at any given time? Yeah, there's ambulances on the way. There's no way to know if that's actually true, right? No, currently not. There's no way for someone, if they call 911 back again, to be able to say, hey, how soon is an ambulance coming?

There's no way to do that, right? No. So you understand the concern that people have that, you know, my kid broke his leg and they're— we're waiting at the playground for the, the ambulance to come. And if it's gonna be an hour, I may make a different choice than sitting there for an hour with my kid who's in pain with a broken leg, right?

That's— I think we're all trying to solve this problem. I, I, I do. I appreciate everything that, that you're saying, and I, we, I think we appreciate what the, what, what the bill is, is intended to do. But, you know, in this situation, like the Speaker's constituent who called, right, we had ambulances responding. So we don't want— but a higher acuity call came in and they needed to be redirected.

So we don't want to tell somebody— You can tell them, hey, you know what, We had an ambulance, they were redirected. We're letting you know this ambulance is redirected and we're looking for another ambulance to send to you. So that, like, information— I know people are busy, but there's maybe some automation that can help in that. It's like we all have the technologies out there that we can do more publicly facing technology to help people with this information.

We agree and we will take a, take a look at that. We know that when they have the information that it might not be coming soon, that they might take alternate action. I appreciate that. And that saves the system in sending an hour later a vehicle that there's no one there waiting for anymore. I want to just turn to the H&H, if at all possible.

So I'm wondering— so we have the SHO program, which sends people out from H&H systems to locations. I'm wondering, has there been any conversations about expanding SHO to relieve some of the tension on some of these calls? I apologize, I'm not familiar with the SHO program. It's basically the homeless outreach and wellness program. And then we have SHO vans down by me that come from Bellevue and up in Harlem.

So it'd be great to know from H&H where you guys are thinking about SHO and expansion of SHO. Yeah, I would have to get back to you on that. Yeah, I really appreciate you getting back to me about that. And how about Bridge to Home? Like, you know, do you know about the Bridge to Home program? I'm not as familiar with that as well.

Okay, so the Bridge to Home program, which is another program operated at H&H, which I think you should become familiar with because this is an H&H program, creates beds inside of hospitals that provide ongoing care for people where they have a door and allows people who may be in and out of the system to have a stable place to be till they can get into a supportive housing unit.

So I'm wondering from HNA's perspective, what's the opportunities to expand on Bridge to Home, which may also reduce some of the call volumes we're talking about? Yeah, I will get back to you on that information. Yeah, I'd appreciate that too. And then I know we talk a lot about Be Heard and kind of the pathway to Be Heard.

I'm wondering how HNA is operationalizing the Once again, those are great details I don't have ready for you right now. I can get back to you on it, but I know we are partnering with 911, FDNY, and NYPD to expand that. Yeah, it'd be great to know more details about what that would look like and what that expansion looks like because I think we're trying to put relief valves on this system.

And if we can't, you know, short-term, we need to figure out what that is. And some of these programs can really be those relief valves that take the pressure off the 911 system. For people who have emergency needs but maybe don't need to call an ambulance, if there are other tools like the SHO-VAN, which is out in the neighborhood already, or other programs that might be available to help people who have acute needs to get some support that they need.

Yeah, I do want to redirect back to the Virtual Express Care, which we talked about earlier, about how we help with DNY by answering calls for them and providing care on the spot and also preventing an ambulance from being dispatched. to that call originally. Yeah, I appreciate that. All right, thank you, chairs.

Thank you. Councilmember Brewer and then Pierina Sanchez.

Hey, thank you very much. I have a couple questions. One is, um, I know you have addressed already a little bit— I don't know what you call them, uh, calls that are not emergencies, but people literally are sometimes just calling an ambulance to get to the hospital. So how— you heard earlier some suggestions maybe how to address that.

People don't read, they don't pay attention. It's not easy to address. But is it about what's the percentage of calls that maybe could be handled elsewhere? I think you have a pretty high number for that. So I'm just trying to think of how we can work on that together, 'cause I know people that do, they call the ambulance when really they don't need it.

Yeah, I think that there is, as stated earlier, there is a misconception of if I arrive by ambulance, I will be seen at the hospital. However, you know, as we've spoken multiple times today, there is a triage process. So it's not how you got there, it's why you're there, right? And, but I think the main thing is that someone who calls 911, I would believe, thinks they are having an emergency.

So I don't know if we want to discourage people from calling 911, but as stated, better educate on what an emergency, what are the signs of an emergency? of a heart attack? What are the signs of someone having an anaphylactic reaction, right? And I think if we educate and start young, start early and educating on what an emergency looks like, it will help us later on.

I also think that, you know, we do have some other things in place like discussed, right? We do have some telehealth stuff where we can, you know, transfer calls to a physician and speak to the physician, you know, without, sending an ambulance. But I think that that is new, relatively new, and it's generational. And I think that when people right now want medical care, they want to see someone in front of them, right?

And I think that as that becomes more normalized, it'll also assist us in being able to divert some of those calls to 911 to that type of care. Okay, I think we'd love to work with you on the education of that in our newsletters, in our forums, etc. Because I know people who I think abuse the system.

Number 2, I too go to the open firehouses, and we've allocated funding for some of them. They want a firehouse and ambulance support in Hudson Yards. Have you heard any discussion about this at all? Hudson Yards? We're not— I mean, maybe it's more on the fire than the ambulance, but it's a feeling of not enough support there.

We did look at that when they opened Hudson Yards, and when they first opened, we did put a rapid response vehicle staffed in there. And at the time, and that's obviously going back a bunch of years, the call volume didn't seem to warrant it. But we'll take a look at the response times over there and see what the need is on both Fire and medical.

Okay.

The other question, which is not— how do the sirens play a role? I am swamped with people who hate the sirens. Swamped. And so I know you're trying to get through traffic, etc., but between the rumbler, the siren, etc., do you have some— we have bills on this topic. I live between 2 hospitals. My community lives between 2 hospitals.

It's a constant complaint. 3 o'clock in the morning, I don't know what kind of traffic you're going through. So is that something that comes up? Is there a reason to keep the sirens? Does it help with response time? We are required, especially as you go through intersections against a red light or a stop sign, we're required when there's traffic to use the sirens to make sure everybody is alerted to that.

Okay, but there are different kinds of sirens. Yes, there are. We have on our ambulances— our ambulances acknowledge or are in accordance with the decibel maximum, but we don't run all the only ambulances in the city. No, I understand. I'm just talking about your ambulances because I know that's what we're talking about. But it's, you know, it is loud.

They are all equipped with the rumblers so that you can feel that even at times when you don't hear it. Okay. I'm letting you know that the 311 calls are not able to be taken about sirens. We're trying to change that. But in addition, I can say that it's a big quality of life issue.

And then just finally, I think my question is just generally, what is it that you— I mean, is it all combination of the challenges? It's the pay, it's the lack of ambulances, I assume it's traffic also. What is the combination, just in sort of like the elevator pitch, as to what needs to be addressed on this? Because it is really making people in the communities frightened and scared.

It is, it is the staffing issue, is in my opinion the overwhelming, uh, the, the, the biggest issue. We, we have to make sure to make EMS a career, right? That people go there for a career, not that just go in there till they're waiting to do something else, waiting to go to fire, waiting to go to sanitation, waiting to get another job.

And, and we believe, and, and the commissioner strongly believes, that if we address the pay issue, we will have people that come here for a career and stay. And, you know, the— there's a big difference between getting somebody that has taken a training class and has a little bit of experience to somebody that's been doing this for 10 or 12 or 15 years, right?

They— a very experienced paramedic or EMT, just by looking at you and getting you to say a couple of words, has a very good chance of properly diagnosing you. And that takes years of experience to get that. And that is what our goal is.

All right, we all agree with that one. Thank you very much. All right. Thank you.

Thank you, Madam Chair, and good morning. First and foremost, thank you for everything that you do, for the work that your members do. So I want to start with 2 experiences from my community. 2 weeks ago, my 90-year-old neighbor fell and struck his head. NYPD officers arrived on the scene, I want to say within 5 minutes. applied pressure to his wound, cared for him for those 25 minutes remaining that it took for an ambulance to arrive.

And then officers in my local precincts, the 46th, the 50th, the 52nd, they tell me how frequently patrol cars are being pulled away from their— from other duties to respond to even nonviolent medical emergencies. And then, of course, I think everyone saw in the news when ICE shot a New Yorker in my community a week, a little over a week ago.

It was an NYPD officer who transported that father to the hospital. And I do want to say I consider that officer a hero. But I think the question here is that while a life saved is a life saved, these experiences are not what New Yorkers should be seeing across the city with NYPD responding to medical emergencies instead. trained professionals.

So my questions are, how frequently is NYPD arriving before EMS at a medical emergency? Is it always 100% overlap that NYPD is responding to these emergencies nowadays given the shortages? How often are police officers transporting patients to hospitals because an ambulance isn't available? And if you don't know that, then period, how often is NYPD transporting folks to a hospital?

And I'll stop there. Thank you. What about the PD? So we don't record when the PD arrives before us. In my experience, most of the time, the great majority of the time, either a fire engine or the ambulance arrives at the scene first. There are times, obviously, that the police department will be there, such as that shooting.

We had units responding. That, that was obviously a shooting. It's a priority for us, and we, you know, got there pretty quick. The patient was already gone. So we know anecdotally that there are times when the NYPD transports patients. Because we didn't have hands on the patient, we don't have— we don't see that. We don't have a report of that.

You have numbers? We know, we know that talk— with talking with the police department, they record that. In their reports, and they were not able to pull it quick enough for us for this hearing to get it from us. But we do know that it happens. Thank you. And let the record reflect that the chair— thank you, Madam Chair— and I did request this information yesterday morning, understanding that's not a whole lot of time, but we really do want to make sure we have that information to have a complete picture.

And then the second question, I probably won't have time for more, but just in terms of the quality of care that happens. So if a police officer's— we know they have basic emergency medical training, but they're not trained and equipped in the same level as EMTs and paramedics. Is that correct? And that is part of the issue, right?

We don't know what training they have or what care is being given. And I'll pass it to Chief Miano. So I do want to say that NYPD does routinely respond to EMS calls and It is sometimes based on why we're being called. If there is a fight or if it's due to a motor vehicle accident, these are things that NYPD has to respond to.

They don't respond in place of us, but we are one emergency response service, whether it's fire, EMS, MPD, and we respond together. And oftentimes NYPD is responding more for us. Right, to make sure that we're okay, to make sure that our members are safe while operating in an environment. Thank you, Chief. I understand that, and thank you, Google also told me as much, but a 90-year-old man, senior, you know, who falls down 2 steps, hits his head, there is no threat to EMS there.

And so, you know, as a layperson, I'm understanding that NYPD is responding because they know that EMS will be delayed. And so I think there's a very big question there to be answered. Please, you know, NYPD and yourselves, please follow up with us. What is the training that they have, and what is the training that they don't?

And I just want to be respectful of time. I can send these in writing and continue the conversations with you all, because my questions here are founded in a deep respect, appreciation, and even love for what our EMS are doing on the ground. You know, I think everybody's repeating that we need to solve this problem. But I guess I'll just close with how does this make EMS workers themselves feel?

How do paramedics feel knowing that NYPD does not have the training that they do, that others do not have the training that they do, but they are nonetheless being dispatched while EMS workers are so undervalued in our city? Sorry. I know that our EMTs and paramedics, I believe, are the best trained and best experienced that we have in this country.

They get out there and they do their jobs and they are very, very good at it. I think that competitive spirit and that can-do spirit that we all have in the fire department is you want to be the one that goes there and does your job. You don't want anybody else doing your job. you want to get there and, and provide that help and save that life.

And that, that's, that's, I think, what makes our people as good as they are. Sorry, I don't believe that we believe that PD is responding in, in place of us. I believe that we all feel that we complement each other, right? Where if, if someone who has basic training, whether it's CFR or NYPD, can start care prior to our arrival, that's just an additional link in the chain of survival that the city's able to provide.

And that's why we do drills and we do joint training with NYPD, with the fire department, with EMS. That's why we work together because when the city is in crisis, those 3 agencies, well, 2 agencies are the ones that are stepping up and we need to be able to work in harmony with each other and understand everyone's limitations and also what we bring to the table.

Thank you, Chiefs. Thank you, Chair. Thank you.

With— and it will be clarification for me with Councilmember Sanchez's question. So When is the EMS CAD dispatch log created, and is that done in conjunction with the NYPD? Is that when, when you're communicating with another agency? It's done as soon as the incident enters the 911 system, and that starts with PD. Okay, which would be maybe why the NYPD has access to that, right?

Right, they get the information first. Okay, so I just want to go now go back to the unknown, because I think that Ms. Daly deserves a few more answers for her son. So why is an unknown condition a low priority, and why wouldn't it be considered a high priority? Because they have not been triaged, so they don't know what the illness could be, and it could be a cardiac arrest.

So we have a computer-aided triage system, right, which as callers give information to questions that are asked. We enter that information into the system, and Chief Werner can expand on this, but that's what determines the call type. It is not the individual dispatcher making a decision. It is a computer-aided dispatch triage system. That information received is placed into it, and it leads you down the road to be able to determine what the call type is.

If we don't have the information, we don't have that to enter in in order to be able to classify it differently. The unknown condition is a priority 4, so I'd like just to add that that is the highest priority of the low acuity types. Of the low acuity? Correct. But in Kevin Daly's condition, it was a high acuity.

I understand. And our dispatchers are also EMTs. So that also comes into the low staffing. Because if you're low staffed in general, then we're going to be low staffed with our dispatchers as well. You have 4,500 personnel, would you say? You said earlier, was it, or in your testimony? The budgeted amount is 4,500. We're below 4,100, 464. spots below budgeted headcount is our actual staffing.

So I know that, that you're taking steps to increase that headcount. Could you explain what you're doing? So we are trying to recruit. Recruitment in EMS across the country since COVID-19 has been challenging. We continue to do classes. We have 163 EMT trainees currently at our EMS Academy at Fort Totten. We have another 150 or so in our paramedic classes out there as well.

