The Real Difference

The Real Difference 

Between Police, Firefighters, Sanitation, Nursing and EMS

It takes a special person to be a first responder. There is a great deal of real danger involved in a job where a person is asked to drive and run towards an emergency that the majority of people are running away from. We compensate first responders for the readiness for that danger. In the case of EMTs and Paramedics, the city and state have basically refused to. The difference between an EMS provider and a Cop or Firefighter is not the risk involved, as Mayor DeBlasio has claimed. The real difference is rooted in demographics and failure of the EMS workers to unite and engage in industrial action as a unified group.

The New York City Council has just passed a non-binding resolution calling for parity with Police and Fire. We need to organize and lobby for such legislation to bear fruit.

EMS is a fully diverse service, the majority of which is composed of Blacks and Latinos from the city’s most underserved districts. Its members and officers are over ⅓ female with many openly gay, including the FDNYs EMS Bureau top Chief Lillian Bonsignore. Muslims, Asians, Jews and new immigrants make up a large percentage of the workforce. Approximately 13,500 Emergency Medical Technicians and Paramedics divided in four sectors and over 100 responding agencies, the FDNY being the largest unified group of 4,300.

But the real difference lies in three distinct variables. EMS daily saves human lives. EMS turns a huge profit. EMS is overwhelmingly people of color.

The real “difference” between EMS and all other services is that we are actually worth way more, though we have been bullied and self censored from declaring it. Everyone says “the very worst enemy we have is ourselves”. There is always some truth to that statement. But, we also have a great deal of actual external opposition to our call for parity and justice. Pushing against our members are an array of powerful actors that by action and inaction purposefully block our progress to parity. 

That opposition can be isolated into the following groupings. The FDNY Management, the Firefighters Union, Hospital Management, the Nursing Unions, the ownership of all private ambulance companies, the political establishment of the City and State, the current Mayor DeBlasio and very importantly our own unions which perpetuate the status quo through a “management of expectations”.  With the exceptions of FDNYs 2507/3621 and the IAEP/SEIU none of the other unions are actually dedicated to or specialized for EMS workers. In the end we are divided amid nine separate unions each negotiating for limited possibilities.

Of course the nurses, firefighters, cops and sanitation workers are completely essential. Vital and important. If not for all those heroes, and we don’t say that tongue in cheek, the city would probably come undone. Of course each of their unions and PR machines would like to sweep away the memory of the times each went on strike, repeatedly over the years. The Nurses of NYP, Montefiore and Mt. Sinai NYSNA nurses with start pay around $97,000 voted to go on strike just last year. Time and time again our heroes paralyzed the city and threatened the lives of New Yorkers for exactly the kind of normative middle class wages and benefits we in EMS are asking for today. Of course EMS would never go on Strike for so many different reasons. Most importantly because people might actually die. But make no mistake every other group of heroes has put their economic well being before their service to the city at some point or another, repeatedly.

Nurses are the integral workhorses of the entire Healthcare system.  Like a Nurse, EMS members need to understand concepts of medicine and are supervised by a doctor. In some precise ways our Paramedic skill set is on the practical level is above the  level of a nurse. Nurses definitely do not intubate people or interpret EKGs, or administer medication autonomously. Nurses work very, very hard, but they do so in controlled situations with a great deal of supervision, guidance and support. During a 1998 nurses strike at Maimonides Hospital Paramedics were used in the ER, with beyond adequate performance. The Nursing unions would like to make sure we are never allowed in an ER again. The nurses unions quite actively work to prevent any clear bridge from Paramedic to RN or PA because it would lead to a realization that people paid half what they make, with a different  background can do their job just as well on the ground. When people start whispering about an ambulance strike, which is also against the law, people say “So cruel, selfish and nearly evil, people could die.” But a nursing strike seems to be as American as apple pie. Could it be that in all the previous Nursing strikes, no one died, no one sued? That was because even higher paid nurses were bussed in to temp for them. 

“Without the Department of Sanitation a plague would overtake this city. Or at the very least trash would pile up high, the city would stink and rats would have field day.”

Like a Sanitation worker, EMS members operate a large vehicle in cumbersome urban traffic and all weather conditions, with near total disregard from the public, especially in the Bronx. We must get through the streets making pickups while the public blocks streets with their cars, darts in front of our vehicles and basically flip out when a street is blocked for an emergency. Like sanitation, we have to lift and carry,  albeit not in a rapid repetition. Sanitation doesn’t have to carry 125 Ibs of equipment up six flights of stairs and carry down people around 250 pounds or more. In some ways, like sanitation, a pause in delivery of service will potentially cost lives. Like when Sanitation went on strike during the Blizzard of 2010. “New York’s Strongest used a variety of tactics to drag out the plowing process — and pad overtime checks — which included keeping plows slightly higher than the roadways and skipping over streets along their routes.” Although the Department of Sanitation has a logo somewhat similar to EMS, and is engaged in a vital part of public health, they have regularly blackmailed the city with strikes and slowdowns. The DSNY went on Strike for 9 days in 1968. In the DSNY today after 5½ years, the salary jumps to an average of $88,616 dollars. They have a 20 and out pension.

