New York City Fire Department - Bureau of EMS

Bureau of EMS

Calls to 911 for emergency medical services (EMS) in New York City are dispatched by the New York City Fire Department's Emergency Medical Dispatch under its Communications Bureau.

Ambulances are staffed by uniformed service EMTs and paramedics of the FDNY or civilian EMTs and paramedics working for non-profit, 'voluntary' hospitals. It is the largest public, non-profit ambulance partnership in the world.

Prior to March 17, 1996, municipal ambulances were operated by NYC EMS under the New York City Health and Hospitals Corporation a public benefit corporation, which dispatched both its own ambulances and hospital ambulances. After that date, NYC EMS was merged with the FDNY and became the Bureau of EMS. As of 2010 it is referred to as the FDNY-EMS Command and is an operational unit of the FDNY which operates under the Chief of EMS, who in turn reports to the Chief of Department.

FDNY-EMS respond to more than 1.2 million medical emergencies per year, or 3300 per day. Although EMS in New York City is controlled and dispatched by the Fire Department, approximately 30% of the ambulances in the system are operated by the non-profit hospitals in New York City, the majority of these being in Manhattan and Queens. These hospitals have historically provided emergency ambulances for over 125 years, with some now subcontracting actual ambulance operations to private ambulance providers. New York City also has a number of neighborhood volunteer ambulance corps that respond to emergency calls, primarily in the outer boroughs.

The New York City prehospital care system consists of three distinct levels: First responder engine companies, staffed by firefighters trained as certified first responders (CFRs) providing first aid, CPR, and defibrillation; basic life support (BLS) ambulances, whose two EMTs provide first aid, defibrillation, and limited medication administration; and advanced life support (ALS) ambulances, whose two paramedics provide prehospital critical care, including patient assessment, 12-lead electrocardiography, pulse oximetry, defibrillation, cardioversion, cardiac pacing, endotracheal intubation and other advanced airway procedures; intravenous (IV), intraosseous infusion (IO), intramuscular (IM), oral (PO) and respiratory therapy, with over 40 medications both under standing medical orders and in consultation with a medical control physician. Each area of response is divided into overlapping grids, with the closest FDNY first responder engine company dispatched to life-threatening emergencies, along with both a BLS and ALS level ambulance as necessary.

Some EMTs and paramedics have been trained as Hazardous Materials Technicians and function to provide patient care while wearing Chemical Protective Clothing in the 'Hot Zone' at HazMat incidents. Recently, all of FDNY-EMS's EMTs and paramedics have been trained to the Hazardous Materials Operations level in order to operate in the 'Warm Zone' of HazMat incidents. Some of the HazMat trained paramedics have been trained at the FDNY Fire Academy as 'Rescue Medics' in order to be able to provide patient care in both high-rise rescue and confined space situations.

While EMTs and paramedics work well professionally with the firefighters of New York City, there have been occasional "culture clashes" between EMS and Fire, for instance, a plan in 2006 to move ambulances into a firehouse in Queens drew an outcry from both the unions of the firefighters and EMS workers and was ultimately scrapped by the city. This is due to several factors, the relative little attention paid to the sacrifices and achievements of EMS workers by the public in relation to that paid to firefighters, as well as the separate mindset that each respective job entails; firefighters must operate as a team and strictly and swiftly execute the orders they are given by their officers to achieve their goals, while EMT and paramedic crews are expected to act independently and usually without direct supervision by their EMT and paramedic officers or medical control physicians, in most cases, due to the nature of the job.