And so even though they're included in that headcount, then that's, you know, below that we actually have out in the field and trained in EMD and in the field working. So continuing to have tests and recruit and try to fill our classes. So if 4,500 is your optimum and 4,100 is what you have now, do you think that even if you were at 4,500, that that would be enough EMTs and paramedics to be in ambulances to service a city of over 1.5 million people?

That would be a great start, and that would be a good problem to have and a question to answer at that time. Okay, so I want to go back to you, Chief Warner. Step by step, what happens when no EMS caller is available and a call comes in and it's taken? PD will release the call to our overflow position, which we refer to as relay.

It will come with a code, and there's a call taker seated there that manages that work, and they will put the job into the system, the incident into the system based on the Okay, and if the call taker is unavailable? At the time that this incident occurred? At any time, if a call taker is not available. Anytime there is not a call taker available, correct, it goes to the overflow position.

Goes to the overflow and then it goes to low acuity, right? Number 5? Not always. Or highest of low acuity? It could be higher. No, it could be a higher acuity. It depends on— PD interviews the caller first. They get the address, the borough, and they ask, what's the emergency? And that information is transcribed into what they categorize their code as.

Some of them are pretty broad. There could be multiple things occurring that it would take that type of code. They need that code to enter the system. They need that code to enter it to us. And then we take that code and we have a list of what each code represents, and that's how we acquire the unknown call type.

And how long does it usually take for an unknown to get properly categorized? As soon as it hits their terminal, they can have it categorized within 30 seconds. It's not— Right, but we may not have an ambulance to respond. Well, once we enter it into the system from the call-taking perspective, then it gets sent immediately to a dispatcher.

Right.

We spoke earlier, Chair Narcisse was talking about once the ambulance gets to the hospital, and I know that there was a pilot program for EMTs to be at the hospital so this way the ambulance didn't have to remain, they could hand off to a medical professional. I don't know if that pilot program is still in existence and has it been replaced by something?

So we ceased that pilot program back at the end of May. That was called the Hospital Liaison Unit and what that did was it had an officer and an EMT in 13 hospitals throughout the city and when a low acuity call was transported to the hospital, if they met that criteria of being low acuity, then they would take over the patient's care report and provide triage to the nurse, allowing that ambulance to return back to service.

While we did see a small decrease in hospital turnaround time, the greater impact on the system was not seen. And we felt that it would be more valuable to reduce response times by having those members back on ambulances to respond to calls. So we did cease that program. However, in times of mass casualty incidents or large volumes of patients being transported to a hospital, we will activate an officer to respond to the hospital as a liaison to be able to better assist through that triage process with the hospital.

And since you are in contact with the hospitals, have you had productive conversation with them regarding handoff, EMTs getting back on the street, whether or not they would not accept a patient for a certain mental illness. And have you had conversations with the hospitals within the H&H system? Yeah, and it's not just specific to H&H, it's with all hospitals, right?

All of our— we have borough commanders, and within the boroughs we have divisions. Those chiefs routinely with our— with the designated Office of Medical Affairs physician that oversees that borough or that division routinely meets with hospitals to discuss statistics, metrics, and work on improving, setting goals, and improving on any areas that we can. Okay, and I know you looked, took a deep dive into Kevin Daly's particular situation.

Was it Was it ever categorized as a high priority? No, it remained, it remained an unknown, and I think that as we did that deep dive through, Chief Werner and her team identified some areas that we can strengthen our communications with NYPD, and she is currently working with NYPD productively to be able to close those gaps.

I just want to ask— just talk about the comptroller's report, and then I'm going to yield to you, Chair. So the comptroller, as we know, came out with a report, and he said in spring of 2026, FDNY shifted its target number of ambulance tours per day from 488 to 332, which is a 32% reduction. Why did it happen?

Where were TORs removed and will this impact response times and quality of patient care? So those 2 numbers are actually 2 separate numbers that are incorrectly being compared. The larger number, the over 400 number, is our physical ambulances. That's the amount of vehicles that we actually have, right, and then our TORs and our units are the ones that are in service that are operating.

So we have a TOR count And our tour count that we want to meet every single day is 640. But we don't run all 640 at one time. We run in 12-hour periods. We run 328 during the day, and then on the evening period, we run 312. So when those 2 numbers are looked at, there's an excess of ambulances, right?

We have 400, and then we have the 300 number, and those extra ambulances are the ambulances that we have that are the physical vehicles that are spread throughout the city at stations in case we have a mechanical issue. We're able to move the unit into one of those spare vehicles.

Okay, I will yield to Chair Marcia. Thank you, Chair. I have a— can An engine RMA a patient to clear the ambulances, which is refuse medical attention. Can you do that for those that don't understand? Right. So RMA refuses medical care when somebody calls an ambulance and then that patient, we arrive and that patient does not want to be treated.

That's a procedure we call an RMA. Currently, only emergency medical technicians and paramedics can do that. So the firefighters on the CFR engine cannot do that. Okay. Because I think for safety, you don't want to IMA someone and then the person need emergency and they're not assessed properly. That's what my assumption is. Is that correct? Under our normal general guidelines, The firefighters that are certified first responders are not tasked with that.

Okay. Should everyone be calling their ambulance of choice? Can they do that? Should they be calling the private or the volunteers or the volunteer hospital? What's your— So if they're— I'm sorry. So volunteer agencies do have ambulances in their communities, right? They're first and foremost, that's their job is to staff their ambulance within their community. And if someone wants to call their community volunteers directly, they absolutely can do that.

Well, when you call 911, you get the closest ambulance in the 911 system to where the location is for the illness or injury. We don't determine whether it's a municipal or a voluntary hospital ambulance. When we dispatch, we dispatch the closest appropriate ambulance to the location where the injured or ill person is. Okay. So I was trying to see if we can decrease the amount.

Can you decrease the amount of folks running, you know, in one space and you kind of like, you know, difficult moment for you, you don't have enough. And then if those volunteer ambulances, like I have Flatland, We have Hatzolah. So would you encourage that to happen in a case that, let's say, you have question, it's not really emergency, emergency, or even for emergencies?

Yeah, so I think, again, if someone has— they're volunteers, right? And I don't know if we can guarantee that a volunteer is always going to be in service, but we can guarantee that if you call 911, we have ambulances in service. Clear. You've made it clear, crystal clear.

Later on, I'm going to ask some of the actual workers because I want to find out what kind of incentive we can create. And you can tell me what kind of incentive we can create. Yes, we want the pay raise. We want that because people have to pay the bill. We understand that. New York City is very, very expensive to live in New York City.

We all know that. And we want our workers What kind of incentive in your mind that we can create, even coming from our side, to make sure we're keeping our EMS workers in place in New York City? So I'm sorry, are we talking outside of pay? Yes. Okay, so outside of pay, which I think pay is first and foremost, right?

But outside of pay, I think the members who are sitting behind me and the members who are on ambulances right now, I think that they deserve respect. They deserve to be acknowledged. They deserve to be understood that when everybody else is having— is calling for us because they need us, we're the ones that are coming. No matter who it is, no matter where it is, no matter the circumstances, no matter the challenge to our own safety, we— they— the members that wear the EMT and the paramedic patch in the City of New York, are truly the most selfless people that you'll ever meet.

And I think that it's time that they get the same acknowledgement that every other emergency agency gets as well. I'm going to say that we have the holiday season coming up. And last year, for the first time, through the— with the work of the unions, along with the former Councilmember Brennan, Thanksgiving dinners were provided to every single EMS station throughout the city.

I can't tell you how much of an impact that had on the membership's morale to be able to actually have turkey on Thanksgiving instead of fast food. We don't get the opportunity to sit inside the EMS station and have a dinner, but to be able to grab a holiday-appropriate meal and eat it all on your lap while driving as fast as you can to somebody's emergency, Just knowing that somebody thought about them was tremendous.

And, and I would just ask council if we can duplicate that again this year, if someone can help work with our unions and work with us and provide our members with those small little quality of life changes that make them feel as important as everyone else. So appreciative of that. I mean, you can consider it done because I know Speaker Menin and my colleagues, Ayola, we're going to make sure we make it happen.

And even if we have— I'm going to commit her money too. Even if we have to do it out of our pocket, we're going to have to do it. Thank you. So yes, that's a little because I want more. I have to acknowledge my colleague De La Rosa that's with us. So that's little, but anything else, you can imagine that you think that we can do beside that, because I'm ready.

I'm already— you can count on me in because I love to feed people. I love to take care of people, you know, coming from being a nurse. So I'm in. There's a commitment, probably your pocket, your private money, or the city. I don't know which way we're gonna go to make sure we make sure— I, I didn't mean turkey, it was filet mignon and lobster.

I'm gonna do everything that we can do because that's the least we can do. I think you're the best, guys. Thank you. And, and I have to say that, you know, just hearing the passion from the council and, and seeing how much that, that the service matters, it means a lot, right? I'm more than willing, along with, along with the Chief of Department, the Chief of, of Emergency Medical Dispatch, to sit up here and answer your hard questions because we're trying to solve a problem that's going to make the emergency medical service better.

And I, and I know all of you Right? Um, Station 58 is on East 83rd and, and, uh, and Flatlands, right? We would welcome you with open arms anytime. Amen. Just come by, come by, say hello. They don't know I'm telling you this, but they'll be prepared for you, right? Amen. And, and I think that's what we need.

I think we need more acknowledgement. I think we need more thanks. And, and this committee does that, but I think it needs to be done on a broader level. citywide. Absolutely. You can— we are committed. I committed her without her knowledge already. That's how I know that she's not going to say no to that. This is the least that we can do.

At the 2024 hearing, FDNY testified that it was assigning hospital liaison officers, which is HLOS. Yes. Along with 2 EMS to 9 of the busiest New York City health and hospital emergency departments to facilitate patients' handoff and reduce ambulance turnaround times. Can you provide an update on the implementation and results of the initiative? Has FDNY measured any changes in ambulance turnaround times, unit Availability, response times, or other operational metrics.

Which hospitals currently participate, and are there plans to expand, modify, or make the programs permanent? I know you started talking about it earlier, but just give me more detail. So we did start initially with that amount of hospitals. We did expand out to 13, but like I said, while it did have a small impact on the reduction of time inside the hospital, The overall greater impact on response time was not seen.

So we reallocated those members back to the field because we felt like the greatest way to impact response time was to have more ambulances available on the street. I understand. The reason I'm asking you over is because I want to know what can we do right now? You used a pilot program, you repeat it for me. Now what can we do to actually decrease it in the emergency room?

with the staff in the hospital? You have seen the program, you did the pilot, it did not work, but I believe that you have learned from it, and what can we do? Yeah, I think that, you know, what's really important is the continued communication between, like I said, the borough, the division, and the Office of Medical Affairs with the individual hospitals to work on tweaking triage systems to be able to expedite patients, you know, off of stretchers and off-of-hour stretchers and onto hospital stretchers.

But each individual hospital is dynamic. So each one has to be individually studied, spoken about, and then different things have to be implemented in each hospital. All right. So have you started the conversation knowing that the pilot program did not work, but we got to do something to decrease the amount of time that they spend at the triage.

So have you heard any positive feedback or whatever the feedback that you had received? Yeah, again, these conversations are happening monthly, in some locations quarterly, right? They are happening and ongoing. The increase in time after the HLU was ceased, we only saw an increase of about 2 minutes. So we are You know, this is citywide, right? This is citywide.

But I'm focused on H&H because it is citywide. Right. So we have a great partnership with H&H. And like I said, we are continuously working together to improve. Okay. Can you walk us through the patient handoff process from start to finish? Once an EMS crew arrives at the hospital, what responsibilities does the hospital liaison officer, Oh, now you don't have that, so we're going to have to walk back there.

So you already give me that part. See, since we don't have that, I will not be able. But there's no plan to return with that because it's only two minutes at the moment. There is not. No. Mount Sinai, Mount Sinai, right? Beth they close. How has the closure of Mount Sinai and Beth Israel in April 2025 affected patient volume?

Hospital capacity in emergency department wait times across the H&H system? Yeah, that's really hard to measure, right, because you have to try to figure out where the patient originated from, where they ended up to. We could say that overall Bellevue has seen a moderate increase in ED visits, which may or may not be related to that closure.

It's not possible to track the exact cause of that. We do know that Bellevue's turnaround time at the city is below the city's average of other hospitals in getting ambulances back on the streets.

Okay. For some of the answers that— I think we share some of the questions. I thought I was going to get more answers from you. But New York City Care. At a previous hearing, H&E stated that it does not collect data regarding New York CityCare. Do you know about New York CityCare? Can you answer some of my questions?

I think I did before, but I can provide some more feedback if you'd like. Okay. I'll try to ask. If you don't know it, you don't have the answer, we'll go back. At a previous hearing, HHS stated that it does not collect data regarding New York CityCare's effect on emergency department utilization. Has HHS since developed metrics to measure Whether New York City Care is reducing avoidable emergency room visits?

At this point, we do not, unfortunately, have the data on that. I know that we are involved with financial counselors getting patients enrolled in New York City Care for preventive care, primary care, and virtual express care. But at this point in time, we don't have data to see how it's decreased emergency department visits. Okay. How many New Yorkers are currently enrolled in New York City Care, and how does that compare with enrollment levels That is a great question.

I unfortunately don't have that data for me, but I'll get it to you. So should I stop on that? Yes. And then we can send you the questions? Absolutely. Thank you. Okay. Fair enough.

Because this is a fun thing, because we're supposed to talk to each other and to know exactly where we're going, how can we help. And I mean, I met people, they say that when they come here, Chair, we ask a lot of tough questions. It's not about us. It's about what can we do together. I hope that— because I heard it from everyone too.

But it's not for that. It's just making sure that we have to be responsible for New Yorkers and we're all in it together. We just have to get through it.

HNH previously reported serving approximately 33,000 unique patients across 55,000 psychiatric emergency services and comprehensive psychiatric emergency programs. How have those figures changed over the past 2 years? So those numbers have increased slightly. So in 2025, we treated 33,400 unique patients, of which 56,600 visits were in our 3 psychiatric emergency services, our 8 adult and child CPAP psychiatric comprehensive psychiatric emergency programs.