Like Nurses, EMS members practice medicine. Like Sanitation workers we pick things up and we put them down. But EMS isn’t at the educational level of an RN or engaged in the physical rigor of a Sanitation worker. Parity is thus pegged to Cops and Firefighters. The two most similar jobs,  we basically share a navy blue uniform with and see them on the majority of our calls.

The real difference between Cops, Firefighters and EMS is not only $50,000 in wage disparity, but in what we all actually do on the job. As well as the physical and mental toll it takes to constantly be around death, dying, sickness and trauma. What our job actually results in, not theoretically, is a daily struggle to keep people from dying. A daily struggle to promote health and wellness. The police protect a system of law and order. The firefighters protect property. EMS protects human life and well being.

The police spend the vast majority of their careers fighting quality of life crime and taking reports.  111 NYPD officers were killed on duty between 1980 and 2010. Another way to think of that is 4 per year. A total of 331 NYPD employees have died in the line of duty since 1950, 5 per year. Deaths peaked in 2001, when 23 officers died in the 9/11 terrorist attacks, but the effects are still being felt today. 206 NYPD officers have died from 9/11-related illnesses, which are separate from the 331 officers who died in the line of duty. Police work is still on the 16th most dangerous American job, but decreasing in the number of deaths and injuries per year.

The job of the Police department is “to be a deterrent to crime and enforce the laws”. Statistically speaking they do not get in that many fire fights and they also do not save that many lives directly, except in a noble indirect way by keeping human tribalism and criminal instincts at bay. In 1971 the NYPD staged a Work Stoppage occuring for five days between January 14 and January 19, 1971, when around 20,000 New York City police officers refused to report for regular duty. While officers maintained that they would continue to respond to serious crimes and emergencies, they refused to carry out routine patrolling duties, leading in some cases, to as little as 200 officers being on the street in the city.

In 2014 the NYPD held a work “slowdown” for about seven weeks as political conflict between protesters, Mayor Bill de Blasio and the city’s police unions intensified. Legally, police officers can’t strike, but for 7 weeks the NYPD arrested no one except in violent crimes. For the week of 22 December, citywide traffic tickets dropped 94% from the same period in 2013. Court summons for low-level offences, like public intoxication, also dropped 94%. Parking tickets were down 92%. Overall arrests were down 66%, as well. Nobody noticed.

Though their publicists and the writers of their many TV serials would like the general public to think they do save many lives, “get the bad guys off the streets” and risk their life every single day, they really don’t. Mostly they write reports, hand out quality of life crime related fines and make quota quality of life crime collars. To justify what amounts to a highly respectable middle class wage a Salary after 5 ½ years of  $85,292 which include holiday pay, longevity pay, uniform allowance, night differential and overtime, police officers may potentially earn over $100,000 per year. 

The public didn’t even notice the Police were on strike in 2014. It had almost no impact on violent crime or quality of life. It was as if their main job was needless fines and upholding a “broken windows theory” now widely discredited. But sometimes they do get executed in their squad car, they do get shot at by criminals and they do die. And while being a cop is hard work, it sure doesn’t directly keep people alive. It doesn’t seem to slow any link between quality of life crime and descent into anarchy and most importantly, quota based policing it has led to mass incarceration, illegal/unconstitutional racist methods of policing like “stop and frisk”, and contributed to the deaths of around 1,200 people of color in police custody or killed during arrest in America each year. 1 in 100 Americans are behind bars, on probation or parole.

The NYPD has a clear resentment to the FDNY Firefighters, who are paid more to do a lot less. 95% of FDNY calls do not involve the risk of actual fire fighting. 

The Firefighters after 5 ½ years earn around 110K, they have 20 and out pensions, they work 2 days a week and they have the enduring love and admiration of much of the public. 

As they should, because encountering flames in close quarters is dangerous and risky. Although it is something done mostly by volunteers across America and tens of thousands are on the FDNY waiting list. There is also a strange macho ideology called “interior attack” which worked its way into FDNY methodology, not used anywhere else in the country. Fighting fire inside a building of a working fire instead of dumping water on it from the outside. They proudly claim this is about “saving lives” but it is actually about endangering working class people to protect property. However, because of building codes and modern technology fires make up only 5% of their total call volume. 

The FDNY Firefighters have lost 421 members in line of duty deaths since 1980. 343 on 9/11 and 222 more of lung disease and exposure later. Adjusting this in the same way NYPD deaths are arranged, that is 10 deaths a year factoring out 9/11, that number would be 2 a year.

The International Association of Firefighters says cancer is now the leading cause of death among firefighters. While thirty years ago, firefighters were most often diagnosed with asbestos-related cancers, today the cancers are more often leukemia, lymphoma or myeloma, officials say.

On Nov. 6, 1973 for five and a half tense hours, most of the city’s 10,900 firemen (they were all men) picketed outside their firehouses or simply watched as some 80 fires burned citywide, chanting ”Scab! Scab!” at makeshift firefighting crews.

