E M S P A C
EMERGENCY MEDICAL SERVICE PUBLIC ADVOCACY COUNCIL
The Emergency Medical Services Public Advocacy Council (EMSPAC) is dedicated to advancing the welfare of Emergency Medical Technicians (EMTs), Paramedics, and EMS Officers/Supervisors. We engage in public awareness, hardship response, and advocacy to support all EMS providers.
EMSPAC is a 501(c)3 not-for-profit charitable entity dedicated to supporting the highly difficult work of EMTs and Paramedics. We will support any member of service and their family in times of hardship through the coordination of mutual aid services.
This includes but is not limited to critical stress management, grants and funding support to manage critical incidents, formal and informal peer mentoring, continuing medical education resources, and general advocacy.
Through public awareness, member media training, and regular press engagement we will increase the exposure of positive stories about EMS members in the press. We will coordinate the release of heroic positive calls, newsworthy member activities, and major incidents to the public.
To read our full mission statement, click here.
1. Why is EMS Different?
Why is EMS “Different”?
- EMS is a reflection of the beautiful diversity of our City, State, and Country. It is representative of women, people of color, immigrants, and the gay and lesbian population.
- EMS is the only First Responder Service that by direct action prolongs human life, expedites extrication from trauma, and extends the ER into the streets and homes of America.
- EMS is exposed to high shockingly high levels of stress and risk, made worse by 60-to-80-hour work weeks its EMTs and Paramedics engage in to make ends meet. EMS is also regularly found at working fires and active crime scenes alongside Police Officers and Fire Suppression.
- Our members are regularly exposed to assault and chaos from suddenly uncontrollable scenes with little to no follow-up or debriefing process in place.
- EMS is a community health resource doing wellness checks, advising on appropriate medical resources, and increasingly engaged in Community Paramedicine; something incredibly fiscally important to the Hospital Systems. If patients are readmitted a month after discharge, the hospitals cannot bill.
- EMS, unlike Police and Fire Suppression, is radically divided across four sectors each funded differently and pitted against each other in labor negotiations.
- EMS, unlike Police and Fire Suppression, has a municipal sector paid for by taxes, a commercial sector paid for by contracts, a hospital-based sector connected to hospital groups, and a voluntary sector that plays a massive role throughout the nation.
- EMS, unlike Police, Fire Suppression, Sanitation, and Nursing IS NOT a stable middle-class career. The majority of the workforce is young, leaves after 4 years or sooner, and views EMS only as a steppingstone to another, better career pathway.
- EMS no matter what sector we work in are third class first responders.
2. Why do EMS members deserve more?
- EMS Members have been paid minimum wages for far too long. Regardless of Sector EMS members need to be compensated for both their moral and monetary worth.
- The Average EMT wage range is $8 to $18
- The Average Medic wage range is $16 to $34
- EMS Members in the municipal sector tend to make $30,000 to $50,000 less than the police or the firefighters after 5 years in the title.
- Outside of a highly moral and just argument that EMS members contribute directly to both community health outcomes and public safety: EMS is also a multimillion-dollar business.
- The majority of both EMS 911 and Interfacility Transports (IFT) in this country is carried out by private commercial ambulance companies such as American Medical Response (AMR).
- EMS is highly lucrative.
- Ambulance calls are billed in segments called BLS 1, BLS 2, ALS 1, 2, and 3.
- The 911 ambulance service charges increased in 2021 from $775 to $900 for Basic Life Support Ambulance service, a 16 percent increase.
- The fee for Advanced Life Support Ambulance Level 1 goes up from $1,310 to $1,525, also a 16 percent jump.
- Moreover, the bill for Advanced Life Support Level 2 medical response rises from $1,420 to $1,625, a 14 percent increase.
- The fee schedule for the first time imposes a new $1,050 “treatment in place” charge if paramedics on the scene with a patient get virtual assistance to treat patients via video or audio hook-up.
- While 911 calls cannot predictably bill, they unofficially patient steer, which is illegal.