So it went from 33,000 to 33,400 and 55,000 visits to 56,600 visits. Uh-huh. Emergency Department Leads, or ED Leads, is an H&H program that places licensed clinicians and peer counselors in emergency departments to identify patients at risk for substance use disorders and connect them to treatment and support services at H&H. Reported over 22,500 in the ED LEADS encounters in 2023.

What are the most recent numbers and what outcomes has been— I mean, have been achieved? Yeah, the LEADS program is a great program. One of the hardest things we deal with in the emergency department is substance use. You have a soft voice, you know that, right? But I want people that Watching us and people in the back to hear.

I, as I guess an emergency doctor, I don't get too excited and I try to maintain my calm. Um, the LEADS program is a great program. It really helps get people plugged into substance abuse care. It's one of the hardest things we deal with in the emergency department. So as you said, in 2023 we had 22,500 encounters.

In 2025, that encounter rate was 30,400. What is it? 30,400 in 2025. There were over 6,500 referrals to outpatient clinics. And over 3,600 naloxone kits distributed.

Oh, by the way, I want to talk about, follow up with my colleagues earlier about Bridge to Home. It's a great program and it's Dr. Katz's baby and my baby too, because the minute he called me, I was so excited. Because when you discharge patients with mental illness and sending them back to the streets, and that's what we— a lot of people are on our streets, and I'm seeing people with gowns, I'm seeing people talking to themselves and just coming out of the hospital.

So Bridge to Home is a baby to Dr. Katz, and I love that baby as well. Supportive housing and show other places that my colleagues was trying to tell you, those are the places that we should push more so we have less folks with mental health in our train station, in different places. We want them to be not in the emergency room.

We have freaking flyers when I used to be in the ER. We know certain people just come because of whatever mentally going on, or maybe they need to be warm, or sometimes they need a little cool of AC. So whatever that we can do to triage those folks, not even the triage nurse. No, no. Because they have freaking flyers.

And they don't have anything. By the time we come and assess them, we can see that— we can ask them the question, what's the problem? And sometimes they be kind of like very honest to the nurses. We can come back and ask them and they don't have to bed in. So I think I'm going to sign off.

Chair, I think I want to hear from the EMS workers themselves. And I have 2 things that we're supposed to do for them. And we'll talk about it, but any more questions, you can continue with your questions.

I'm going to take a break.

Okay. So what are the specific gaps being addressed with NYPD and FDNY dispatch communications? Better methods for sending and receiving messages. And I'd like to ask for a translation. transcript of all the calls related to Kevin Daly. I'd like that to be sent to committee counsel. He'll be reaching out for that.

I'm going to switch gears for something that I believe causes response times to go up, and that are— that's street closures. Ambulance companies and fire companies are reporting instances where emergency responses are impacted by street closures. We've had discussions about specific streets, specific stations where complaints have been received. However, there's currently a street redesign on Cortelyou Road in Brooklyn.

The administration has stated that the local firehouse, which the DOT is required to get input from on that project, had many objections to the project that would affect the emergency response and public safety and their response times. Our office alerted you, but DOT is moving along with the project as originally presented. When was the last time you brought these objections to DOT's attention, and have you asked why they're continuing to move forward with this particular project, even though the safety of the people in the area would be at risk?

So in accordance with city regulation, that the— Local Law 6. Local Law 6, we did reach out to the local fire company. We did get their feedback and comments. That was provided to Department of Transportation. They are aware of our concerns, but as you know, we don't have veto power on that. You do through Local Law 6.

You do. We? It has to be approved by the local firehouse. And I— that was a bill I passed. So they need input. Input should be adhered to because the input says We will not be able to traverse this street if it is reconfigured, whether closed or bike lane or any type of reconfiguration of a street. It will impede our ability to get to a fire or any other public safety issue quickly and efficiently, and will impede our response times and impede our ability.

We see it all the time where big rigs, big fire rigs, are unable to make a turn because there's a street closure, or they have— they have their— have to put the ladder across the street because one side of the street is closed. So that's what Local Law 6 was all about. So this was a specific issue where the input from the firehouse at Cortelyou Street said, We cannot do our job as effectively if this street configuration is changed.

So Local Law 6 is still in effect. It's not— I know that it's— the mayor's looking to reverse that with a referendum, but as of right now, the FDMY can push back with DOT. We make our concerns known. We share that information from the firehouse. with DOT, and, you know, DOT proceeds. Have you spoken to the local councilperson in that area?

I have not. Perhaps I'll have that conversation.

Thank you. At the 2024 hearing, FDNY testified that it was working to educate New Yorkers about urgent care and other non-emergency options. This included use— I mean, included using PSAs on when to dial 911. Is this being expended? Did it work? Did you try it? Because we've been talking and I forgot to ask that one. We have not instituted that as of yet.

All right. But that's one of the things that, as you can— you know, you've been hearing about me, how we can do things. things better, and that's what I wanted to collaborate with. So let's work on this. I think that would be very helpful. We've had it, you know— In the permission of the chair, because she's the chair, so I still have to— yeah.

No, I'm just bothering you. Yeah, we can work it out. Yeah. Um, thank you on that one.

Um, one of the things, I don't know if I forget— forgive me if I— I don't know if the chair had asked that. How many 911 did your crews determine on the scene did not need emergency care or an ambulance transport? Do you track that number? We have the number of ambulance transports. No, my question is, did you— I mean, on the scene, that they don't need the emergency at this point?

So when we arrive at the scene, we don't tell someone they don't need emergency care. If they want to be transported for the If someone— if we— if someone says, I just want to be evaluated, I just want my blood pressure taken, right? And we take their blood pressure and, you know, everything seems like it's okay, and the patient decides they don't want to go to the hospital, that's where that RMA that we spoke about earlier comes into play.

But we don't go to someone's house or the location where an ambulance is called to and tell them that we're not taking them to the hospital. Okay. So, AMA will be very good at that point because if the person qualify to tell the person, wherever that they assessing, they good, they have the training, they one of the best, right?

So taking them to the hospital, I don't know. Yeah. If— I mean, even as a registered nurse, I don't know because if they don't need it, That's how we end up with the freaking flyers in the ER that make over— overloaded the ER too. So is that a way we can— I think that it's some kind of— it needs more discussion, right?

I don't think that— but if someone calls for an ambulance, right, our job is to respond, evaluate, treat, and transport. And if they want to be transported to the hospital, we take them to the hospital. Yeah. I mean, that's a tough one. Cherry, you agree? Yeah. And also, right, we can't just abandon a patient. There's state regulations on abandonment, and we can't just tell somebody we're not taking you and walk away.

I get that. But yeah, that's a tough one because that's why now I know why I was getting frequent flyers for no reason, because they call 911, they get in. So Chair, I think I've finished with my question because that's been a long process.

I don't know if you have any more questions. Oh, yeah, I just want to make mention that Councilmember Albedal has joined us. And if the councilmembers do not have any further questions— Councilmember Ressler? Sure.

Thank you so much to both of the chairs for this important hearing and greatly appreciate leadership from the department being with us today. You know, I have appreciated your all's, I think, candor and forthcomingness in recognizing that we have a crisis with regard to staffing and compensation of our EMTs. And I apologize that I've been in and out a little bit this morning, but just, you know, I think your testimony was clear and compelling that your response times aren't where you want them to be because we just don't have enough people power.

That's correct. Could you speak to efforts that you're making now to increase recruitment, and what do you think a reasonable timeframe is for us to expect a significant increase in our EMT headcount? So we are partnering with the schools, colleges, trying to get the word out that we are hiring, that these That these are good jobs. But the recruitment problem going back a couple of years is across the country, and it's staggering us, stifling us a little bit.

And I've been— I found each of your and the commissioner's kind of candor, again, refreshing, that kind of recognizing that if we don't increase pay, we're going to have a serious problem and we need to resolve outstanding contract issues to make sure that workers are compensated fairly, to increase the— to improve recruitment and increase and improve retention.

But, you know, recognizing this has been an issue that's going on, the contract issue has been going on for some years, that there's a nationwide shortage on workers. Is there any kind of plan that you can share with us today or timeline for when we think things could start to improve. You know, things aren't where we want them to be right now.

And I, you know, recognizing collectively that there's a problem is the starting point. But then the question is kind of what are we doing to fix it and how are we going to get there? Is there anything you can speak to of kind of how we anticipate an increase in headcount happening in the near future? It's not a resource issue.

It's just a recruitment challenge. We continue to run our EMS academy. We would like to have classes of 250, and we haven't hit that goal. Could you speak to the current number of people who are in classes and when they'll be graduating? Right now we have 163 in our EMS academy. We started with 200. We're down to 163, and they will graduate in the middle of December, and we'll see an immediate, you know, pretty And when is that?

Do you have a timeline for the next class after that? It'll be early in the new year. That a new class will begin, and when will they graduate? Yeah, the recruitment period is open. And, you know, I ask, we have a very robust recruitment unit. Any event that you may be hosting or having where we can get room at a table, please let us know and we will bring recruitment there.

We also have our CPR training unit, which we love to bring, right, and inform people on the importance of CPR and be able to get that message out there. So any events that you have, please contact us in recruitment, and we will make sure that we're able to get somebody out there to try and, you know, get people from your districts into our EMS Academy.

Well, I really— oh, go ahead. Was there something? No, I just wanted to say I really appreciate that. I think that we want to work together to improve this. I think that we've got the contract issue as the other side of this coin. And if we're improving compensation, the recruitment gets easier and the retention improves as well.

And so I really hope that the administration is able to resolve this with the unions. I've appreciated that this new fire department has made clear we have some serious issues among our EMS workforce that have to be addressed. And We really are excited to start to hopefully see some progress on that very soon. We'd love to work with you more on recruitment, and so we'll be in touch on that.

And it's not for today's hearing, but I will just make a note for the record that I am committed to figuring out some solutions on siren noise. I know that Councilmember Brewer's— it's a passionate project for Councilmember Brewer for many years now, and we'd love to work with the department to try and improve not just the well-being of our neighbors, but the well-being of staff who deal with extraordinary noise every single day.

Thank you, Chair.

While you're here, I know that I work closely to do Christmas party with FDNY. I am blessed to have the doctors to be representing H&H here and talk about, you know, all the questions. But I promised something that I was going to do. They never called me a clown because I don't know. Probably they did somewhere around, but not on my social media.

They call all of us like elected official clown. But I have find out that there's a company, Healthy Humor, that actually for all the children that suffering in the hospital with cancer, and I want to put this on for them to say, for all the clown that doing it, continue doing it. Bring laughter to those kids that suffering. in New York City and in general in our country.

And to all of the kids, God bless you. And I put this to show you that, yes, I can play it a little bit. So thank you. Thank you for the strength. Thank you. Thank you. Thank you for that. So we have 2 short follow-up questions, one from Councilmember Alderbol, the other from Councilmember Brewer, and then we're going to wrap it up.

Thank you. Thank you for being here with us today. And thank you, Chair Arias.

I have a question about retention, just following up on Councilmember Ressler's question about recruitment. You get them in the door. How long does it take for them to actually, once you recruit them, for them to get actually hired? And then what are you doing about retaining your workforce? Do you have any ideas of how How you can keep that workforce here.

I understand that EMTs leave being an EMT to become firefighters. That's like the next step, the next progression. But there isn't anything in between. Like, there isn't within the EMT service steps or promotional steps or salary steps, or, you know, for them to progress through, to have to stay in a career in EMS? And are you thinking about that and thinking about retention strategies for this workforce?

Yes. So I would push back a little bit on saying that becoming a firefighter is the next step. People join EMS Right? Because they have a passion for the work. And I think that everything that's been discussed here talks about a livable wage and that being one of the main reasons why people have to leave, right? They leave for other reasons.

Maybe they have other goals. Maybe they wanted to become firefighters or they wanted to become a nurse or they wanted to become police officers. But EMS should never be viewed as the starting step to something else, right? It needs to be its own career. We have recruitment periods. Once those recruitment periods end, we process the members, they go through physicals, and then we put them right into the next class.

It's been stated multiple times, none of us sitting up here, nor the commissioner, has a role in pay, right? But we fully support that being a driving factor to increasing that, to be able to make sure that we retain people. But what we can do as leaders within the fire department is try and change the quality of work life that our members have.

And I think that we're taking a real hard look, right? The commissioner has a long, long story. The commissioner is a longstanding veteran of the Emergency Medical Service. All of my staff, have more than 20 years on the job. We speak frequently with the unions and we try and address the quality of life issues that we can address within our capabilities.

And that's just one side of what's going to make people want to stay. If people want to do the work and they enjoy coming to work, they're going to stay. And if they're able to pay their bills, they're going to stay. So we will work on our part about making sure that we are doing everything we can to improve their quality work-life while the unions and the city are working on the pay side.

And in the EMS, there are significant promotional opportunities. As you come in as an EMT, you can stay in our HAZTAC, which is some specially trained hazmat people. You're able to promote to paramedic. You can become a rescue medic, a HAZTAC medic, And then we promote up. Chief Miano and Chief Werner promoted up through the EMS side up to Chief of EMS.

As long as we're on that topic, though, because you mentioned the collective bargaining, so are you aware of how many collective bargaining meetings that the FDNY EMS have had with the unions and the mayor's office, if you know that? I don't know that, but I'm told that there are, you know, positive actions going on. And the incentive, which I'm very much, you know, from my business background, incentive to keep them within the structure.

You give us advice and what we need to do, like what we all can do to let the EMS know that we love them, we appreciate them, we respect them. So how about within the structure itself? What are the incentives that you're giving beside the paycheck to help them, to encourage them to stay within the structure? So the department offers a wide variety of different things.

I guess we can We can call or consider them incentives. Like, there is tuition reimbursement for college, right? You can work here at the fire department and earn a degree. Myself, sitting in front of you, earned my bachelor's and my master's degree through the assistance of the fire department, right? So, that is one way that, you know, I guess we can call it an incentive, you know, to know that we have that backing.

We have other agencies like— I'm sorry, not agencies, but we have the FDNY Foundation. We have the EMS Help Fund. These are all— they all collaborate and have programs with different types of assistance that they can provide to our members, including the unions. The unions have a very substantial network of people who can assist them with financial mortgages, attorney, just other life things.

