NY State EMS in Trouble, But Some Fixes Being Made

The condition of EMS in New York State is dire, but some fixes are being implemented. That’s the takeaway from Steven Kroll, Executive Director and Chief of Delmar-Bethlehem EMS in Albany County, New York. In addition to heading up this nonprofit mixed career/volunteer department, Kroll is the principal author of the New York State’s State Emergency Medical Services Council (SEMSCO) 2019 report, ‘EMS Workforce Shortage in NYS: Where are the Emergency Medical Responders?’ and its 2024 update. (He is also legislative committee chair of the New York State Volunteer Ambulance and Rescue Association, which represents not-for-profit EMS agencies in New York state.)

“Back in 2019 and still today, EMS managers are saying that they don't have enough responders to cover their schedules and that their current responders are putting limits on how long they're going to stay in EMS,” said Kroll. “It’s a general negative outlook for New York State’s EMS workforce. People are considering leaving and going to do other things based on issues related to the job, plus poor pay and benefits. This is because EMS in New York State has not received the attention necessary in a changing healthcare system, a problem that was exacerbated by the COVID-19 pandemic. It stressed the entire healthcare system and certainly EMS providers were on the front lines of that.”

Disturbing Statistics

The data released in SEMSCO’s 2024 update is disturbing. Here’s a sampling of its key points:

• The total number of ambulance services in New York State (NYS) has decreased by 9% over the past 10 years from 1,078 to 982 (2013-2023). 

• The number of active NYS-certified EMS practitioners has decreased by 17.5% from 2019 to 2022. The drop has gone from 40,046 to 33,002 certified and active providers, out of a pool of 78,173 certified providers overall. 

• 58.4% of NYS EMS agencies indicated that the decline in the number of certified and active responders has diminished their ability to cover calls and schedule shifts.

It gets worse:

• 62% of EMS leadership respondents had an unfavorable outlook on their agency’s ability to recruit enough certified EMS responders to adequately serve the community in the future. 

• 37% of EMS respondents plan to leave the EMS field in the next five years. 

• Replacement won’t necessarily be found outside of New York State, as 45% of EMS respondents who took part in the NAEMT 2022 National Survey of EMS Workforce plan on leaving the profession within six years.

• Only 48% of respondents to a 2023 SEMSCO survey believe they have a long-term career in EMS. 27.5% said “no” and 24.5% were “unsure."

So why are NYS EMS agencies having problems attracting and keeping staff? One major reason is poor pay. According to the 2024 SEMSCO update:

• 45% of EMTs report having an hourly base wage of $19 or less; 76% report having an hourly base wage of $24 or less. 

• In comparison, the average salary of a retail salesperson in NYS is $19.23 per hour. 

• 35% of Paramedics report having an hourly base wage of $29 or less; 61% report having an hourly base wage of $34 or less. 

• In comparison, the average salary of a firefighter in NYS is $35.35 per hour. The average salary of a Registered Nurse in NYS is $48.14 per hour.

Three more statistics explain why being an EMT/Paramedic in New York State is losing its appeal for many in the profession:

• 89% of respondents to a 20233 SEMSCO survey have experienced a traumatic event or incident when working as an EMS provider.  

• 85% of respondents have experienced burnout or compassion fatigue in their role as an EMS provider. 

• 73% of respondents reported working more than 40 hours per week; 37% worked more than 50 hours per week; and 17.7% worked 61 or more hours per week.

Some Progress Being Made

When viewed as a whole, NYS EMS is in a sad state, with much that needs to be fixed to turn things around.

The good news? Through the combined lobbying efforts of the New York State Volunteer Ambulance and Rescue Association (representing nonprofit and volunteer agencies) and the United New York Ambulance Network (career agencies) at the state level, some progress is being made.

“For instance, we’ve achieved the availability of a 10% local property tax exemption for volunteer EMTS/Paramedics,” said Kroll. “We got an increase in Medicaid emergency ambulance rates. They're still far less than it costs, but they increased them somewhat significantly. We also got the Direct Pay Law passed, which compels insurers to pay EMS agencies directly rather than sending checks to patients and expecting them to pay us, which often doesn’t happen.”

This being said, “we have a lot that's left undone,” Kroll noted. “Our bill that would make EMS an essential service did not pass at the end of this year’s legislative session. It passed the New York State Senate, but not the New York State Assembly. So we're going to have to go back and work on that in the next legislative session, which begins in January of 2025. And we are going to continue advocating for an increase in the Medicaid payment rates. We would like the Medicaid ambulance payment rates to be at least equal to what is paid by the federal Medicare program. And, to support volunteers, we want the New York State volunteer first responder tax credit to be increased from $200 to $800 a year.”

The bottom line: New York State’s EMS agencies are in serious trouble, but they are succeeding in improving the situation. What remains to be seen is if the success they are enjoying will be enough to turn the tide.