Today, 95% of the time the FDNY and fire houses across America respond to medical EMS type assignments. Engine company CFRs show up on priority 1 to 3 EMS jobs, just a little bit before the ambulances because they get the call 30 seconds before. The “enthusiasm” they have for battling combustion in the shadow of 9/11 is not translated into an enthusiasm for medical first aid. It is very well documented by now that firefighters leave calls without being released or even assessing patients, firefighters not giving even the most basic report before asking “if you guys got this” to EMS, as well as firefighters abandoning EMS crews before anyone even knew the status of the patient.

Firefighters do sometimes give oxygen and do CPR, in varying combinations of one or two hands, which is to say they don’t do it well a great deal of the time, they do give “lift assists” and they vary radically in level of respect by fire house. They do anything they can to get off the scene as fast as they can. Although they have around 48 hours of CFR training, and some of them are or were EMTs and Paramedics, they don’t ever take vitals. They rarely if ever give any meaningful reports. Then, they remain out of service for 30 to 40 minutes after the release of care. It is also very expensive to send 5 firefighters to participate in this insulting charade. By the hour the same cost would fully fund 4 or 5 entire BLS ambulances. Thus also ending the excuse of their wider geographic distribution.

During the Covid 19 Pandemic they were released of these responsibilities for the worst 2 weeks. For the next worst 4 weeks they slowed down and regularly abandoned EMS crews in the field. 

They had so much time on their hands they took to feeding nurses on television and turning out for the daily public clap. During the course of the pandemic over 30% of the FDNY went out sick. Over 1,000 EMS members and over 2,000 firefighters. The rapidly overwhelmed 911 system had to call in hundreds of the very same private ambulance EMS providers they so regularly denounce and make life difficult for on a  daily basis. That is because the FDNY was unable to manage the pandemic response, as it is unable to manage the normal daily call volume.

9/11 type terrorism, Superstorm Sandy or pandemics aside the FDNY only manages to staff ⅔ of the 911 ambulances. It’s EMS members resign after just 4 years from poor conditions and low wages. It is also the lowest paid 9/11 employer in the City of New York.

There are of course many very brave firefighters, no one begrudges them their good wages and benefits, but they don’t treat EMS workers very well, especially not the 4,300 FDNY EMS workers they share a uniform with. On every conceivable level of abandonment, FDNY firefighters use a combination of the 9/11 legacy and the leverage of their political weight to force an inefficient model of response on the taxpayer. We are literally paying for a loud and nearly useless show since there is no reason that 2 EMTs and 2 Paramedics and a Lieutenant with a Lucas automated compression device cannot manage a cardiac arrest. There is no reason to have 11,000 firefighters when 95% of the calls are EMS calls. There is no reason the FDNY cannot pay its members a living wage in their city.

The realization that our workforce is also a billion dollar operation means that not only do we get exploited, we are propping up the establishment which exploits us.

Parity is a justice whose time has come for people who serve this city. We deliver your babies, we bring back your dead, we carry your wounded off the bloody streets. We check on your grandparents, we bring the ER into the homes of the poorest and most vulnerable, we head to the fires with the firefighters, we careen with ungodly speed towards the shootings of police and gangsters alike. We are there when you are born and when you die. It takes an unknowable toll on our bodies, minds and souls.

Amongst ourselves we must defeat ethnic, garage, agency, union and sector tribalism. No single faction or group has enough members to win this fight. The cops, the firefighters, the nurses, the sanitation workers, the teachers and bus subway operators. They have all used their “essential nature” to bargain for better wages and workplace rights.

EMS will never strike. Because people will actually die, because every day in big and small ways we actually are simply essential. So we are left with two strategies moving ahead and we need to unite 13,500 strong around them. First, we need to tighten the belt, unite the ranks across all sectors and step up the hearts and minds game in all districts. Second, we need clear concise united demands backed up by escalation of industrial action.

If the City Council is allegedly now behind us on parity and the public knows how hard we grind for them before and after Covid 19. We must look our mayor,  managers, unions, institutions namely the FDNY Management, the Hospital Groups and the CEOS in the eyes. We need to say in one voice, “As long as there is blood in our eyes and there’s pain in our backs. As long as we can’t afford the good schools. When we can’t afford to live here and you are unwilling to help us advance our lives! We won’t turn our backs on the public ever, but we can hit you in the pockets. And the public will approve.”

Never forget that the price of one ambulance ride is billed from $724 to $4,000 and that our median wage is $18 an EMT and $25 a Paramedic per hour. Never forget that we do over 4,000 911 calls and 2,000 private calls per day. Never forget that we are completely essential. The time for Parity and Justice is now.

By Walter Adler | Paramedic 

EMS at 9.11

EMS Providers Recall 9/11

There was no way to fully plan for what happened on Sept. 11, 2001 because no one could ever have expected the massive loss of life and destruction that occurred simultaneously in New York City, Arlington, Va., and Shanksville, Pa.

“It was the unexpected times the unimaginable,” said former Fire Department of New York (FDNY) EMS Chief John Peruggia.

Those who responded to 9/11 have not fully survived the event—because what they experienced has not ended. The trauma of that day continues to plague the physical and mental health of many of the responders and, in many cases, shatter their families in a never-ending reverberation of pain and suffering.