So when you look at that, and I don't know if we want to call them incentives, but we have these things available within the department, within the unions, within organizations that are interested in helping us that you only get by being a part of this department. And about wellness, since we're dealing with a lot of stress, especially that kind of work that we do, like in the ER or EMT, to deal with clients.

How are we addressing mental health, wellness, encouragement within the structure? So the first part of being able to address that is having someone come forward and say, I need help, right? We can acknowledge that somebody may be having an issue, and we can say to them, hey, we have these things available for you, like our peer support system, like our counseling service unit, right?

We partner with New York City Well, right? But we have to— people have to accept the help. And we are working on breaking that stigma of it being a sign of weakness to say something is bothering me. You know, I spoke earlier about being able to save a life and deliver a baby. But there's nothing worse than being— than having to look at a parent while you're unable to help their child, right?

Nothing worse than able to look at a child while you're unable to help their parent or their grandparent. I can't tell you throughout my 27-year career how many times on Christmas morning I've worked cardiac arrest under a Christmas tree while families are watching. Those are things that will weigh on you for the remainder of your life. And if It's up to you to be able to say, I need the help, and this department is doing, along with the collaboration with the unions, is doing everything possible to be able to get people who need help, help.

Thank you. Hero care and hero need care as well. So thank you for your time. Thank you. Thank you very much. The new head of OLR is a rock star, so she'll figure all this out. That's what I know. I have 2 questions quickly. Military, a lot of the EMTs I know come from the military, so I'm wondering what the percentage is and then how you do recruitment there.

That's question number one. Second is, I think at one point there was some kind of an app to tell us this is what you call 911 for. I wish New Yorkers understood this. And this is what you call, you know, other means. Don't use 911 in this case, maybe use telehealth, etc. Is that app still around? Yes, it is. still in play?

And then just finally, I think the fire department got at one point some kind of a National Science Foundation grant to help with response times at $2 million. I just was wondering what happened to that initiative. So concerning the app, I'm not familiar with that. We'll look into it to see if that, you know, What the status of that is.

We will get the percentage of veterans, military veterans that are in EMS. And do you recruit from them, from the military? We would certainly hire, and I guess we could look at some recruitment with them as well. And the $2 million grant? And I'll look into this grant from— is it National Science Foundation? National Science Foundation, NSF, yes.

And let's talk about response time. Okay. Thank you. Thank you.

Okay, so I think we've really discussed so many very productive things here today, and I think incentivizing is very good. I think that until they are properly paid, making Making them feel as though they are valued and a topic of conversation, that they're not just forgotten, that they're not just out in the street. They are the topic of the conversation here, in the press, in the administration, at the council office, at the speaker's office.

They are probably the most talked about division within the FDNY right now, are the EMTs. And I think we need to, in addition to the compensation, we need to give them uniformed, you know, first responder status. We need to give them civil service status. We need to recognize EMS civil service exams for an EMT or captain, deputy chief, division chief, whatever it is.

Let them know that they can rise up in the ranks as you did. And that there is a way. So I am completely dedicated to the FDNY, EMS, and any branch of service that are public servants and protect the lives of the people in this city. That is why chairing this committee is so important to me. That is why we ask the questions over and over again.

I cannot tell you how appreciative I am for the answers that all of you, even H&H, you know, even though you belong to— you belong to all of us. But your preparedness, your heart for the job, what you want is what we want. And we all know at the end of the day what we need first is more money for our EMTs.

And in conversations that we've had, I am with the unions, and the unions will testify. I do believe we're at a precipice right now where we have the ear of the public, the ear of the— of government, and the unions will be able— I feel very confident to strike a very good collective bargaining agreement now, even though it has been passed over for so long.

I don't think there's ever been a time where more people and more levels of government will be looking at the discrepancy and the disgrace in pay equity for EMS workers and thankfulness for the job that they do. Thank you, thank you, thank you all so very much. Your portion is over. Please, you're dismissed.

The panel is dismissed, and we will go to public testimony. So there, yeah, there will be someone from the mayor's office staying as well as someone from fire department staying through the public— they won't be questioned, but I want them to be able to hear what's going on. Thank you. For higher education? Yes. I am now opening the public hearing portion of— yes.

Thank you. I'm now opening the hearing for public testimony. I remind the members of the public that this is a government proceeding and that decorum shall be observed at all times. As such, members of the public shall remain silent at all times. The witness table is reserved for people who wish to testify. No video recording or photography is allowed from the witness table.

Further, members of the public may not present audio or video recordings as testimony. Thank you. They may submit transcripts of such recordings to the sergeants-at-arms for inclusion in the hearing record. If you wish to speak at today's hearing, please fill out an appearance card with the sergeant-at-arms and wait to be recognized. When recognized, you will have 2 minutes to speak on today's oversight topic— hearing topic, ambulance response times.

If you have a written statement or additional written testimony, And you wish to submit that to the record, please provide a copy of that testimony to the sergeants-at-arms. You may also email written testimony to testimony@council.nyc.gov. That's testimony@council.nyc.gov within 72 hours of the close of this hearing. Thank you. Audio and video recordings will not be accepted. For in-person panelists, please come to the table once your name has been called.

I will now call the first witnesses: Michael Greco, President of Local 2507; Vincent Variale, EMS Officers Union Local 3621; and Anthony LaMarena, Local 3621.

Good morning. 621 FDNY EMS officers. Thank you so much for coming to testify in person today. You can pick who goes first. Thank you. Thank you, Chairperson. I didn't know whether I should start with testimony or all that rebuttal, but we'll go with the testimony first. Good morning, Councilmember Areola, Chairperson. Good morning, Mayor de Blasio, and members of the New York City Council.

My name is Michael Greco. I am the president of Local 2507, representing the EMTs, paramedics, and fire inspectors who serve the people of New York City. I am here today angry, frustrated, and deeply concerned because we are running out of time. New Yorkers are calling 911 for help, and our emergency medical system is struggling to get ambulances to them in time.

We cannot continue to accept this as normal. We cannot keep holding hearings, issuing reports, and making promises while people wait for help that may not arrive. The Comptrol's report confirms what our members have been warning about for years. Life-threatening ambulance response times have increased more than 41% since fiscal 2015. More than 500 EMTs have left their position in fiscal 2026 alone.

These are not just statistics. These are people whose lives are hanging in the balance. Recently, a 14-year-old Queens student suffered a stroke at a school. His school nurse called 911 and repeated calls were made, but an ambulance did not arrive. His parents ultimately drove to the hospital themselves. In East Harlem, a 22-year-old reportedly waited more than an hour for an ambulance after an apparent overdose.

Police eventually transported him to the hospital. Where he was pronounced dead. We cannot say that every delayed response results in death, but we can also not pretend that delays like these carry no consequences. When someone is suffering a stroke, cardiac arrest, or a life-threatening overdose, minutes matter. Every unnecessary minute is a risk we should not be asking New Yorkers to take.

The FDNY tells us it's training as many EMTs as capacity allows. But that should alarm this City Council, not reassure it. We are still losing more EMTs and paramedics than we can train and bring into the system. The problem is not training new recruits. It's retaining the EMTs and paramedics we already hired. You cannot train your way out of a workforce crisis when you refuse to address why people are leaving.

The reason for systemic delays, staffing shortages, and long wait times facing FDNY EMS is because of the way EMS is devalued, underpaid, and under-resourced in the FDNY. This is a result of a tale of 2 departments in which one of the co-equal branches of the FDNY's uniform emergency response system is not recognized as uniform and not treated equally.

The only way to solve this problem is to change policies and provide pay equity. This is the obvious result of EMS not being provided uniform status, only being budgeted a quarter of the uniform staff while responding to 75% of the calls, and severely underpaid is what you are seeing today. All of the discussions about efficiency— EMS are incredibly efficient, not taking meal or bathroom breaks.

Traffic— traffic has always existed. The difference now is that units have to travel further with less staff to get to emergencies. And dispatch time, again, traveling longer is the result of being understaffed. That misses the point, an attempt to blame EMS for a systemic and cultural problem in the FDNY. Compensation is a major part of the answer.

An EMT with 5 years experience earns approximately $60,000 in base salary, compared with $109,000 for a firefighter of the same time. That disparity makes recruitment more difficult and drives experienced professionals away. These are people responding to the same emergencies, entering dangerous situations, and carrying enormous responsibility for protecting human life. How can the city expect to retain an experienced workforce while treating these professionals as though their service is worth substantially less?

Local 2507's lawsuit challenging the city's inequitable treatment of EMS personnel is about more than a contract. It's about whether the city recognizes EMS as an essential part of the public safety system. Fair compensation is not simply a labor benefit, it's an investment in the people who answer 911 calls. Our members are working New Yorkers, are working-class New Yorkers too.

They are people getting up every day, putting on their uniforms, answering the call when someone is having the worst day of their life. They deserve to be able to afford to live in the city they serve. They deserve a fair contract, competitive compensation, equitable treatment, and real commitment to retaining the experienced professionals this system desperately needs. I hope that you will recognize this for what it is: one of the greatest challenges facing public safety.

They deserve a fair contract. They're experienced professionals. We are losing ground. We are losing experienced personnel. New Yorkers are waiting far too long for emergency care. But we can turn this around. We can invest in our workforce. We can give our members a fair contract, give New Yorkers the emergency medical system they deserve. We are ready to work with anyone to get that done, but the city can't wait any longer.

Thank you. So I'm going to ask each of you the same question, which was the last question that I asked of the administration. Are you Are you able to state that there have been collective bargaining meetings with the mayor or his OLR staff, and if so, how many have you had? Our collective bargaining started 2 years ago, so I can't give you the number.

It's stalled. I'm talking about this particular year. This particular year, we have not had a collective bargaining meeting in that traditional sense. We are currently under confidentiality to discuss the extent of the conversations we are having. They have been positive, but like I've said to the new OLR Commissioner, positivity and $3 get me on a subway. Right.

So we have been left on the altar way too many times. So as positive as this is, every day we wait, another person will die. So we look forward to continuing these conversations, and we hope to get to a resolution that's both equitable treatment to us and a fair, equitable wage. But we are in a positive, hopeful status.

Okay, good. Thank you.

Sir? Good afternoon. Thank you, Chairwoman Joanne Areola. I'd like to concur with President Michael Greco. We haven't had any collective bargaining meetings. We had conversations, positive conversations, and yes, we have been left at the altar many times, so take that for what we can. So my name is Vincent Variale. I am an EMS lieutenant and president of the Uniformed EMS Officers Union Local 3621, District Council 37, representing more than 600 EMS sergeants, lieutenants, and captains in the New York City Fire Department.

I am here again to report that New York City is facing a crisis. Not one that is coming, but one that is here now. One that threatens the lives of all New Yorkers. This is a warning that no longer comes only from EMS unions or the Fire Department, both of which have repeatedly advised that inadequate staffing is hindering the delivery of timely, life-saving care.

The Mayor's own management report released this month, and more recently, the New York City Comptroller's report released last week, confirms the seriousness of the problem. These reports identify low wages and inferior benefits as major contributors to the poor recruitment and declining retention in EMS ranks. As a result, the city cannot consistently staff enough ambulances and officer units, response times have increased, and experienced EMS members continue to leave.

What I find to be most troubling is survival rates have fallen from a high of 35% to now just a low of 16%. The problem is not just low wages. The low wages and high response times are caused by the FDNY's failure to properly recognize EMS as a co-equal branch of its Uniformed Emergency Response System. This is dangerous to the public and discriminates against members of EMS who are the most diverse of the first responders in the 911 system.

The majority of the calls that both fire and EMS respond to are medical. Let me say that again. EMS and fire respond to the same emergencies. 85% of them are EMS calls and less than 2% are fire calls. The majority of the calls that firefighters respond to are to provide medical care in non-fire medical emergencies. While firefighters have less training and qualifications and provide lesser skills on these calls, EMS responding to the same calls while providing advanced life-saving care Are paid half that of firefighters.

On top of this, EMS, with 25% of the staffing, are forced to handle 1.6 million calls annually, while fire, with a staffing of 13,000, handle closer to 500,000 calls. Meanwhile, fire receives approximately 84% of the FDNY budget, while EMS is given approximately 16% of the budget. This means that while we are paid half of what the fire— Can I interrupt you?

Firefighters are paid to respond to emergencies. Our fire counterparts enjoy the luxuries of firehouses, recreational facilities, state-of-the-art kitchens, and sleeping quarters, while we in EMS are left on the street corners, forced to sit in a cab of an ambulance for 8 to 12 hours, responding back-to-back to emergencies, often without even opportunity to properly clean up or, God forbid, take a bathroom break.

Imagine the emotional and physical toll this has on members. It is easy to understand how this stark difference in treatment negatively affects the morale and has EMS leaving the job. We can't look away from the cause of the problems we are here to discuss. It is not about EMS efficiency. EMS are highly efficient and somehow miraculously are able to handle 10 times the call volume of fire.

It is not about traffic. Traffic has always existed. The problem is When you have to send a unit from Manhattan to Staten Island to respond to an emergency due to understaffing, that is going to slow down responses, increase response times, and we can't blame EMS or look to EMS to continue to shoulder the, shoulder the solution. This problem will not go away until the city takes the steps necessary to treat EMS as a co-equal branch of the FDNY's emergency— uniformed emergency services.

Anything else is just a Band-Aid. Every day that this crisis continues, more New Yorkers lose the chance to receive timely life-saving care. It does not have to be this way. The mayor has the ability to negotiate a settlement that would address the conditions driving this crisis. EMS is among the city's most diverse uniformed emergency services, and the workforce composed predominantly of women and people of color.

The city should take the 2 immediate steps: ensure members of EMS are treated as equals, to members of fire operations through leadership and recognition and compensation, provide EMS personnel with the pay and benefit compatible to those of the firefighter counterparts, adopt policy changes that strengthen recruitment, improve retention, and encourage new FDNY EMS members to build on long-term careers.

Together, these actions will help stabilize the EMS workforce and improve emergency care for all New Yorkers. Thank you. I'd like to comment about what was last said Regarding opportunities in EMS, there are other opportunities other than going to fire. There are promotions to lieutenant, which is a civil service exam. There is captain, deputy chief, and division chief.