- IFT or Interfacility Transport Calls are regularly caught engaging in fraud, illicitly encouraging crews to document their “patients cannot walk” or provide oxygen illegally.
- Medicare and Medicaid predictably pay our $300 for a basic life support IFT to dialysis or as much as $1,6225 + $60 for Oxygen + $10 a mile for ALS 2 using ventilators or medication drips.
ALS 3- Critical Care Transports and Flight Transports can go well above $10,000 operating ICU equipment between locations or engaging in helicopter-based EMS.
3. What is EMSPAC All About?
Improving the lives of EMS Workers through higher wages, better benefits and total parity with police and firefighters.
EMSPAC is a public advocacy organization led by active-duty EMS members and allied civilian professionals who hope to advance wages, secure benefits, and increase public understanding and appreciation of the EMS Service. We organize a wide range of hardship support for EMS in need and we advocate for tangible goals in the realm of collective bargaining to be achieved by both union to management negotiations as well as laws which protect EMS workers on the job.
- EMSPAC is about making the lives of EMS Workers better TODAY by achieving pay and benefit parity with police and firefighters.
- EMSPAC was founded in the Bronx at the height of the 2020 Pandemic when over 37,000 New Yorkers died.
- The majority of its initial members belonged to Empress Montefiore, SCEMS Barnabus, Citywide Bronxcare, and the FDNY EMS Bureau Division 2/7 some of the busiest areas in New York City 911 and lowest paid garages. In months immediately following the founding of EMSPAC over 75 active and retired EMS MOS died, 15 or more by suicide.
- EMSPAC is a public advocacy organization led by active-duty EMS Members and allied civilian professionals who hope to advance wages, secure benefits, and increase public understanding and appreciation of the EMS Service.
- We operate a 501(c)3 to provide hardship support for sick and injured EMS MOS.
- We advocate for tangible goals in the realm of collective bargaining to be achieved by both unions to management negotiations as well as the actual laws which protect EMS workers on the job.
- We have 5 theories of change as an organization:
– We need to improve inter-EMS solidarity and morale
– We need to build up public sympathy
– We need to build a united EMS labor movement
– We need State and Federal Omnibus Laws to Support EMS Workers
– We need a BS/MS Program to elevate educational standards.
4. What leads EMSPAC?
Active-duty EMS lead EMSPAC
Not a single one of which is paid to do so.
EMSPAC is led by a 7-person Board of Directors and a 38-person Steering Committee with legal governance and recognition under NYS law.
All of the leadership are subject to term limits and face election. The Steering Committee is made of Coordinators managing geography jurisdictions and Cochairs or Directors managing Committee staffing.
Virtually all of EMSPAC leadership are still actively employed as EMTs or Paramedics.
5. Who funds EMSPAC?
EMSPAC is an ALL volunteer, ALL member supported mutual aid network led by active-duty EMS members. It does not accept financial contributions from any of the labor or management/ownership stakeholders it is engaged with. EMS Members support EMSPAC operations by contributing to Crowdfunds for specific time bound projects. We also sell T-Shirts and throw parties.
EMSPAC is an all-volunteer, all-member-supported mutual aid network led by active-duty EMS members.
We don’t charge dues and we don’t pay our organizers.
We do not accept financial contributions from either organized labor or management/ owner stakeholders we are engaged with.
Unlike NREMT which holds us captive in monopoly to charge us for national certification, NAEMT which is funded by the American Ambulance Association (AAA), is a grouping of owners seeking more money from reimbursement; EMSPAC is a grassroots, democratic movement of active-duty EMS.
We have a strict SOP in the palace to prevent the capture of our organization’s message, movement, and structures by organized labor, hospital groups, and/or ambulance owners.
EMSPAC is funded by Crowdfunds and its members contribute voluntarily to stage operations involved in hardship help, mental health peer support, and general advocacy.
These budgets are voted on by an elected Steering Committee and a Board of Directors.
6. What are the differences between a “Public Advocacy Council?”, a “Political Action Commitee” and a “Trade Union”?
The main differences have to do with how money can be received and what it can be spent on.
