New York City’s emergency medical services (EMS) will begin the new year in a state of crisis. As the need for ambulance services increases, the number of EMS workers is declining, and response times, which can mean the difference between life and death, are climbing.

Moreover, EMS workers are beginning their fourth year without a contract and struggling with starvation wages. Posturing over this unfolding disaster, local politicians and union officials are paying lip service to reforms that are no more than palliatives even if they were implemented. The situation will not be improved until workers take matters into their own hands.

Entry-level emergency medical technicians (EMTs) receive roughly $18 per hour, which is little more than New York’s minimum wage, and less than the wage of food delivery workers. A living wage in Manhattan for one adult with no children is $32.85 per hour, according to the Massachusetts Institute of Technology Living Wage Calculator. Even after five years of service, an EMT’s annual salary tops off at $59,800, which is still below a living wage in one of the world’s most expensive cities.

Financial difficulties force many EMTs and paramedics to work tens of hours of overtime per week or hold multiple jobs. EMS workers often live many miles away from New York to avoid its high cost of living. It is common for EMS workers to live in their cars or in homeless shelters.

As a result, the EMS workforce has dropped from 4,600 employees in 2020 to 4,100 today. Hundreds more of the city’s EMS workers are expected to leave in the coming months as many become firefighters. In addition, Northwell Health, a hospital that participates in the city’s EMS system, eliminated three Manhattan ambulances and their staff due to budgetary pressures from President Donald Trump’s Medicaid cuts, which are already underway. More hospital systems are likely to follow suit.

While staffing has declined, demand for ambulance services has risen to 1.6 million EMS calls annually. This number represents an increase of 227,000 calls since 2021.

EMS response times for life-threatening emergencies, a key indicator of outcomes, have risen every year since the pandemic began. They approached 12 minutes in 2025, up 2 minutes from their 2021 average of 9 minutes and 34 seconds. These long response times negatively affect an untold number of patients.

Workers in Local 2507 of the American Federation of State, County and Municipal Employees District Council 37 (DC 37) have been without a contract for over three years as working conditions have rapidly deteriorated. Former Mayor Eric Adams was unwilling to offer a pay raise higher than the pattern offered to other civilian city workers, a roughly 16 percent raise over five years. This does nothing even to make up for the record inflation over the past several years.

The responsibility of Local 2507 officials, who have bargained away concessions for years, cannot be overstated. They have played a particularly shameful role during the pandemic, where EMS workers spent the first several months of 2020 working with inadequately rationed personal protective equipment, while the union did nothing. After a period of silence, Local 2507 President Oren Barzilay emerged to promote vaccine conspiracy theories and outright lies about EMS workers dying from the COVID vaccine.

Since 2020, 10 of the city’s EMS workers have died of COVID-19, and 12 have committed suicide.

The previous contract, which expired in July 2022, added 131 contractual work hours to the calendar year, effectively stealing 7 percent of EMS workers’ income. It also gave up the eight-hour workday by switching to an exploitative 12-hour platoon schedule, which awarded the city massive productivity gains for nothing in return except “built-in overtime.” The union heads and Mayor Bill de Blasio celebrated the contract as a “historic win” for EMS workers, while leaving entry-level EMT salaries at the minimum wage.

The current negotiations between EMS and New York are taking place amid an ongoing crisis that was triggered by the COVID-19 pandemic and is growing due to the attacks on healthcare led by Trump.

At a City Council hearing in November, Councilman Justin Brannan sponsored legislation aimed at splitting New York’s EMS from the fire department (FDNY). The proposal is ostensibly intended to shore up EMS and improve patient care. Brannan and union officials linked EMS worker-retention problems and increasing response times to the lopsided FDNY budget, only 20 percent of which is allocated to EMS, even though 70 percent of emergency calls are medical.

Since the merger of EMS and FDNY in 1996 under Mayor Rudolph Giuliani, EMS calls have doubled, while staffing has remained the same, Anthony Almojera, vice president of the Uniformed EMS Officers Union Local 3621, said at the hearing. The lack of EMTs and paramedics has contributed to longer response times. As the staffing crisis in EMS has deepened, the media have reported many patient deaths that might not have occurred if these medical emergencies had been addressed more quickly.

Brannan and Almojera blamed the low numbers of EMTs and paramedics on the fact that many of the FDNY’s EMS personnel go on to become firefighters. After five years, a top-paid EMT receives an annual salary that is only half of what a firefighter makes.

When asked by journalists about the proposal to separate the two agencies, new mayor Zohran Mamdani was noncommittal and said that he would have to be briefed further on the issue. But he has appointed retired EMS Chief Lillian Bonsignore, a 31-year veteran of the FDNY who opposes the separation, as fire commissioner.

By retaining Police Commissioner Jessica Tisch, appointing former acting Labor Secretary Julie Su and making a pathetic pilgrimage to the White House, Mamdani has shown that his priority is to reassure and serve the interests of Wall Street.

EMTs and paramedics must take the struggle for decent incomes and humane working conditions out of the compromised hands of the union. Local 2507, and DC 37 more broadly, are happy to preside over the poverty of workers while they line their pockets with union dues and “negotiate” with the city in perpetuity.

EMS workers must form rank-and-file committees to wage their struggle outside the control of the treacherous union. They must appeal for support from other healthcare workers, who are facing similar attacks, and warn the public of the consequences of the accelerating collapse of the EMS system. The fight to save New York’s EMS ultimately requires a fight against for-profit medicine and for workers’ control over healthcare.