For many years, those titles were not civil service titles. They were pick 'em, basically. I like you, so I'll make you this, or whatever. They did an interview, but basically, if they liked the person, they would pick that person to get promoted. That changed in 2019. A law was passed and signed making EMS Captain, Deputy Chief, and Division Chief all civil service titles.

The department and the city refused to recognize those— that exam or those titles being civil service. We filed a lawsuit, and just over about a month ago, we won that lawsuit on 8 counts, all in favor. I'll quote the judge on this. the city has violated the constitutional rights of the members in EMS by not providing them with an equal and fair opportunity of merit and fitness to promote to these civil service titles.

And today we are still left with no civil service exam to these titles. I had members, officers, lieutenants, who after hearing that this promotion is not going to be recognized still, are resigning. They took a pension loan, and they're moving out to another place to get a job in another city or state that would better recognize and treat EMS better than we do in New York City.

And again, we lose more experience that we paid for in training, that was gained through years of working with patients, and the damages continue. These are— my point is that these are not just— these things, the issues are not just about money. We need to make this a career, a place where people want to come and stay.

Encourage those to say, hey, I want to join the EMS ranks in New York City because there is a career there. I can stay there for 20 to 30 years, earn a living, and have a ladder to go up on. Without that, we'll get— the problem will continue. Thank you. That's all. Thank you.

Thank you. Sir. Good afternoon, Chairperson and members of the City Council. Thank you, Chairperson Aviola, for having us as always. My name is Anthony Almaguera. I am a lieutenant with FDNY EMS for 23 years and vice president of Local 3621, representing the officers of FDNY EMS. I will reiterate, we have been left at the altar, but I would argue we've never even been asked for our hand in marriage by this city.

I don't— I would like to be left at the altar to get to that point, but we've never been there. But unfortunately, we in— I would like to thank you all for your time today, but unfortunately, we in EMS do not have any more time. And more importantly, neither do the people of New York City who call 911 expecting someone to come, And save their lives.

I want to begin by reading some numbers from this past week, which I've been documenting. These are the numbers of ambulances out of service across New York City at 2:00 PM each day, starting on October 11th. Sunday, 138 ambulances. Monday, 89 ambulances. Tuesday, 92 ambulances. Wednesday, 68 ambulances. Thursday, 94 ambulances. Friday, 101 ambulances, and Saturday, 10/17, 122 ambulances. 7 days, 7 snapshots of a system struggling to put ambulances on the street.

And right now, as I'm speaking to you, I asked somebody to send me the numbers. We are 112 ambulances off service and 51 calls in holding. The majority are over 3 hours. As I'm speaking to you right now. That's an average of more than 100 ambulances out of service at 2 o'clock in the afternoon. These aren't numbers on a spreadsheet to us who are working them.

These are ambulances that aren't responding to emergencies. These are resources that New Yorkers cannot count on when they need them. Now let me tell you what those numbers look like when they become human beings. In late August, on Staten Island, a woman suffering a medical emergency waited 2 hours and 47 minutes for an ambulance to arrive. 2 hours and 47 minutes.

She was unable to walk. While waiting, she suffered a heat stroke and she died. In September, a woman in, in Long Island City suffered an open compound fracture of her tibia and fibula, her shin bones, a devastating injury with broken bone exposed through the skin. She lay on the hallway floor of her apartment building waiting to help, Waiting for help, not ten minutes, not thirty minutes, three hours.

Three hours lying on the floor with a broken leg, waiting for an ambulance in the wealthiest city in the wealthiest country on Earth. And on October eighth, during an ice-related shooting, as the councilwoman from the Bronx mentioned, a man was shot in the neck. An ambulance was requested, but ultimately it was NYPD officers who transported the wounded man to the hospital.

Think about what that means. Immigration enforcement and ICE operations have become a major public safety concern in this city, yet when an incident involving federal immigration agents results in someone being shot, we cannot even be certain that an ambulance will be available to provide timely emergency medical care. Regardless of where anyone stands on immigration enforcement, when someone is shot, they need an ambulance.

In October, a woman in the South Bronx was suffering a heart attack. She called 911 repeatedly, She waited approximately 2 hours for an ambulance, and when an ambulance finally arrived, it was too late to save her. She died on the way to the hospital. And then in the most recent incident on the Upper East Side, with Councilwoman Menin— thank you— publicly demanded answers from the FDNY about the ambulance that did not arrive for the patient.

Think about what that means. A teenager is injured in Manhattan, people call 911 repeatedly, They wait, they call again, and eventually they realize they cannot rely on an ambulance to come to help them. This is New York City in 2026. And I want to be absolutely clear about something today. We have spent years— my first city council meeting was 22 years ago, saying these same things, listening to the union leaders then.

We have spent years warning about the direction the system was heading. We warned about the staffing shortages, and that is what it is. There is no magic pill. I've listened to these chiefs say, we're going to do X, Y, and Z and squeeze more blood from a stone. There's no more blood. We warned about the pay disparity between EMS first responders and firefighters.

We warned about the loss of experienced EMTs and paramedics. We warned about the ambulances being taken off the street. We warned about the growing response times. But we must also confront a deeper truth about how we arrived at this crisis. For decades, the FDNY has maintained a culture that treats EMS as a subordinate branch rather than an equal partner in public safety.

Despite legislation enacted in 2001 recognized the uniform status of EMS, New York City has continued to deny EMS the institutional recognition, respect, and resources afforded to the fire side. Think about that: the overwhelming majority of the emergencies. Firefighters respond to are in medical nature, yet the EMTs and paramedics who provide the advanced medical care wearing fire department uniforms, they are treated as less valuable with the very same department.

That is not merely a question of professional respect. It is a systemic failure with consequences that extend far beyond the workforce. I am almost done. Please bear with me. When you systemically undervalue the people responsible for providing EMS care, you create the conditions for understaffing, attrition, longer response times, and ultimately preventable deaths. And for years, New York City has allowed this system to continue.

The patients waiting for an ambulance are now paying the price. And for years, we have described EMS as a system that is failing. I am here to tell you today that we have passed that point. EMS is no longer failing. EMS has failed. We are in failure. Not because the EMTs and paramedics have failed. Not because the dispatchers have failed.

Not because the men and women who put on the uniform every day have stopped calling— answering the call. They continue to show up. They continue to work. They continue to do everything they can with the resources they are given. But dedication cannot replace staffing. Compassion cannot replace an ambulance. And courage cannot turn a 2-hour wait into a 6-minute response.

The people who work EMS cannot keep carrying the consequences of decisions they did not take. Councilwoman Narcisse mentioned mental health. 47 members have reached out to me since 2020 saying they wanted to commit suicide. We have had 14 members commit suicide. That's only the people who reached out. We are not here asking for applause. We are not asking to be called heroes.

We are asking for the resources. We need accountability. When the patient waits 3 hours for an open fracture, someone needs to answer for that. When a woman waits 3 hours for an ambulance and dies, someone needs to answer For that, because the next person waiting for the ambulance could be your mother, your father, your spouse, your child.

As the woman who testified from your district, Councilwoman Ariola, we cannot keep calling this a crisis as though it is something that might happen in the future. It is happening right now. People are waiting right now. People are suffering right now. I began by thanking you for your time. I will end by reminding you that. Time is one thing our patients do not have, and New York City EMS has run out of it.

Thank you. I believe Councilmember Ressler has a question for this panel. I do. Thank you so much. Firstly, thank you all for your compelling and impassioned testimony and your consistent and forceful advocacy on behalf of your members. It makes a real difference, and we are all rooting hard for you. to get these contracts done and to ensure that EMTs are getting the wages that they deserve.

I just wanted to drill down, President Varielli, on a statistic that you mentioned in your testimony on survival rates, that they had fallen from 35% to 16%. Could you clarify the data points that you're referring to and from when to when have we seen this decline? And when you say— and what that means, that the survival rate has Sure.

So I got that from the mayor's management report that's in there. The survival rate, I believe the highest it was in 2019 was at 37%, between 35% and 37%. And the survival rate basically is the person, the patient was found clinically dead, cardiac arrest or any other way, and then was revived by EMS and survived. When they were brought, you know, treated, transported to the hospital.

From a height of 35%, as I put on the record, that survival rate has plummeted to 16%. Now, some can say it's because the staffing isn't there, so we're not getting to the call quick enough, which is probably part of it, but a lot of it also has to do with the lack of experience because many members have gone, members with experience have gone.

And where I get that from is there is a study that was done in Penn State that showed an increase in the survival rate whenever they had an EMT or paramedic with 6 or more years of experience. They saw an increase of 27% on the survival rate. Hmm. Now, to strengthen that study, there was a study done about 15 years ago, maybe, maybe more, in the FDNY that showed whenever an EMS lieutenant was on the scene of a cardiac arrest, the survival rate of that cardiac arrest increased.

At first you think, well, why would that be? It's not like they have to really supervise EMTs. They know their job, or paramedics for that matter. It made sense. The majority of EMTs and paramedics have less than— I think it's 75% have less than 5 years experience. The majority of the officers have over 7 years 10 years experience.

So again, it strengthens this, the research that was done by Penn State saying if you have more than 6 years of experience, the survival rate will increase. And that's what that meant. So by not having enough staffing, we can't get there on time. By not having the experience, the veterans that we need, we can't save their life.

It certainly, I really appreciate you sharing that study and that and highlighting it. it doesn't surprise me at all that somebody with more experience on the job is better at it, right? As a councilmember, I'm better in year 5, despite what some of my colleagues might say, than I think I was in year 1. I know that a teacher gets better in year 5 than he or she was in year 1, and it really makes a difference.

So ensuring that we're retaining this workforce is critically important for the health and safety and well-being of New Yorkers. But I still just want to drill down on this stat because it's so disturbing. So just so I make sure I understand it, forgive my ignorance, the survival rate, it refers to the number of people that have been revived.

Is that right, from EMT showing up and people— So I'll put the numbers in it for you. Yeah, I mean, I just, I'm sorry, 'cause I'm the one when it comes to numbers, I'm brain dead. I want you to elaborate further, I just— So we do about 80 cardiac arrests a day, right? So that works out to about 29,000 cardiac arrests a year. 16% survival rate, that means 5,000 people survived that year.

At a 37% survival rate, 9,000 people survived that year. So how do you put a cost on what is going on? That means 4,000 people died this year that didn't need to if they would have gone to 2019. That's what I was— I was gonna get to that. Oh, thank you. No, I just, I have to say, I don't think that there is a single more compelling thing that anybody could say this entire day than that.

Well, thank you. Thank you very much. I'm out. No. I really mean it. I mean, like, how— what— for all of us as public servants, as policymakers, that is a number we have to solve for. Thousands of people that are dying in the streets of New York City that shouldn't be, that are in crisis that shouldn't be, because we don't have the workforce in place that is responding in real time as well as we did just several years ago.

The fire department's gone. Well, that— and that was my point when I brought this survival rate, is because I've heard everybody talking about response times, which is very important. Obviously, we need the staffing for that. But the survival rate shows that we're losing the experience. They are leaving. And I gave you that story about the 2 officers who left.

It's just more experience just going out the door because we're not doing anything to give them here to make them stay. I appreciate you highlighting the importance of experienced workforce. I think it's both. It's, it's, it's— that is an important component here. But I just think the numbers themselves are Yeah, thousands of people. Thousands of people are dying in New York City that shouldn't be.

Right, can I give you one more number? It's been brought up about this transfer to fire, they call it a promotion. We are now losing officers to the fire class. So you talk about experience, the experienced rank has been traditionally the officers, that has gone down over the years, and now people have moved up 3 ranks and they're going into the fire class because they don't make enough money here.

And we bring numbers since we moved to training. The chief of the department, in his testimony, with the promotion cycle of 358 EMTs, 63 paramedics, numbers help. OLR's numbers, it costs $45,000 to train an EMT. It costs $100,000 to train a paramedic. So that means this year we've thrown $22.3 million into training. and sent them over to another service.

We have done the same amount of calls this year that we have done last year. The reimbursement rate this year is down $50 million. And they wanted to know why. Well, when you're holding jobs for 3, 4 hours, and then you're making a phone call that says, hey, you still need us? You're not billing for that. So if for no other reason, you don't care about a life, you don't care about nothing else, You just wasted $75 million on poor management.

We all know the city of New York has policies, has bureaucracies, but if the FDNY EMS system was run as a Fortune 500 company, we would be bankrupt. It would be— it's terrible. Your stat of putting a human life to this is why we're having positive discussions. We've been up 22 years. Talking about our members homeless, nobody seems to care.

Not because they don't care about the individual, because the system won't let it done. Why are we having positive conversations? Because in your district, in your district, in your district, people are hurting or dying. My colleagues mentioned how we have real-time stats. I got a call right now. It's called a gynecological hemorrhage, which means there is a woman bleeding possibly from that area.

She's been sitting in a lobby for 2 hours right now. Wow. That's the stat right now as I look at the phone. So the fire department's going to come up here and say, this is a non-critical injury. This is New York City. This is not a math problem that I need Albert Einstein to solve. Fire has a 5-minute response time because they got 13,000 personnel that deal with 100,000 fires.

They are so overstaffed that they can do the overflow of 400,000 medical calls. Give me 15,000 people and anybody and their mother can call 911 and get an ambulance whenever they want. This is a crisis in New York City, and eventually every single one of us in this room are gonna have to answer for why people are dying left and right.

And that's why we're here today. As Anthony said, as Vinny said, this isn't a crisis that's coming tomorrow. This is going on right now. If I can add to that also, the, the non-life-threatening calls that they hold, like as you said, 2 hours, and I don't consider that life-threatening. You're bleeding out, that's not life-threatening. Um, but I'm not— a non-life-threatening call can very easily turn into a life-threatening call.

Nobody's there. And I was— I'm glad you brought up the unknown, uh, um, the segment unknown. They classified as a segment 4. I don't understand why it's a segment 4. It should be higher than that because it's unknown. How do you know it's not a cardiac arrest? I can tell you my personal experience as an EMT. I've had a call that came over as a non-critical injury because the person said, in what I was reading on the computer, the person fell.

When I got there, the person fell because they had a heart attack. They were in cardiac arrest. Now it turns into a priority 1, and now I got to ask for ambulance, for paramedics, and all sorts of more resources. But if you don't know, it should be a higher priority. I would think at least in the top 2, 3, not a 4, right?