A 501(c)3 Charity can receive tax deductible donations and distribute the funds on mission without paying taxes on them in the form of grants.
EMSPAC is a 501(c)3 as over 70% of our budget/ operations are on EMS MOS Hardship help and Advocacy/Education on the main issues.
A 501(c)4 Lobby (A Political Action Commitee) can take donations without tax deduction and then use the money to make campaign contributions; legalized bribes to get items on agenda before politicians.
A union is the legal collective bargaining organization for a body of workers, also known as 501(c)5 trade unions. It can collect dues, not pay taxes, and can lobby but the money it takes in is not tax deductible.
As the only legal representative a garage/station/base or agency has to redress grievances with their employer and the only entity able to establish employer to employee benefits in a periodically renegotiated Collective Bargaining Agreement.
There are currently ten separate unions representing about half of the NYC area workforce.
An additional 6,000 + NYC area EMS are non-union. Less than 11% of all American Workers are in unions.
Unions are typically part of Labor Federations; groups of unions that lobby together.
1. Local 2507– 4,500 FDNY EMS
2. Local 3621, 500 FDNY EMS Officers
3. SEIU 1199– 1,200 hospital-based EMS
4. CSEA-Hospital Based/ Private EMS
5. Locals 741– Citywide Mobile Response 500 Private EMS
6. Local 22-Hunter EMS-500 private EMS
7. Local 713-Assist Ambulance- 400 private EMS
* 741, 713, 22 are small, amalgamated union for privates
8. Local 707 is part of the major union for truckers International Brotherhood of the Teamsters. Teamsters represent many EMS around the nation.
9. IAEP-is mostly for private EMS; around 30,000 nationally
10. IAFF-for dual FF/EMS-a FF specific union many EMS happen to be in.
A “Public Advocacy Council” such as EMSPAC focuses on EMS member engagement and welfare regardless of the sector of employment.
SO AGAIN: EMSPAC is an NYS registered 501(c)3. A charitable entity whose spending has to be highly transparent and on a mission of EMS Hardship Help and Advocacy.
A 501(c)3 cannot endorse politicians and it cannot spend any large part of the budget on lobbying work or labor organizing to form or join a union.
A 501(c)4 however can lobby, can endorse candidates, and make campaign contributions.
EMSPAC helps form strategic relationships, build bridges between stations/garages/bases, and aid with messaging when dealing with the media. We help negotiate inter-union action and forge relationships with politicians, the private sector, and civil society groups.
A 501(c)3, c4, and c5 can legally be in active collaboration as long as they have distinct boards, bank accounts and do not pose a conflict of interests. They have to put a great deal of structure and legal documentation in place to prevent that perspective, or reality.
A good example would be the overlapping staff of the EMS FDNY Help Fund, a 501(c)3, and the FDNY EMS Officers Union 3621 a 501(c)5. Or, how SCEMS, a private corporation, has overlapping staff and connections to nursing homes, medical supply companies, the REMSCO Board, and various EMS Schools.
A Political Action Committee or “527” is a fund created by an alliance that is used for direct political lobbying in the policy realm and the contribution to political campaigns.
No individual stakeholder, including the owners via the AAA, has managed so far to bring money and votes to bear to achieve legislative goals.
7. How many EMTs and Paramedics are there in the Greater NYC Area? In America?
We believe there to be 15,000 EMS working or volunteering in the five boroughs + Westchester + Long Island, but it is a very rough estimation.
We carry out an annual census aided by our advocates on the ground.
That number is a little hard to pin down with many members working 2 or 3 jobs, some working 2 full-time jobs at separate garages.
IN SHORT MOST EMS WORKERS DO THE LABOR OF 2 WHOLE PEOPLE
We know that FDNY EMS has around 4,800 and they manage 2/3 of the annual 1.6 million 911 calls.
We know 1199SEIU represents about 1,200 Voluntary members and non-Unionized New York Presbyterianism EMS has around 500.