The reality is that the death toll from the attacks grows larger each year. And although physical wounds have healed, the emotional scars remain for many of the responders a decade after 9/11.

However, the ripple effect of that day hasn’t been all bad. In New York City, it has led to many positive changes, the likes of which even seasoned responders never imagined, including an internalized culture of safety that’s widely accepted and practiced; a newfound respect and cooperation between fire and EMS personnel; and even—gasp—New York City firefighters and police officers taking the first baby steps toward building a foundation of trust.

None of these changes would have happened without the cataclysmic event we call 9/11. Twenty years later, we look back and remember.

The Way We Were

The primary EMS provider for New York City is the FDNY EMS Division. In addition, more than 30 hospital systems (referred to as “voluntaries”) contract with the city to provide 9-1-1 response units, delivering full-time, professional BLS and ALS service to specific areas of the city. In 2001, there were approximately 950 ambulance tours every day for a city of more than eight million residents and countless tourists.

On 9/11, 24 EMS supervisors were involved in the World Trade Center incident, along with the crews from 29 ALS and 58 BLS units. Assuming each unit had a minimum two-member crew on board, nearly 200 EMTs and paramedics were on site when the towers fell. By evening, an estimated 400 additional EMS personnel had made their way to the World Trade Center.

Arlington

What many people failed to realize on 9/11 is that the Pentagon, while not as tall as the World Trade Center’s Twin Towers, was occupied by more than 23,000 people and is one of the world’s largest office buildings. The 6.5 million square-foot structure has 3.7 million square feet of office space, three times the floor space of the Empire State Building. The Capitol could fit into any one of the five wedge-shaped sections. It has 131 stairways, 19 escalators and 16 parking lots.

Because of the high security around the building that is headquarters to our nation’s Department of Defense, and its expansive security perimeter, which includes 200 acres of lawn, the Pentagon incident appeared to be much smaller than it actually was.

Although the death toll at the Pentagon was less than that at the World Trade Center, the same command and control, firefighting and associated physical and emotional stressors were present in the Arlington, Va., incident.

Then the Towers Fell

The first EMS crews to arrive at the World Trade Center had established staging areas and began triaging patients, per protocols. They started transporting burned and traumatized patients to nearby hospitals. They dodged the falling bodies of people who elected to jump more than 100 stories to their deaths rather than die in the fires that raged on the upper floors of the north and south towers.

The responders who were there that day, say that the sound of those bodies crashing to the ground will haunt them for the rest of their lives.

Then the towers fell.

Surprised to find that they were still alive, the men and women who were on scene began what could be described as “the long climb to recovery.” Crawling out from under vehicles after what seemed like an hour of entrapment in a suffocating environment and wading through mountains of debris, they entered a new reality—a post-9/11 world. A world of darkness, choking air and “deafening silence.”

“I remember that first breath,” says Al Kim, executive director of Westchester (N.Y.) EMS. Searing hot and acrid, it could barely be called air.

Kim had been walking toward the lobby of the South Tower when it started to fall. Like many at the scene that day, he mistook the roar of the tumbling building for the third plane that was reportedly heading to New York. He dove under a New York Presbyterian Hospital sport-utility vehicle for protection.

When he finally emerged, a thick blanket of gray dust blocked the sun and covered everything within his limited eyesight. The eerie silence was pierced by a single sound—the PASS alarms of hundreds of firefighters. It’s an audible alarm that signals a firefighter is no longer moving. It was a sound he had never heard before—and never wants to hear again.

Physical Toll

The lasting effect of 9/11 is the physical and emotional toll that continues to plague those who responded. New York City’s officials estimate that more than 21,000 people who worked either on a paid or volunteer basis after 9/11 have developed physical and mental disorders as a result of their exposure to toxic substances and traumatic experiences. Most of the responders we spoke to for this article in New York; New Jersey; Arlington, Va.; and Shanksville, Pa., described some degree of physical or mental impairment. For many, the effects cost them their livelihoods and/or relationships.

Since 9/11, many serious health issues, such as chronic respiratory infections and gastrointestinal diseases, have been directly related to the acrid dust and smoke breathed by those on scene. Testing completed by the EPA in the days following the collapse of the towers revealed a complexity of chemical compounds and particulate structures unlike anything ever encountered.

Dust particles, especially those in the air immediately following the collapse of the buildings, were measured at 10 microns or less; particles so small that they are capable of doing damage regardless of the chemical content because of their ability to be inhaled and transferred deep into the lower lungs.

For years, first responders fought for health benefits to help pay for the expensive tests and treatments they required. Gradually, as studies acknowledged that the health issues were due to exposure to toxins as a result of the 9/11 attack, responders began to receive healthcare coverage, but how much and when varied widely.

On Jan. 2, 2010, President Barack Obama signed the “James Zadroga 9/11 Health and Compensation Act,” establishing the World Trade Health Program. It will provide $4.3 billion in federal funding for both treatment and financial compensation to those suffering effects of the attacks. This is a help, but due to the slow-moving wheels of bureaucracy, it comes very late for responders who had already endured years of fiscal, physical and emotional hardship. Some have already died.