Because we don't know. And in that case, that kid had a stroke. I mean, I don't know how that wasn't reclassified. I can't blame the dispatch system. I know they're trying, working very hard. They're also understaffed. So, you know, all this stuff has to go back to we need to support and fund a life-saving service called EMS now to have turned this ship around, because it's not going to happen overnight.

It's going to take time to do it. So every day we wait, we're going to be waiting longer to get to see the results. So thank you. Thank you so much. Each of your, your testimonies were so compelling. And if you didn't think that we are in a state of emergency now regarding EMS and the lives that are being lost, daily because we don't have enough EMS and ambulances on the street because they are not compensated and cannot be retained, then I hope you know it now.

We are in a state of emergency. Thank you so much for your testimony. And I just want to end with this, that we understand this is a difficult problem to solve, and as a union, it's a pretty interesting place to be when everybody agrees with us. So this message goes out to OLR, to the mayor's office, to the Office of Budget, to City Council.

The union is here as the answer to your problem. We are willing to work with anybody to get this done, and, and we hope we can get there before more people die. Thank you.

Thank you so very much. Okay, the next panel is Valerie Guadino, Logan Clark and Joseph Ranieri. Thank you, Julia. Thank you. Appreciate it. This is important. This is important. Thank you, Josh. Good to see you. Next Friday. What? You got a date without me? I know. I'm. Yeah. Okay, let's go. Ms. Guardino, would you like to begin?

Logan will start. Yeah, sure.

Hi, uh, good afternoon, uh, Chair Areola, and, uh, I think that's all we've got today, uh, and other members of the committees on, uh, Fire and Emergency Management and Hospitals. My name is Logan Clark, and I am the Assistant Director of Government Operations and Community Services at the New York City Independent Budget Office. I'm joined today by my colleague Valerie Gudino, who is a budget and policy analyst at IBO.

IBO is a nonpartisan government agency whose mission is to enhance understanding of New York City's budget, public policy, and economy through independent fiscal and policy analysis. We appreciate the invitation to testify at today's hearing on ambulance response times. IBO has analyzed emergency medical services staffing over the past— over the 5 years presented in the fiscal year 2023-2028. 6th Mayor's Management Report, or MMR.

The recently published MMR documents longer end-to-end average response times for life-threatening emergency medical emergencies that are designated as Segment 1 to 3 incidents within the 911 system. This system includes both FDNY ambulances and voluntary ambulances operated by the city's nonprofit hospital systems. End-to-end response time measures the total time it takes from when a caller dials 911 until an ambulance arrives.

The most recent MMR reveals that ambulance response times have increased by nearly 3 minutes since FY22 and now average more than 13 minutes. The fire department cites call volume as the primary reason contributing to this troubling increase. Although call volume has increased by 5% since 2022, it is currently down from its 2024 peak. Even with that decline, end-to-end Responses have continued to worsen.

Meanwhile, since 2022, the daily average number of ambulance operating hours in the 911 system has consistently declined. Daily ambulance hours, including both EMS and voluntary ambulances, have decreased by nearly 10% from 8,900 in 2022 to 8,100 in 2026. In recent years, and as recently as January 2026, voluntary ambulance operators have made up roughly one-third of all daily ambulance tours.

However, FDNY states in the MMR that 11 hospital systems removed their ambulances from the 911 system in FY26. It is unclear what the exact impact of those hospitals leaving will have on the proportion of voluntary tours. IBO does not have information on why these hospitals withdrew from the 911 system or any staffing IBO analyzed EMS personnel staffing levels and fluctuations from 2022 to 2026 using the city's Human Resource Management System, or CHARMS.

EMS staffing includes emergency medical technicians, who typically staff basic life support units, EMS paramedics, who staff advanced life support and paramedic response units, and EMS lieutenants and captains, who supervise but typically do not respond to calls. go directly to calls. Out of those titles, EMTs have the lowest starting salaries but are eligible to be promoted to higher trained and paid paramedic and firefighter titles through a civil service exam.

There has been substantial volatility in staffing, both decreases and increases, during the period from fiscal year 2022 to fiscal year 2026, which could have affected operations. There is higher attrition among EMTs than among paramedics and supervisors. Many EMTs separate from the agency or look for promotional opportunities as paramedics or firefighters. While the number of paramedics and supervisors has remained relatively unchanged, the number of EMTs has fallen and decreased their share of the EMS workforce from 69% to 63%.

Staffing levels have also sharply increased at times as new classes are brought in roughly 3 times a year following a 17-week training, with the largest month-to-month increase happening in October 2024 with 324 new EMS staff. Many EMTs and paramedics take the promotional firefighter exam. Although providing clear access to higher-paying careers is laudable, the structure and timing of the firefighter promotional exam relative to EMS hiring initiatives effectively ensures a cycle of periods of high attrition at EMS.

This may challenge EMS capacity, especially when coupled with standard attrition in what is already a high-stress occupation. EMS staffing levels tend to decrease most following the establishment of a new promotional list for the firefighter title, which requires an 18-week training period amongst other prerequisites. The largest decrease, with 252 active EMS positions, occurred in March 2025, which aligns with when the 18-week training period would begin before the June firefighter class?

There's no single cause of worsening ambulance response times, nor any simple answer to address this trend. In the broader context of more hospitals pulling their ambulances from the 911 system, more of the call burden is being placed on FDNY EMS staff. This follows a nationwide trend of hospital systems dropping ambulance service, driven at least in part by insurance reimbursement rates well below the cost of providing those services.

But as one step towards a remedy, EMS can attempt to address the high levels of attrition and staff turnover and expand its capacity for more EMS classes. The solution must consider the promotional list of firefighters and balance consistent staffing levels at EMS with providing promotional career opportunities. We thank you for your opportunity to testify today, and we're happy to answer any questions.

I'm glad that you did the study, and that was very smart. Thank you. Thank you. Sir, please.

Thank you, Councilwoman Areola, and I want to thank the New York City Council for holding these public hearings and keeping EMS on the public agenda. It's been far too long in the making. So I am Joseph Ranieri. I'm the executive director of at the Regional EMS Council of New York City. Our body is a nonprofit organization with statutory authority under New York State public health law with coordinating EMS resources throughout, throughout our region.

You often do not see us at these public hearings because our primary focus is in medicine, developing good medicine for our EMTs and paramedics to follow. However, the state of our current EMS system We felt that it is necessary for us to be here and to reinforce everything that's been stated up until this moment. EMS has a true retention problem.

One of the things I do want to specifically address was the idea about going single paramedic, having an EMT and a paramedic. We at the council vehemently think that this is a bad idea. Thank you. Paramedics treat very complex patients. They rely on having 2 paramedics on the scene to bounce off of each other to help with their clinical judgment.

So to give one example that Councilwoman Narcisse will appreciate, in conducting a cardiac arrest, the ECC guidelines recommend having a cardiac team of at least 6 individuals to work that arrest. In EMS, that often will consist of 2 paramedics, A supervisor and maybe an EMT crew. The 2 paramedics are the clinicians on the scene. They are doing weight-based medications, some of which, if they get the dosing wrong, will have extremely negative effects on the patient.

So I do want to address, specifically address that and say that having dual medics provides good medicine to our patients in the field. Related to the retention issue that is at hand, obviously pay parity is at the top of the list, right? This is not something that is just occurring at the New York City level, but also at the state level and the national level.

Our EMT members need better pay. They also need better work-life balance. They need clear career paths for promotions, but also, as well as incentives for them to remain in the field and treating patients at better pay and incentives, such as being a field training officer. In addition, our EMS providers, a lot of the discussions we've heard today has been about efficiency.

Efficiencies are things that we discuss on with dealing with mechanisms and machines and systems. These are people. We should not be trying to wring an extra 1 or 2 response calls out of our EMTs and paramedics in the field. We should be looking at what is causing them to have these high rates of callouts. Thank you. A lot of times, unlike on the fire side, where if a firefighter responds and goes to a fire, they are given some time to recover, both physically and mentally from that call.

However, if you've ever worked in EMS or in the hospital and you've had to work up a difficult arrest or a pediatric arrest, that's both physically and emotionally demanding. Our EMS members are often not given that same time to recover. All right, so these are all things that obviously need to be brought up with the contract negotiations that are occurring.

One of the things I will point out, a lot of times we've referenced— that's been referenced throughout this hearing has been the Labor Relations Board. I think it would be interesting to have them up here and speaking on these issues because it seems that the mayor is in support. Obviously, the department itself has claimed their support. The City Council, who is the will of our New York City residents, are in support.

So we need to really identify where the hang-up is and what's preventing this from getting done. I also want to address the issue with regards to that was brought up on the firefighter promotional exam. It is not a promotion. It is a change in career, a change in field. Now, it is beneficial to have firefighters that are trained in medicine.

That does help because it is an expectation of the public that when a firefighter company responds that they have medical training, just as it is an expectation of the public that our police have some medical training, and they do. They're trained in basic CPR and first aid. So that is a benefit. However, particularly when we lose a paramedic to the fire side, those skills, those advanced life support skills, are not carried over to the firefighter level.

CFR units do not carry the ALS equipment that paramedics use, and they're not exposed to the continuing medical education that's needed for a true clinician that a paramedic is. So that training, that experience is lost. And as has been brought up before, the less experienced providers we have, the worse outcomes there are for our patients, both in the field and then when those patients end up going back to the hospital.

So a lot of the efficiency things that have been brought up really are trimming around the edges. We need to acknowledge the fact that our society relies more on medicine today. We have more calls, more patients, more complex patients. Our EMT members that are trained today, even at the BLS level, the EMT today, right, carries twice as many medications today as they did 20 years ago when I first became an EMT.

That's medications that have to be trained on, how to administer, how to recognize the appropriate patients to give them to, the contraindications for it. We're expecting more from our providers, both in their knowledge and their skills, and how many calls they respond to, but we're not adequately compensating them the right way. So with that, I thank you for your time.

Thank you very much for your testimony. We appreciate it. I appreciate it. I came at the end because I'm between 2 hearings, and I have a staff listening so we can approach it. My apology that I have to be in 2 places at once. I wish I could clone myself. But I'm so appreciative of it because someone trained for taking care of an acute person is not a police officer.

The police officer have their job. So they can have the CPR to keep you alive until you get the appropriate paramedic to come to take care of the person. So thank you for sharing. And you've been here, you've been hearing that we are on the move. Thank you. your side. We're trying to make sure we reach, because if the staff not feeling good, not seeing the support, not respect, not getting the pay as well, they're not going to be able to give, to deliver the care that they need to deliver.

And I'm in agreement with you. Thank you. Yeah, absolutely. It's the position of the council that a real investment needs to be made in EMS at all levels, at the frontline provider levels, but also at the support levels. calls. Yes. You know, that includes physician oversight. Online medical control is often staffed by a single physician. That's right.

If you get 4 or 5 cardiac arrests that are occurring, right, we respond— we heard today we respond to over 80 of them a day. If you get 2 or 3 of those at a time, that's a single physician providing clinical oversight to 2 or 3 calls at a time, in addition to some of the other calls.

Again, these complex patients. So that's just a microcosm of how far behind we are in supporting EMS as a system. Thank you. I appreciate you. Thank you. Yeah, now. Thank you.

And we have been joined by our colleague Gutierrez. Jen. Thank you. The next call is for Jacourtney Williams and Desku Fasira or Fasima. When you come up, if you're here, you can always correct me if I did not say your name. I don't like to butcher people's names. The next is Jack Chapman. The next is Walter Adler.

Steven Northmore, or Northmores? Northmore. Thank you. I think that's all for now. I have 2 more, but we don't have no more chairs, so I'm gonna leave this chair. Yeah, you're gonna leave it for the next one because there's 2 more on the panel. I don't know if they're here. Christian Lopez? Is Christian here? Yes. Okay, they're bringing you a chair.

Perfect. And the next one is James Kerr. Yes, I'm here. James, yeah. Thank you. Andrew, yeah, I call Andrew. Where's Andrew? They bring your chair, Andrew. Thank you. We can begin from that corner and pass it on, and you can say your name because I know some names was difficult for me. Absolutely. Good afternoon, Chair.

Well, members of City Council, I'm Christian Bear Lopez, 25. I'm a paramedic who's worked in EMS since graduating from St. Francis Prep in 2019. I testified here in March. I'm back because the problems remain. FDNY EMS Lieutenant Nelson Sito served this city for over a decade. On February 17th, 2025, he called 911 struggling to breathe. An ambulance arrived in 6 minutes.

Nobody answered, and they left. His family found him dead hours later. His ambulance was not delayed. It was outside his home. The responding EMTs had less than 2 years on the job combined. I started at 18, and I'm not blaming them. I'm asking why we can't retain experienced providers. We ask FDNY EMTs to spend 4 years in EMS to qualify for a firefighter promotion, then start over on another pay scale for another 5.5 years.

We're losing experienced providers because we haven't made EMS a career worth staying in. EMS needs sustainable wages, career development, and educational pathways into healthcare through New York City Health and Hospitals. But EMS itself must remain a viable lifelong career, not merely a stepping stone into firefighting or other healthcare professions. I appreciate Councilmember Areola's transparency and her efforts towards it.

But a text notification cannot perform CPR, train an EMT, or staff an ambulance. Municipal EMS should be staffed to meet demand independently. Hospital ambulances and CFR fire engines should complement our EMS system, not what keeps it running. Intro 0521 proposed an independent EMS department in 2024. Sanitation, police, and fire have their own commissioners. Why shouldn't EMS? An independent department would give EMS dedicated leadership, budget oversight, and direct accountability.

I'm 25. My generation is inheriting these problems while caring for your constituents and showing up here on our days off. We were essential in 2020 during the pandemic. We're essential today. If this council is committed to EMS reform, why aren't we holding a hearing and conducting a fiscal assessment on implementing Intro 0521?

Thank you. I yield my time. Thank you so much. How you doing?

My name is Jerodney Williams. I'm a United States Army veteran, former New York City correction officer, and a current New York City paramedic. I just want to start by giving a rundown on how severe response times are because of lack of staffing. So I work on an ambulance on East 86th Street and Lexington Avenue, and when I log on, my first call of the night is on East Houston Street.