We know that Private Commercial EMS has several hundred members working at hospitals in the 911 system so you can place that total number around 2,000.
We know that the fifteen Private IFT agencies table up to nearly 6,000.
We know Hatzalah alone has over 1,500 members and there are 48 other VACs in the greater NYC area. Yet many of these overlap with numbers at paid employers. Let’s call that 4,000.
From that we estimate:
- FDNY 4,800 +
- +1199 Voluntary Hospital 1,200 (union)
- + Northwell 1,000 and NYP 500 (non-union)
- + Private contractor EMS to hospitals 2,500 (bad unions/ no unions)
- + 6,000 Transport staff in the Privates
- + 4,000 Volunteers is around the total even adjusting for overlap.
- + 500 EMS who work as site medics (construction/ film/night life)
- Thus, the total number of possible EMTs and Paramedics is above 21,050.
- Seems a little too high?
- Bear in mind again: many if not all people work in 2 to 3 places.
- So, the number we currently use is 15,000 NYC Area EMS.
- We believe there to be between 500,000 and 4 million active-duty and or retired EMS nationwide in the U.S.
8. Why do so many people leave the field of EMS?
Why do so many people leave the field of EMS?
- 70% of all FDNY EMS Workers have less than 4 years on the job.
- 4-5 years is also the national average time EMS members stay in the field.
- There is of course a huge staffing shortage currently and the powers that be are working double time to get people into subsidized (indentured) EMT classes.
- Israeli Studies estimate 5 years of full time 911 has similar PTSD effects as being deployed to an active war zone.
- Most people use EMS as a steppingstone into another career and that is because the pay is very low, the benefits are generally inadequate, and are unevenly spread out. The job of being around sick and dying people takes a physical and mental toll.
- There is a high level of disregard and contempt shown to EMS by Fire Suppression and Nursing in particular.
- There are very real stresses of being around constantly sick, dying, and maimed people.
- The job is hard on the back, body, and mind.
- We have some of the highest national rates of suicide, alcoholism, and PTSD.
- There is a total lack of respect or appreciation from owners, officers, and managers besides the yearly EMS Week BBQ, some cheap gifts not wanted or needed or some liquor drenched holiday party.
- The job is surrounded by stigma and negative energy, the public often doesn’t care if we live or die.
- Public figures like Mayor Bill De Blasio openly belittle our entire field.
- The hours are very long, the mandations are constant, you lose your civilian friends, you miss major holidays, birthdays, weddings, and funerals.
- The time off is pathetic, many agencies make their EMS MOS use it as sick time.
- Quite often “we are our own greatest enemy”; we simply treat each other like shit with a sort of garage-based tribalism.
- Agencies whether they can admit it or not actually profit from a young, disposable workforce being replaced every few years that they do not need to compensate adequately or account for.
- Physically EMS operations over time cause hearing loss, cumulative sleep deprivation, poor eating habits, weight gain, and reliance on alcohol for self-medication.
- Psychologically, EMTs and Paramedics suffer from depression, post-traumatic stress disorder and have higher rates of self-harm and risk-taking than comparable fields.
9. Which EMS Sector’s Progress will come first?
EMSPAC fights for all EMTs, Paramedics, and EMS Officers/Supervisors regardless of their Sector. Municipal EMS has specific needs and grievances, as do “the Privates” (the Commercial Sector), the Volunteers, and the “Voluntary” Hospital-based members.
Without a doubt what affects the Municipal Sector (FDNY EMS) will affect all of the other sectors based on the scale of the Bureau, i.e. 4,800 EMS. All of which have the highest levels of job security and some of the best benefits.
- FDNY EMS has the most job security with the lowest wages.
- Hospital-based EMS has the highest wages and benefits with far less job security.
- The Private sector has poor wages and poor benefits.
- Volunteers want better 911 integration, higher tax credits, greater state subsidy, and educational scholarships for working for free. This is what volunteering is no matter what one’s motive is: it’s performing work without being paid or given any benefits.
As each of their funding mechanisms is different, each union representative of the majority of these sectors (and the councils representing the volunteers) has almost preset priorities to their upcoming bargaining.