Emotional Toll

Even 20 years later, many of the responders are haunted by quirks of fate that day. If a partner hadn’t been late to work, that crew would have been beneath the tower when it fell. If the building had held up for just a few seconds longer, another person wondered if they would have made it into the lobby and certain death. The decision not to take shelter in a subway stairwell or simply to run left instead of right, made the difference between life and death that horrible day. In psychiatric circles, these feelings are called “survivor’s guilt.”

For most of the personnel we interviewed, the initial anxiety has subsided, although several said they’re still uncomfortable above the third floor in high-rise buildings. Some say they have a tendency to hurry their patient out of high rises and into the confines of their ambulance located on the firm ground below.

However, many continue to be plagued by nightmares, especially as the anniversary of 9/11 approaches each year. Some are still being treated for post-traumatic stress disorder. A number of them no longer work in EMS. Some have sought professional counseling. Others wish they had.

“It was extremely difficult because most of us went back to work that day or the next day. We didn’t have any time off to sort of reflect and recover, which I’m not sure now was a good thing or a bad thing in the end,” FDNY EMS Division Chief Janice Olszewski says.

“When I drive past the site—and I do quite frequently—I still get little butterflies in my chest. I mean, all this time later,” she says. “That’s how strong this kind of [exposure to] trauma is.”

Others can’t bring themselves to look at the World Trade Center site. “I drive with my head turned away and hope I don’t hit a car in front of me,” says former FDNY EMT Frank Puma. After 11 years at FDNY, Puma retired following a non-9/11-related injury. “I try not to let it consume my life. I still have my issues with it, you know. Things that will never go away,” he says.

When you ask what the most vivid memory I have of 9/11 is, what represents the most emotional stress on me and many others that day, it was the smell; the smell of death.

That morning … You know, we’ve all smelled dead bodies; freshly dead bodies. I’m not talking about decomposed bodies [that have a distinctly different smell]. At Ground Zero, there was that smell of blood and death … coupled with the smell of lots of things burning,” says Lahita.

“And there were trees that had no leaves. Pieces of clothing, like dresses and shoes and stuff. I would look up—there was catastrophe. I would look down—there was catastrophe. Everywhere I looked, things were burning. It was like something I’ve never seen. And I hope I never see it again. It came back to me recently when I saw images of Joplin, Mo. It was similar to that, but worse because at Ground Zero, there was also a sea of dust mixed in with all the wreckage!

One of the firemen I was working with a few days after 9/11 made an observation that’s still unfathomable to me and many others who were at Ground Zero. After the collapse, you did not see any contents of the towers that were intact or in their original composition; no chairs or desks or file cabinets, or windows or computers … Just a lot of dust.

It was like everything was totally vaporized. And I mean that. There was nothing that was recognizable. Everything was literally vaporized,” Lahita says.

After 9/11, many say it was hard not to bring those emotions to work. Or worse yet, they bring them home.

Sean Boyle, a Bayonne (N.J.) firefighter and per diem EMT with Jersey City Medical Center, part of LibertyHealth in Jersey City, says that, since 9/11, he and many of his colleagues in EMS, fire and law enforcement no longer sit with their backs to the door when in a restaurant or other public place. He says, “Most responders today have the mindset that they have to walk around with their head on a constant swivel.”

Families

Relationships, marriages and family cohesiveness have also been significantly strained and broken in the aftermath of 9/11. Although there’s no official record, unofficial reports suggest that the divorce rate is high among 9/11 responders. It’s unclear whether the struggle just became too much for some relationships or, like some have suggested, surviving this country’s worst terrorist attack gave those responders a new sense of purpose and perspective.

“I think if you really take to heart that life is short and you should appreciate everything you have … [and] not worry about the small stuff, then, that could take a toll on those around you; or it could be beneficial,” Kim says.

Part of the problem may have been that spouses were left out of the counseling loop. Although counseling was offered to the responders through work and to many of their children through their school, there was no organized effort to assist the wives, husbands and significant others who inherited the emotional victims who suddenly became quiet, silent or different inside.

Getting Help

“We were very fortunate in that we had a peer counseling program set up before 9/11,” says Jack Delaney, retired director of New York Presbyterian EMS. The problem, he says, is that some of our paramedics wouldn’t go for any kind of counseling because doing so could eliminate any chance of getting hired by the fire department. To work around that, New York Presbyterian established a peer counseling program.

“One of the most important aspects of our department before 9/11 was our focus on behavior health. Working with our Employee Assistance Program, we develop trusted relationships with their counselors that contributed to our overall wellbeing during and after the tragedy,” says Arlington County Fire Chief Jim Schwartz.

Responders like former FDNY Deputy Chief of EMS Charles R. Wells, who have taken advantage of the counseling, found it to be of significant benefit. “There’ve been setbacks along the way. You get nightmares. You get times where you have these feeling of impending doom. Thank God for the counseling unit … because they’ve been miracle workers, with me anyway,” he says.