So to go from East 86th to East Houston Street is a 25-minute ETA. 25. 25 minutes for an unconscious patient on the bus. So now the bus driver has to pull over, get rid of everybody on the bus, and wait for an ambulance to get there. We get there, the patient's seizing, we stop it, we get him to the hospital.

After we clear the hospital, we get another call, 121st and 1st for domestic violence. From East Houston to 121st and 1st, another 25-minute ETA. The police department is there, they can't clear the scene until the ambulance gets there. So now the MTA worker's waiting for us, the police officer's waiting for us. We assess that patient, she refuses, we get to the next call.

The next call, old lady fell down, hit her head. The fire engine gets there. The fire engine is waiting for us to clear the patient. So all of these response times are— they all work together. So fire's waiting for us, PD's waiting for us, MTA is waiting for us. If you've ever had to exit a train because you have a sick passenger, They're waiting for an ambulance.

All of this makes the city less efficient. We have 6,000, at least 6,000 calls a day. That's the equivalent of what we had on 9/11, what we experienced during COVID We have, we're receiving those calls every day. We are in dire need of more ambulances on the street. In the meantime, along with the staffing issues, Going on with FDNY EMS, you have hospitals who contribute to the 911 system who are pulling ambulances out of the system because it's not profitable for them.

Hospitals are pulling ambulances out of their EMS system because it's not profitable for them. I happen to work for one who pulled 3 ambulances out last year, got rid of the staff, laid them off, lost 3 ambulances from the Upper West Side, very busy area. This is the biggest city in the world, and we're asking for mutual aid for ambulances.

This is shameful. This is extremely shameful. While I appreciate the help, the mutual aid, I think that's so— one, I think it's union busting also, but that's another topic. But for us to ask for mutual aid is shameful. The chief earlier mentioned the closure of hospital units, and I think it's Uh, uh, uh, uh, a very important piece of this EMS thing we do here.

Like he said, we do 1/3 of the calls in the city, but with the, with the, with the staff decreasing, we're doing more and more and more and more and responding to more calls out of our area, which is increasing response times. My ambulance sits on the Upper East Side. I'm responding to calls in East Harlem, Washington Heights, SoHo, Chinatown.

The Bronx, the response times are ridiculous. Today you heard 2 separate stories of 2 children being delayed care. Children in our city being delayed care because there are no EMS, there are no ambulances, there are no paramedics, there are no EMTs to respond to these calls. And I think it's just extremely important that we address the issues, FDNY pay issues, but also hospitals pulling ambulances out of the system, which is ridiculous.

Hospitals, billion-dollar hospitals who have money to build new buildings in these neighborhoods, but somehow don't have the money to continue EMS services.

I think we spoke a little bit about that. The hospital closure and all this pulling ambulance is not right to the— yeah, absolutely. We hear you. Thank you.

Good afternoon. My name is Andrew Freena. I'm a former EMT, a current PA. Not to beat a dead horse about the response times, we've heard a lot of harrowing metrics, but the FDNY commissioner— or not the commissioner, the chief— I think he said something correct, that they don't hold life-threatening jobs. But if you look at the statistics, the percentage of time across all 5 boroughs where the paramedics arrive under 10 minutes Is 26% as of the last month, which is pretty awful.

So you must be holding jobs. Regardless, it's nice to hear this discussion here, how everyone's recognizing that the pay is the problem and that it needs to be solved. But it just— it confuses me why the issue is not solved. I see it as relatively simple, right? This really isn't a partisan issue, a political issue. Whether you're a Democrat or Republican, a social— whatever, right?

If we live in the city and our families live here, we want the ambulance to show up fast. I think it's what, like $200, $300, maybe $400 million to achieve parity? Yes, that's a lot of money, but out of a $112 billion budget, it's not that much. When you see that other agencies receive federal funds or state funds, that's another alternative.

So, plus the insurance billing, there's a lot of solutions here. And it makes me start to wonder, you know, dude, I don't mean to say this offensively, but like, do you have your own private ambulance services or do you not live in the city? Because aren't you worried about yourselves? Like, I just feel like that's, you know, this is also an issue that you can be a little selfish about.

But it frustrates me as someone who's not a politician, not a union leader. Like, what do I do? I call my office. I live in Long Island City. Thankfully, I wasn't on the ground, you know, with a compound fracture, but they don't care. Julie Wan doesn't care, right? We call these politicians and they don't want to do much, and there's a lot of trying to blame the fire department, and then they try to blame you guys, and people just keep pointing the finger.

So it becomes very frustrating as a constituent, and I just hope we can actually— you know, we're talking about it, that's great, but I hope we come to a solution now.

Thank you.

Good afternoon. My name is Walter Adler. I am a hospital-based paramedic. I am the president of the Emergency Medical Services Public Advocacy Council. I'm also an 1199 delegate. I'm here today, uh, as a paramedic who works for the voluntary hospitals to say it is painful and shameful to watch what is happening to the bleeding of FDNY EMS.

We see how their union leaders are struggling, organizing, negotiating, fighting, for 4.6 years is what it now feels like. And we give them respect. We see their members. We do our jobs with their members. I'm the ALS. I have some FIDNY BLS. I began my career as a scared little 18-year-old working for TransCare in Canarsie. I became a Midwood Teamster.

I was in 2507 for 4 years as a fire department EMT. And now I'm a proud, proud, proud member of 1199 at a hospital. hospital. And I will say this, above all else, I am a paramedic and I was an EMT, and I want our brothers and sisters in Finney to know that we're not a competing force.

We're out here with them. We get paid completely different ways in different sectors, but that is by design. It is not that there's a villain in this story. The council makes resolutions that say parity is important. Mayors make promises, they do their best, The OLR isn't a hateful group of people, so we think. Everybody's trying their best to get justice for our municipal EMS workforce.

And we, the about 3,000 members of the 1199 hospital-based EMS, with our brothers and sisters in Presbyterian who are non-union, we are saying we are not a competing force and we see you out there. That then said, I think there have been solutions introduced. The most important ones I would just like to list off in whatever time I have remaining because they are important and they are not being considered.

Everyone says, where is this $200 to $400 million to pay Finney EMS going to come from? And the answer is we need to reduce call volume in this city by 10%. That is in the citizen budget report. We need to use medic and EMT units We need to use firefighter and EMT units, and we need to reclaim the EMS that have gone to fire to be a resource.

And we need to reduce CFR utilization except when necessary, because it is more expensive to send 5 people that make $109K than send 2 people that make $57K. This is all the 2018 Citizen Budget Commission, and I believe it should inform us where some of the money could come from and things that could be acceptable to the UFA and to 507.

Finally, I know I'm over time. There is something called the Gilbay-Mallett Proposal. They are senior members. They are paramedics. Their first thing is well known to everybody. We want to get FDNY EMS to $109K after 5 years of service, or as close to. That is our conception of parity. 2, We need to end the promotional to fire because people should not use our field as a stepping stone, and it closes the gap and attracts people from other sectors that want to make a career.

Third thing, we need to educate the public on 911 overuse, abuse, and misuse, because if the public is truly educated about what is 911 calls, we go from 6,000 calls to 3,000, and then it can be handled by the various— 911 calls. Alignments we have. Finally, Brandon introduced the independent Department of EMS on behalf and in solidarity with Local 2507 and 3621, not because anybody wants to wrench EMS out of the hands of the fire department, but a serious conversation has to be had about 70 actors that are deploying ambulances, 4 sectors, 10 unions.

And if we do not force that conversation through a Department of EMS that does not necessarily need to command and control all ambulances, then we are creating piecemeal solutions, which respectfully, Chair Ariola, I understand what your local laws do. They create accountability, they create structure, but our men and women are dying, our citizens are dying, and it feels often like the city and OLR and the mayor Good afternoon, members of the City Council.

I'd like to first thank the committees for holding this hearing. It is imperative that we discuss the importance of maintaining efficient ambulance response times in a city that houses over 8 million people. My name is Jack Chapman, and I am here on behalf of 1199 and the EMS workers that we represent. Thank you, Mr. Chapman. I've been working in EMS for over 15 years.

I think I can skip reading the statistics on the increasing response times at this point, as it has been well discussed. There are many reasons for the rising delays in response times across New York City, including staffing shortages, higher call volumes, low pay, packed emergency departments, and hospitals removing their voluntary ambulances from the 911 system. Much like other parts of our healthcare system, EMS has been affected by exacerbating staffing shortages, and funding being taken out of healthcare.

EMS personnel across FDNY and private ambulances have an average starting salary around $40,000 a year. In a city as large and expensive as this, and for a job that can be both physically and mentally taxing, these wages are not competitive or attractive. One could make the same amount of money simply taking advantage of the newly required hourly pay for delivery app drivers, and there would be no intensive training or prerequisites.

EMS personnel wages also lag behind firefighters, with many who are already in the FDNY system eventually leaving to become firefighters themselves. Approximately 4,300 EMTs and paramedics left their positions between fiscal year 2019 and 2026. In addition to increasing staffing shortages we are seeing in EMS, ALS call volumes across the city have increased over the past decade. Outpacing non-life-threatening medical emergencies, and the life-threatening medical emergencies have increased by 22.9% since 2015, compared with a 2.5% increase of non-life-threatening emergencies.

This increase is also happening at a time when many hospitals are reducing voluntary ambulance services from the 911 system. So EMS personnel are now being asked to take on a bigger workload with an increase of ALS calls, While working with an understaffed team and being paid minimal wages. The city's first responders play a critical role ensuring the health and safety of those living here, and they are in the event— they are here in the event of illness or injury to provide on-scene treatment and transport to a hospital, but are being tasked with providing those services without the resources necessary to do so efficiently.

While FDNY recognizes the shortage of paramedics that they have, they do not have an active pathway to recruit credentialed paramedics. Certified paramedics must join as EMTs and then be accepted to the department's paramedic program to then go through almost a year of paramedic school again when they're already credentialed to do this job. It's also worth noting that many calls are often triaged in ways that upgrade them to require an ALS-level response, just for the ALS providers to arrive on scene to find a patient that does not require the interventions that they are able to provide.

ALS units are regularly sent to calls that BLS units are more than capable of handling, which results in less ALS units being available. The system is understaffed and overworked. We are now at a point that we are seeing NYPD seek out alternative resources when they are unable to get an ambulance on scene because the EMS system is in such backlog.

There are many factors that have led us to where we are now, which is resulting in ambulances not being able to arrive in a timely manner to those who truly need them the most. The time is now to effect meaningful change and provide our members with the pay and resources they need to effectively continue to provide rapid on-scene care and transport for those who need it most.

One of our union officers just told me about an event that just happened at the nearby Virgin Hotel this past Saturday, where it took 40 minutes for EMS to respond to a STAT-EP, which is short for status epilepticus, and simply put, stands for ongoing or prolonged seizures and is a true life-threatening emergency. Over 40 minutes for EMS to get on scene.

Chronic abusers of the 911 system, many of whom call daily, call themselves in in a way that identifies them as high-priority emergencies and take that resource away from those who need them the most. Recognizing that that does not mean these individuals do not deserve a response, the city should try to find a way to identify this and create a plan to minimize wasting the resources that are so wasted every day.

Thank you for your time.

Thank you. Good afternoon.

My name is Stephen Northmore, and I am representing myself. I have been a member of FDNY EMS for the past 14 years, starting in 2012 as an EMT, then paramedic, hazmat medic, and finally rescue medic. We are out of time. I have firsthand account in the last month that a patient waited 40 minutes for an ambulance to be assigned after they had started showing Symptoms of a life-threatening cardiac condition.

A crew confided in me the next day that the same previous day as the cardiac patient, a patient who had suffered a serious accident with three of their limbs broken, which if not handled correctly could cause a fatal bleed or nerve damage causing permanent disability, had waited 50 minutes for an ambulance to arrive. A few weeks ago in Brooklyn, I heard a fire company over the radio that had been waiting at the scene of an. injured child for 30 minutes, who can compensate and appear very well after injury until they suddenly rapidly deteriorate, be told that there were no ambulances available.

Another crew a few weeks ago confided in me that their patient had died from a manageable bleed while waiting 40 minutes for an ambulance to be dispatched. I'd heard of another pediatric patient with an obviously and painfully broken arm, again if not handled correctly could lead to a life-threatening bleed or permanent disability, had waited an hour for an ambulance to arrive.

That same crew informed me another patient of theirs with an immobilizing broken bone had waited 3 hours for an ambulance a couple of weeks before. A toddler with a critical second-degree burn from boiling liquid spilt on them, waiting in their mother's arms for 30 minutes for an ambulance to be dispatched. This is the testimony of one member out of thousands.

The line of credit this city's and state's legislatures and executives have taken out for decades from the rare and exceptional people willing to descend into these situations for shameful compensation and disrespect has run out. This situation has not been brought on by some force of nature or act of God. It has been willed into existence by past city council members being informed of a clear and present danger to the citizens of this city and stating, moving on to new business.

It hasn't been manifested by a weather emergency or pandemic, but by past mayors stating the work is different to justify our racist and sexist second-class first responder status for decades. True. The member of this council's mayor of the city and government of this state Have not overseen the decades of belittling and undervaluing of the members who take care of people hit by trains, seizing on sidewalks, lost all of their skin in fires, drowning in their own fluids from pregnancy complications, entangled, maimed in heavy machinery, or descending into the darkness of pandemic.

I do commend the members of this committee who have spoken out and are proposing these measures, but as any member of the city's emergency services will tell you, the people of this city do not want want to hear words of comfort with our arrival. They demand action. The commissioners have sounded the alarms. The chiefs have sounded alarms.

The unions have sounded the alarms. The EMS service has followed every avenue to prevent this, and they have failed. Hospital liaison units, paramedic response units, tactical response groups, mutual aid ambulances, closest hospital transports, volunteer ambulances, one-for-one relief mandated over time, All to ignore the bleeding, seizing, wheezing, inconvenient truth in the corner of the room. I've seen every other measure to fix this system tried and failed except the primary one that almost every member agrees on: our pay that is as fair as the separate but equal policies of this nation's past.