EMSPAC argues that everyone should endorse the same high-level demands articulated in the 2022 Objectives, but autonomously pursue its sector priorities.
- FDNY EMS should have direct parity with Fire Suppression.
- Hospital-based EMS should have greater security and the ability to transition to ER roles.
- Private EMS needs to be advanced across the board.
- Volunteers need better integration and tax refunds.
- Since no Sector commands the overwhelming numbers needed to form a viable “Political Action Committee” with enough fiscal and voting leverage, all 9 EMS Unions and outside allies are needed to participate in the betterment of all EMS Workers.
- Since many of the existing EMS Unions are “Amalgamated Unions”, and all are locals of larger mostly non-EMS parent federation unions without such an alliance no block of EMS workers can negotiate from a position of strength.
- Implicitly EMSPAC encourages labor coordination before lobbying.
- All EMS should consolidate behind a single bargaining agent.
- Since none of the 9 will be willing to accomplish that we should use EMSPAC as the organization of EMS Unity to change the ground conditions.
10. How does EMSPAC perceive these salary and benefits will get funded?
We think this question has to be segmented by sector.
We begin this conversation by saying that EMS is a money-making machine and no matter what hospital groups tell you, they are using it for patient steering. The FDNY EMS is subsidizing the firefighters who do not add value to medical calls. Their workforce is far too large to be justified by the annual count of working fires. There would not be fifteen private EMS companies if they didn’t make money. How many of them are owned by the same families and pose a long-term conflict of interest, self-dealing backward and forward linkages we don’t know.
- In the case of FDNY EMS, this is an appeal to a reality where 95% of all fire suppression calls are to show up briefly on EMS runs and a large portion of the daily 4,000+ EMS calls are billed to insurance companies.
- The EMS Bureau simply deserves more of the FD city budget.
- In the case of Voluntary Hospital EMS, this means a larger portion of the bill from admitted patients needs to be invested back in the EMS Department.
- In the case of the Private Sector, a larger share of Medicare and Medicaid needs to reimburse calls and more profits need to go back into payroll.
Because three different mechanisms fund these sectors we cannot expect across the industry adoption of our objectives uniformly. Unless through an EMS OMNIBUS LAW in Albany.
Are the EMSPAC Objectives “unreasonable”?
- When formulated in 2020 our “Basic Collective Bargaining Objectives” attempted to pin wage and benefit demands to those of the FDNY FF and NYPD Officers.
- In 2022 the Steering Committee revised those 15 demands to 20 called the 2022 Objectives. These are still being debated by our leadership on their feasibility or often specificity.
- In Fall 2022 the Steering Committee will change the program from BCBO to the “EMS Bill of Rights” in 20 program points. This change in language is moving from the idea of objectives as “demands” to objectives as legislation.
- Going forward Divisions or Chapters will be asked to either use the 20-Point Parity Program or form a local BCBO.
- The 2022 Objectives represent nearly verbatim benefits and wage structures of the other First Responders (PD and FF) as well as the health worker trades (RN/PA).
- Specifically those of fire suppression, law enforcement, sanitation, nursing, and PAs.
- As EMS is a “uniformed First Responder” as well as an essential medical profession that operates large vehicles we see it natural to emulate demands in directly comparable professions.
- In 2021 2507/3621 gained FDNY EMS a 12% raise
- SEIU1199 gained an 8% raise and most other entities granted a unilateral 3% Cost of Living Adjustment (that really rose by 6-7%) to shore up their staffing.
- During this period inflation rose at least 7%.
- As it is the 10 Unions, not the EMSPAC sitting with the management, we make recommendations that have to be tempered by reality-based funding considerations.
- But beginning this year we have begun a DESERT-DEAUTHORIZE-REVITALIZE program with an eye to run EMSPAC slates in Delegate races and reduce the number of ineffectual, unaccountable unions.
- That’s a nice way of saying none of these unions are going to get anywhere besides 2507/3621 and 1199 because it’s bargaining alongside 450,000 other health workers.