In many cases, the relationships that allowed couples to share their love for EMS and their love for their partner seemed to cave under the excessive emotional pressure and attention the rescuers paid to the job or recovery efforts after 9/11.

To find closure, some responders needed to bring the event full circle. For Olszewski, it meant retracing that day’s steps. Initially it was hard to get her bearings, she says. The landscape is so dramatically different. One day, she returned to the front of the Millennium Hotel, where she was standing when the north tower fell. She walked past the church on the corner, the subway stairwell she nearly ran down into and finally onto Broadway Avenue and safety. “I felt better when I did that,” she reports.

Puma says it helps him to talk about it, but, like many others, he’ll only talk to people who were there that day. “In the beginning I didn’t want to talk about it to anybody,” he says. Eventually, his wife convinced him to open up a bit and participate. She reminded him that someday his baby boy is going to have questions about 9/11 and his father’s role on that terrible day. “Whether you like it or not, you’re a part of history,” she told him.

A few responders, like New York Downtown Hospital paramedic Juana Lomi, emerged from 9/11 feeling affirmed. At first, she says she spent days locked up in her room crying. But she was able to gain perspective by writing a personal journal about her experience and her feelings afterward.

“I think the whole incident … was like a defining day, but it was also a day of confirmation of what I, we, live life to do,” she says. “I made it out of this one, so I better do something better. Keep doing what I’m doing, because it must have been … God’s will that I be there and I should keep myself [in EMS] until I can’t do the job anymore,” she says.

Lomi is the only employee left at New York Downtown who responded to 9/11.

Lessons Learned

“Our system of regional automatic and mutual aid, developed over several decades, was a significant advantage. Units from our neighboring jurisdictions, with whom we work every day, fit into the response as if we were one organization.

Terrorism had been an area of focus for us before 9/11, and one of our most important partners was the FBI. They established a liaison with the Fire and EMS departments in the region in 1999 and were training with us on the morning of September 11,” says Schwartz.

Since 9/11, FDNY approaches EMS and fire operations differently. “We all talk about our careers as before September 11th and after September 11th, and it’s been totally different,” says FDNY Fire Commissioner Salvatore J. Cassano. “It certainly has changed the way we do business. It’s changed the way we think about our job in that we don’t just fight fires anymore. We have so many other responsibilities.”

The first order of business for FDNY was to assign new leaders for the fire department. When the towers fell, the FDNY lost Chief of Department Peter J. Ganci, First Deputy Commissioner William Feehan and 21 other chiefs. Lost with them was significant experience, institutional memory and decades of succession planning.

Those who were left had to step up. On the morning of 9/11, Cassano was a citywide tour commander. Within 24 hours, he was named acting chief of operations, second only to the chief of the department. The formal promotion came just days later. He vowed to institute changes that would guarantee this type of catastrophic leadership void would never happen again.

To that end, FDNY embraced the National Incident Management System (NIMS), putting its own twist on it and dubbing it Citywide Incident Management System. With the help of a NIMS team from the Southwest IMT, FDNY has learned how to better staff and manage long-term incidents, sending only those who need to be at the scene directly to the incident site.

A state-of-the-art fire operations center at FDNY headquarters in Brooklyn was created after 9/11 and now uses live video feeds from police helicopters and Department of Transportation cameras, digital photography, and multiple maps and displays to give ranking officers a global view of an incident and avoid the need to have all command officers on scene to direct operations.

To groom future leaders, the department began an aggressive leadership training program. “We send our staff chiefs to all kinds of management schools,” Cassano says.

In 2002, the fire department established the FDNY Fire Officer’s Management Institute (FOMI), an executive program to provide fire and EMS chiefs with leadership and management training.

In 2004, then EMS Chief Peruggia became the first member of the FDNY to complete the National Fire Academy’s Executive Fire Officer Program, a four-year course aimed to develop leaders in the field of fire service. Since then, six more officers have participated in the program, including Olszewski.

A New Culture of Safety

EMS and fire personnel have a new perspective on safety since 9/11. Looking at the risk/reward through a different lens, the safety of the EMS providers is paramount. “We’re the ones who are going to have to treat the patients, so it’s better to take a safer approach,” says FDNY EMS Command Chief Abdo Nahmod. “We have learned to work smarter and safer.”

New “recall packages” deploy personnel depending on the type and size of an incident. A recall may now involve only 25% of personnel, leaving 50% to relieve the other 50%. Or, if the incident warrants it, only special operations command personnel may be recalled.

According to Cassano, FDNY has quadrupled training since 9/11. “We got fanatical about training, and between training and safety, we’ve been pushing each incredibly hard since then,” Olszewski says.

FDNY’s Certified First Responder Program is helping to improve the relationship between FDNY firefighters and EMS personnel. The program is also part of the curriculum for all probationary firefighters. “It just becomes part of their job vs. something that’s thrust upon them that they didn’t bargain for,” Olszewski says.

Other joint training efforts include firefighter Mayday drills that involve EMS crews. Previously, firefighters would run right past EMS crews with an injured firefighter, not knowing exactly where to take them. Today, Olszewski says the emphasis is, “Bring them to me. I care. I want to help him. I think that’s a big deal,” she says. FDNY also now offers a formal rehab process for its members at all major incidents.