It will not fix all the problems with this system, but unless this pay issue is addressed, I have no confidence any other measure will exceed— succeed. It is the wound that is bleeding us of personnel, morale, resources, wisdom, experience, and talent, from the ranks of EMT to paramedic to lieutenant to captain to chiefs to even our supervising doctors.

The past remedy has been only to pump in new blood as we bleed out. You do not have to be a doctor, medic, or EMT to know when faced with what to address first— pumping in new blood or stopping the bleeding Stop the bleeding. The EMTs, paramedics, and officers and doctors of FDNY EMS will continue to answer the rising tide of emergency calls in this city under solemn oath and dwindling resources.

With the blood on our boots, placenta fluid on our pants, and cerebral spinal fluid on our sleeves, we await for the appropriate response to this clear and present danger to the citizens and visitors of the City of New York from all the the other oath-takers for the public safety and public good. Thank you, and may God bless the members of EMS.

Thank you. Good afternoon.

My name is James Kerr. I served as Executive Director of New York City EMS from 1980 to 1988, and this man's testimony was the best introduction I could possibly have. I want to tell you that although there have been, I think, some changes in EMS in almost 40 years since I left, sadly, many of those challenges still remain today.

And I have to say that we, you know, we talked about problems with response time, and response time is clearly a symptom, not an isolated issue. It's a symptom of other problems. The thing is, the mayor has to take responsibility for this. Happily, I no longer work for any mayors or anyone in the city government. And I want to tell you that the things that have been talked about today, from the beginning of this meeting till today, till right now, are things that some of which the fire department has control over, but many of those things the fire department does not have control over.

They need help, as this gentleman went through in a quite articulate manner. The fire department can't, can't address these challenges by itself. I'm recommending a mayor-directed EMS Improvement and Modernization Task Force, bringing together the fire department, OMB, OLR, EMS labor, health and hospitals, and the broader hospital community to put together— to work together, to focus not on finger-pointing, but to work together as a team to try to figure out the various issues and responses to the various issues that are necessary.

It's very clear, you don't have to be a rocket scientist to recognize that they need competitive pay. They need, you know, dare I say parity with the fire department. In addition to that, if you want to deal with the increased call volume, You're going to need more staff than you currently have. I'm talking about staff beyond the 45,000 that they currently have.

Yes, they're at 41,000 or whatever the number was, 40,000— 4,150 or whatever. But the goal is 45,000. But the goal is 45,000. That's fine. But there's been a 41% increase since the 20-teens. Did their budget increase, their budget for staff increase by 41%? I'll tell you, the answer is no. So the mayor has to put this— has to be the convening person who puts this group together, people who work for him, who have to collaborate with one another to address these issues.

And I'm proposing that within 90 days, the task force submit in an implementation plan that establishes clinically appropriate response time targets, identifies the staff, ambulance capacity, and operational improvements needed to meet those targets, and specifying the resources required and the agencies responsible for implementation. The process could be measured by the percentage of patients reached within those targets.

And what I'm saying is, you want an ALS unit 95% of the time in 6 minutes, not an average of 10 minutes, because the averages cover— they cover up an awful lot of outlier calls. The outlier calls are the things that we're talking about here. The difficulty is that it's not 1 or 2 outliers, it's tons of outliers.

The system-wide problem requires a system-wide management response. And New York City, I believe, has the data, the expertise, and the technology to improve EMS performance. What is needed is a coordinated mechanism to turn that knowledge into action. The objective is faster, more reliable access to appropriate care, and better patient outcomes. Thank you.

Thank you so much. Any questions for this? No? No. I just want to let— what's his name again? Stephen North. Stephen. I just want you to know that Chair worked very hard and she's a fighter. It's not that we're sitting here just to listen. And she's surely going to follow— we're all going to follow up. And I'm in to support what's going on as a registered nurse.

So we hear you. We're not here just to just to talk. All right, thank you. And I don't— and I said it before and I'll say it again, I don't think there's ever been a time when there's been such focus on the fact that EMS has failed in the way it is now. And it did— this mayor inherited this problem, but he is the mayor now and it's his job to solve it, and we'll be there to assist him in doing that.

So thank you. Thank you. That's the end of our in-person Q&A panel. So it has been concluded. We will now turn to virtual panelists. For virtual panelists, once your name is called, A member of our staff will unmute you, and the sergeant-at-arms will set the timer and give you the go-ahead to begin. Please wait for the sergeant to announce that you may begin before delivering your testimony.

Now I will call our first virtual panelist, Tyler Weaver. You may begin. Thank you.

Good afternoon. My name is Tyler Weaver. I wish to thank the council and Chairpersons Areola and Narcisse for hosting this meeting. As I said to this committee 2 years ago, you know, my 24-year-old son, Nikos Costello, suffered a cardiac arrest in the Bronx in 2023. Unfortunately, it took an ambulance 20 minutes to reach him, and due to severe brain damage from too many minutes without enough oxygen, he was declared dead in ICU the next day and taken off life support.

And the loss of Nick, of course, has been a heavy blow to my family. 4 years ago, the MMR reported a cardiac arrest revival rate of 20%. 2 years ago, that dropped to 17%, and then last year dropped down to 16%. Um, with the 20,000 or so cardiac arrests each year, that's a, a 1/5 relative drop in revival. is significant, and it means hundreds of less New Yorkers were revived.

Back in June 1981, the average response time to critical calls by EMS was 13 minutes. And we just heard from Jim Carr, who was there at that time, and under his leadership, they were able to lower that down, I think, all the way down to 9 minutes. So there's ways to solve this issue. Even during 2020, when COVID hit, the final average for that year was 10 minutes.

However, since 2017, response time to life-threatening calls has been increasing, and for the first time in 40 years, it just hit 13 minutes again. So this milestone should be a major wake-up call to everyone that the city has now gone back to ambulance response times from the early 1980s. Incredibly, the situation continues to get even worse. Monthly averages recently reached 15 minutes, and the Bronx even hit 18 minutes.

FDNY EMS workers get paid a lot less than other first responders, so it's no wonder why they keep leaving. They haven't had a contract in 4 years, and the downstream effect is that they're understaffed by 400 positions, and numerous— up to 100 ambulances are left sitting unstaffed daily. I believe that increasing EMS pay, renewing their contract, would be one important part of fixing the response time crisis.

And the mayor and the Office of Labor Relations should reexamine their priorities and their overall approach to EMS labor issues. In the meantime, all major EMS stats keep going in the wrong direction, and New Yorkers in medical distress are suffering harm while waiting too long for for ambulances. And I want to thank you for having me here today.

Thank you. Mr. Weaver, we just want you to know that we will not give up until EMS brings their response times down, and a tragedy that you have suffered will never happen again to any other family. Thank you so much for always showing up for the hearings. Thank you.

Next, we have Cheryl Bernard. Hello. Hi, can you all hear me? Yes, we can hear you. Hi, how are you? Good evening. Good afternoon.

My name is Cheryl Bernard, and I want to say afternoon to the chair members, the city council, the members of the committee, the Committee on Fire and Emergency Management Hospitals, and everyone involved in this meeting. I want to say thank you to EMS and their FD for their service. I myself, I'm a retired member, 29 years of NYPD for communication division that oversees 911 system.

So trust me, I know about the calls that come in. I also want to say my condolences to the family of Nick. My comment is population and housing increasing, hospitals decreasing. NYPD, FDNY, and EMS workers retiring. All these situations make response times decrease. I am all for the pay increase. I am definitely for that because as one on the receiving end, we definitely need more money and we're underpaid.

But you can increase the pay, you can remove personnel from the desktop, you put them in the field, everything else you can think of. The common denominator here, and the main problem, is DOT's active project of bus lanes, bike lanes, and street thinning and street closures and rerouting. I have a video where ambulance was called to an emergency on Rutland and Kingston.

No traffic can pass because the newly installed protected bike lane— no one can pass. In the video, there's no bikes traveling on the bike lane, but all the cars were backed up and they had to find another route to leave. Can you imagine if this was reversed? Let's say that— and this happens, we're in New York City— so someone had an emergency, that's a car driver who required medical attention, and the ambulance was behind the traffic.

How is the ambulance supposed to get to the person needing assistance? The latest is a concrete slab. It's right in the middle of the intersection of Winthrop Street and Kingston Avenue, and it's right at the location of an ambulance hub. How can they put this extended street narrowing concrete slab right at the corner of an ambulance hub?

How are fire, police, and EMS supposed to get to an emergency if DOT keeps causing traffic delays? A few more comments just on this, and then I'm done. An NYPD RMP can maneuver a lot better through traffic, and the shorter distance turns that it's going to take with the bus lanes and the bike lanes. The bus lanes and bike lanes are creating where it's hard to make a U-turn, it's hard to make a turn.

NYPD can get to a response time or a medical emergency quicker than the ambulance because they can't maneuver through traffic. And there's no way, absolutely no way, and I beg of you, that the City Council should support a 911 operator or dispatcher giving the public any ETA for any emergency vehicle to arrive Because they cannot determine if a bike or bus lane where they have to travel, for example, they want to put bike lanes and bus lanes on Utica Avenue, Flatbush Avenue, Church Avenue, which is a main hub.

It's a main street. They want to thin it to one lane of traffic. How is an ambulance and a fire and an RMP, how are they supposed to get through this traffic when it's only one lane? Giving a response time will cause the city To be at jeopardy of being sued, but then again, I guess these ballot questions in November they tend to take away the rights of the public anyway.

But city council should not. I think you all should go for a ride along to see and experience how it is in trying to get through traffic when the bike and bus lanes are creating one lane of traffic. It is you can hire as much people as you want. The response time is. Still going to be slow because they have no way to travel.

That's the end. Thank you for hearing my, my plight.

I'd like to just say that I align myself with each and every one of your statements. Thank you. Christopher Kaganar. Yes. We can hear you. We can hear you. Okay.

So my name is EMT Christopher Kagan. I've been an FDNY EMT now for over 27 years. And I take a little bit of problem with you saying EMS has failed. The New York City government has failed EMS. And that's a big problem because I have trained numerous people in the streets and we can't keep them because they go to transit, they go to court officer because they make more money.

So we can't keep people. We bring them in, we train them, they go into the academy, and then when they come out, they stay for like maybe a month or 2 months or a year. And then they're gone. And then I have to train somebody else again. I've done this like 1,000 times. If you don't fix the pay, how are we going to keep EMTs and paramedics in New York City?

And that's it pretty much. If, if somehow we don't get some sort of legal thing to go and fix this with OLR, This is just going to get worse, and then people are going to die, and there's nothing we can do about it unless we get the people that we need to man these ambulances. I know already 20 people that are talking about retiring.

That means 10 ambulances are going to be down in New York City because we're not going to have nobody to run them. Because they're going to be retired. If we don't fix the staffing issue and fix this money issue right away, New York City is going to head into a doomsday. That's it. Thank you so much for your testimony.

I certainly do agree with you, and we made it more than clear to the administration that EMTs need more money and they need uniform status and they need to be respected more. And I— when I echoed the sentiment of the unions who represent the EMS and EMTs, they said that they weren't going to fail, but they have failed because the government has failed them.

So that was the full statement, and I agree with you 100%. Thank you.

Next is Chowdhury Mahmood. You may begin.

Thank you, Chair Ariola and the council members. Again, I thank you because I have heard all DOT, the people from FDNY, they're all working. My name is Chowdhury Mahmood. I am computer specialist, FDNY Bureau of Enterprise Technology, with certification I have. related to computing like CISA, CSM, PMP. I am here because what we are investigating are the main ambulances are slow.

It is connected to what I have watched happen from inside FDNY Technology Division. Both FireCAD crashed 3 times in 6 months. It is more visibly internally in ITSM, which is Information Technology Service Management, and also managed any authority other than civil servant, and that it is going to the contractors. So there is a consistency and accountability gap I found.

So 3 crashes on a system that cannot go down, a system that routes emergency vehicles to people in crisis. Each time the vendors are Accenture, each time defects I have documented, 3 proper channels have not been fixed. So each time we leadership choose not to invoke the contract remedies that existed to hold Accenture accountable. So this is one of the reasons that also a council member asked in the middle, what if any technology can, you know, can help to, um, shift the process?

So I have seen all inside, like, it is because of the really vendor control. So when I have escalated my findings, I was not thanked. I was retaliated against. Marginalized, you can say, and also harassed by this leadership. And ultimately forced off the, you know, the division that is related to EMS-CAD and FireCAD. And there is one reason, that is the environment at which FDNY is now building EMS-CAD, the system that will dispatch the ambulances with same vendor Accenture under a $20.66 million no-bid sole source contracts signed in October 2025.

Nearly $20 million in uncompetitive contract, same vendor. No accountability mechanism that has been enforced. So council members, ambulance response are not in a— is not a staffing problem or a traffic problem. They are in part a technology accountability problem. If EMS EMS-CAD is built with the— no, is, is the way EMS-CAD was managed. This defect will be suppressed, you will be silenced, and a vendor that faces no consequences for failures.

Then go-live will not be the end of the problem, it will be a beginning. I am asking the committee to do, or requesting the committee to mainly, you know, focus on 2 things: demanding a milestone-by-milestone accounting of EMS-CAD deliverables and verify independently, not by, you know, FDNY management, because, you know, it is all internal. They are just supporting the vendors. 2, requiring independent technical certification before EMSCAP go live, not Accenture award, not FDNI award, an independent auditor. 3rd of all, protect the Civil 7 employees who— Thank you, your time has expired.

Uh, thank you. Actually, I have also, uh, provided the written testimony more detail and to the— with the data point collected.

Thank you very much for allowing me to Thank you so much for your testimony, and you can submit the rest of your testimony to the— it's testimony@council.nyc.gov. Thank you. We have now heard from everyone who has signed up to testify. If we inadvertently missed anyone who would like to testify, please feel free to come forward. Thank you.

Please let us know. Seeing no one, I would like to note again that written testimony, which will be reviewed in full by committee staff, can be submitted up to 72 hours after the close of this hearing by emailing it to testimony@council.nyc.gov. Thank you to all who came, all who testified. The entire staff, our sergeants at arms, thank you for everything that you do.

Committee councils, don't know what we'd do without you. This hearing has ended. Thank you.