Press Release City Budget

CBC Recommends Reforms to Improve Emergency Medical Services in New York City

November 25, 2018

The Citizens Budget Commission (CBC) today released "Reviving EMS: Restructuring Emergency Medical Services in New York City," a report that highlights major inefficiencies in the City's current emergency medical services (EMS) and identifies reforms that could enhance performance.

New York City spends $1.1 billion to provide EMS, but an excessive share of resources is allocated to response to noncritical incidents for which timeliness is not a factor in the outcome. In contrast, too few resources are devoted to the medical emergencies for which speedy response times are critical.

The Fire Department of the City of New York (FDNY) responded to 1.5 million medical incidents in 2017 with EMS ambulances and fire engine companies. CBC identified three factors limiting the cost-effectiveness of this response:

  1. The EMS system is bogged down by avoidable or unnecessary requests for assistance that are better handled in ways other than FDNY response;
  2. Increased resources for EMS have been devoted to Basic Life Support (BLS) ambulances that handle noncritical emergencies, while the number of tours of Advanced Life Support (ALS) ambulances capable of responding to critical incidents has declined since 2014; and
  3. The use of fire engines in addition to ambulances to respond to medical incidents is wasteful. Heavily staffed fire engines are far more expensive than ambulances: In 2017, the estimated average cost of a fire engine response to a medical incident was $1,970, while the average cost of an ambulance run was $486. In addition, for many of the incidents to which they respond, fire engine personnel are not trained to deal effectively with the medical condition.

"Well-run emergency medical services are a matter of life and death for New Yorkers," said CBC President Carol Kellermann. "With the right reforms, the City can save money and lives."

"Other cities have been more nimble in adapting emergency services to handle increased medical calls and reduced fire emergencies," said CBC Vice President Maria Doulis. "New York City should make reform a priority."

In order to improve service quality without additional costs and potentially yield taxpayer savings, CBC recommends dramatic changes to FDNY EMS protocols and suggests the City implement reforms, which include:

  1. Implementing programs to lessen residents' unnecessary or inappropriate requests for an ambulance. Reducing unnecessary use of EMS by just 10 percent would save the City $58.5 million annually which could be reallocated to services that better address medical incidents;
  2. Increasing the number of and more efficiently staffing the ambulances which are best able to respond to life threatening incidents;
  3. Reducing reliance on fire engine response to medical incidents. Fire engine staffing costs about $7.2 million per engine annually, and these resources could be reallocated to higher priority services.

To read "Reviving EMS: Restructuring Emergency Medical Services in New York City," visit