Nahmod and his colleagues in Virginia, and Pennsylvania say that all agencies have learned an important lesson about collaboration since 9/11. “No one agency can handle an incident like this,” he says. “It’s the dialogue that makes it happen, not the technology. You have to figure out a way to collaborate.” FDNY does close to 100 drills with various agencies. It has also established inter-agency liaisons with police and fire to address issues before they become unmanageable. Nahmod admits that there are no Kumbaya sessions yet, but it’s a start.

New Programs

“We in EMS here in New York City have learned to adapt to the ever-changing threat landscape,” Peruggia says. “We are doing great things to serve the people we protect.” In the fall of 2011, the EMS Division deployed a new, triage tag with an orange triage level to identify patients who develop a major medical issue as a result of the incident, not because of it.

“Initially those kind of chest pain or difficulty breathing patients were tagged green because they would be the walking wounded,” Asaeda says. But even with diligent re-triaging, these patients can get lost in a mass-casualty incident. The orange tag category now allows EMS personnel to identify these patients early as a medical triage and get them the treatment they need.

Increased Awareness

There are fewer and fewer of the first-to-arrive 9/11 responders left working in New York City. Those who are still on the job are different. They’ve seen the face of evil, and it has changed the way they work and train. “We realized now … it has affected many, many people, and we just don’t know to what extent,” Asaeda says.

Olszewski says she knows from her firsthand experience on 9/11 that she may again need to deploy the new protective equipment, such as the compact respirator assigned to each member. For others, it may be just another piece of equipment to leave on the ambulance. “But having been through 9/11, I take it with me. And I encourage those under my command to do the same,” she says.

Orlando Martinez was promoted to lieutenant in 2011. As a FDNY EMS officer, he finds that his experience 10 years ago as a responder on 9/11 gives him a valuable perspective. “I’m definitely more aware,” he says. He’s also very protective about the younger personnel working the job. “I’m there for their safety,” he says. “And I’m very emphatic in my orders for the crews to wear the protective gear issued to them.”

For Martinez and his colleagues who responded to the Pentagon, their hyperawareness doesn’t end when their shifts are over. The responders are now aware of all the exits when they are in public places. “It’s always in the back of my mind,” says Martinez. The negative aspect of this new “watch your back” thought process is that it has subtly added extra stress to the lives of responders and their families when they’re supposed to be “off duty.”

What’s Next?

Everyone has their own ideas about what the next attack would look like. Cassano says it doesn’t really matter. It may not be a terrorist attack; it could be a tornado. Rather than focus solely on terrorist attacks, FDNY takes an all-hazards approach to major incidents, something Cassano says all emergency providers, no matter where they live, should consider.

The key is to provide for the safety of emergency workers so they can provide for the safety of the public they serve.

Cassano says that the personnel at FDNY feel a profound gratitude for all the assistance they received following the attacks and they want to give back. “We’d love to share what we’ve learned,” he says.

“We needed a lot of help to recover after September 11th, and we got it from a lot of different departments throughout the city … state, the country, the world. Whether you’re the smallest department in the country or whether the FDNY, we’re all in this battle together,” he says.

Conclusion

As the 20th anniversary of 9/11 approaches, many of the responders we spoke with said they choose not to participate and, in fact, many who can, plan to leave town during the event.

The reality is that the responders to each 9/11 attack site will never be able to forget what they heard, felt, saw and struggled with that awful day. Each responder realizes that they must move on with some semblance of normalcy in their lives. And each agency involved in the 9/11 incidents has learned much from their experiences, struggles and stresses. They’ve instituted new processes to better manage incidents in the future. 

Flight 93

Jill Miller, manager of the Somerset Area (Pa.) Ambulance Association on 9/11, responded to the crash of United Airlines Flight 93 in Shanksville, Pa., as a paramedic on the second-arriving ambulance. She then assumed the position of on-site EMS coordinator.

“What I remember most about that day is the utter shock that there was actually a plane that had crashed. The plane crashed into unsettled Earth, which was then thrust into the air and completely covered in the ground. There was very little debris and even fewer pieces that appeared to be from a plane.

Several days after the incident, when I was made aware that the plane was actually beneath the ground where we first parked and walked, I could not fathom the possibility of it all. I remember that it was one of the most beautiful fall days I could ever recall. The sky was bright blue, and the sun was shining. I pay more attention to those kinds of days now,” she says.

Christian Boyd, a full-time EMT with Somerset Ambulance that day, realized that in less than five minutes, there were no survivors, and there would be few intact bodies to be recovered.

Boyd says that no matter how he tries to forget the crash of Flight 93, he still has vivid memories and subtle reminders of the incident. And, like other responders from New York City and Arlington, Va., after that day, he initially refrained from returning to the crash site. It wasn’t until November 2002 that Boyd drove past the site.