- We aim to set the bar far higher with BCBO 2022 but these are goals formulated around what firefighters and nurses have had for quite some time.
- Remember that unions actually train their stewards to “manage our expectations”.
- EMSPAC will assist any EMT or Paramedic in unseating a shop steward or delegate that isn’t responsive to your members.
- We will also advise any EMT or Paramedic on certification and decertification procedure through the National Labor Relations Board.
11. Is government intervention via EMS Legislation contrary to market forces and Health Care realities in the United States?
Everyone will claim that it is.
- Before anyone begins to say that pouring money into healthcare, single-payer insurance schemes, and having a heavy government role in healthcare is “radical”, “socialist” or somehow contrary to individual liberty we should look at the healthcare systems of little countries like Canada, England, France, Germany, Switzerland and all of northern Europe.
- In these places, health outcomes are better, and EMS is a career, not a steppingstone.
- Everyone will claim that what we want is unreasonable since in the status quo the owners and hospital managers as they line their own pockets.
- However, the USA has one of the most bloated inefficient Health systems on earth. It is driven by profiteering and medical apartheid for the rich and poor.
- A-State and National “EMS Advancement Law” or “EMS OMNIBUS Law” would set minimum wages and standard protections below the bar of the BCBO but certainly improve reality for the workforce.
- Coupled alongside EMS Advancement Legislation will also have to be reimbursement reforms that the private sector has long argued for. But Private Sector and Hospital System profits need to invest back in EMS.
12. Is a “20 and Out,” 3/4 Final Year Salary realistic in this economy?
- This benefit is already held by police (22 years), Firefighters (20 years), and Sanitation Workers (20 years).
- This benefit is appropriate for all high physicality, dangerous front-line essential fields and EMS needs to gain it.
- Many studies suggest a mental and physical toll EMS work takes on its members with high rates of the line of duty injury as well as burnout and suicide.
- We propose a state-administered, pay-in Pension for all full-time career EMS that carries between agencies.
- Structuring this appropriately for each sector is to be a negotiation by labor unions but this BCBO Goal is one of the most important.
13. What about Community Volunteer Ambulance Corps? What stake do they really even have in this?
- Across the country this method of ambulance delivery is dying out.
- VAC and VAC Firehouse-based EMS make up a large portion of EMS in this country.
- VAC does however have practical needs for funding and personnel.
- All VACs are 501(c)3 charities, are tax-deductible and are totally reliant on donations, grants made by politicians, and grant-making in general.
- As mostly unpaid services, Volunteer agencies still rely on grants and state funding.
- Many VACs however still pay their paramedics because sourcing them for free is hard or impossible.
- VACs are still regulated by EMS protocols and are operational assets of the FDNY in states of emergency and natural disaster.
- While VAC members are not paid or have benefits, we all perform the same functions in the field. As a result, we encourage VAC participation in the EMSPAC alliance to leverage common numbers and needs.
- VAC groups are some of the most dedicated EMS and their service should be recognized. The 49 NYC agencies take thousands of calls from the system.
- However not all VACs are the same and the ones that don’t really run ambulances should be merged or shuttered.
14. If I support EMSPAC will my job be vulnerable?
In EMS regardless of Sector the ideology of “out-of-sight, out-of-mind” took hold many years ago and got us where we are today.
No manager of any sector can encourage or allow politics on the job. We discourage activists from handing out any printed materials at work or discussing EMSPAC in units with live recording cameras.
You can be fired or jammed up for hundreds of small and big things in EMS. Constitutionally you have protected rights to free speech and association. We discourage EMSPAC activism on the job. You will get jammed up.
If you feel like you are being targeted or discriminated against for your involvement contact your union and our legal affairs unit immediately. We will not hesitate to get the National Labor Review Board involved in matters big or small.
Just remember that no other service got one raise, benefit, or protection they didn’t fight for.
Contact the Emergency Medical Services Public Advocacy Council (EMSPAC) to join us in this campaign for parity and justice.