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.

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. 

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.

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.

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.

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.

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.