By Teresa McCallion, EMT-B

EMS Martyrs of 9.11.01

EMT Maurice Bary PAPD/ Rutherford Ambulance 

Paramedic Bob Cirri PAPD

EMT James Coyle FDNY FF

EMT Brian Ellicott FDNY EMS

Paramedic Keith Fairben 

NY Presbyterian EMS

EMT Andre Fletcher FDNY FF

EMT Rodney Gillis NYPD ESU

EMT Lauren Grandcolas No Affiliation

EMT Linda Gronlund No Affiliation

EMTJoe Henry FDNY FF

Paramedic Felix Hernandez FDNY EMS

Paramedic George Howard PAPD

EMT Stephen Huczko PAPD

EMT Karl Joseph FDNY FF

EMT Je Jung No Affiliation

EMT Thomas Jurgens No Affiliation

EMT Timothy Keller FDNY EMS

EMT Michael Kiefer FDNY FF

Paramedic Charles Laurencin 

US Air Force

Paramedic David Lemange PAPD

Paramedic Carlos Lillo FDNY EMS

EMT Cynthia Mahoney No Affiliation

Paramedic Kathy Mazza PAPD

Paramedic Yamel Merino Montefiore EMS

EMT Richard Pearlman 

Forrest Hills Volunteer

EMT Jean Peterson Madison Ambulance Squad

Paramedic Kevin Pfeifer FDNY FF

Paramedic Ricardo Quinn FDNY EMS

Paramedic Deborah Reeve FDNY EMS

Paramedic Mario Santoro 

NY Presbyterian EMS

EMT Mark Schwartz Hunter Ambulance

EMTJeff Simpson-Dumfries VA Triangle Rescue Squad

Paramedic John Skala PAPD

EMT Frank Spinelli Short Hill, NJ VAC

Paramedic Daniel Stewart FDNY EMS

EMT Marc Sullins Cabrini EMS

EMT Kenneth Swenson Chatham Emerg Squad

EMT Sean Tallon FDNY FF

EMT Clive Thompson Summit, NJ VAC

EMT Hector Tirado FDNY FF

EMT Mitchel Wallace Bayside Volunteer Ambulance

EMT Glenn Winuk Jericho FD

EMT Zhe Zeng NY Brighton Ambulance

EMT Felipe A. Torre, Bureau of Training

Paramedic Martha Stewart, EMS Station 8

EMT Joseph A. Rodriguez, EMS Station 58

The 46 EMS Martyrs of the 9.11 Terrorist Attacks. Our hearts grieve for our fallen brothers and sisters and ask everyone who reads this to honor them by contacting their families to give

support for our fallen angels, each one a hero from our ranks.

The Front of the Frontline

“Front of the Front Line”:

EMS Honors its Covid-19 Dead

Whatever the “Front of the Frontline is”, that is where the women and men of EMS always stand.

Sometimes people hand you a dead blue baby, and you have to do everything at 10,000 miles an hour. Sometimes you turn up on a huge hysterical crowd where a couple people were shot and are bleeding everywhere. Sometimes you have to deliver a baby in a project stairwell. Sometimes you show up to a tight asthmatic gagging ready to arrest. Or you bring back a junkie, over and over and over again. The same junkie. Or sometimes you show up and someone was just raped in a park. Or you show up and shots are still being fired or a building is still on fire and you have to stand across the street in case someone has been burned alive get carted out and thrown on your stretcher.

You have to rely on your training. For an EMT three-months and for a Paramedic one year.

You had to feel and to care so much to have even shown up for the training. But to keep working you have to learn to un-feel and un-care and learn to forget. 

You had to learn to drive with an efficiency and speed that allows you to get to these terrible moments quickly. You have to carry with your partner 125 pounds of gear up the stairs, or down a subway tunnel, over the river or through the woods. You have to bring the first thirty minutes of the ER out to the streets. 

EMS did this during Hurricane Sandy, we did it on 9.11 and we did this for the very worst five weeks of the Covid 19 Pandemic. We are made “different” by how much we bring, but also for being closest to the danger of an emergency, we always are bold. We leave no one behind. 

It was like a vast invisible wave broke over the city and suddenly everyone who was elderly and everyone who was infirm started going into cardiac arrest.

It was like a natural disaster, except that it wasn’t. There was no clear epicenter or limit to the contagion. There was no sense that the worst was ever over. There was no warm zone. There was nowhere to retreat to except sleep when you could get it.

For most of the Pandemic it was all of us together against an invisible relentless enemy, rapidly spreading out amid fever, cough and death. Unlike all other “front line” services, EMS was running towards unpredictable death, as usual with inadequate equipment, shortages of everything, being compensated as though it were all a summer job. 

I remember very well the worst five weeks of the Pandemic, for there we were with our ambulances, our stretchers, our chairs and our oxygen tanks, arriving at cardiac arrest, after arrest, after arrest. Using the same masks for weeks. Carrying men and women out of their homes in our stair chairs as they desaturated and respiratory arrested right in front of us. In a city that suddenly couldn’t breathe. 

In the very worst period, those five weeks of total chaos; 20% of the FDNY went out sick. Fire Fighters stopped going out on medical calls, then going in much much slower than usual. In that chaos hundreds of EMTs and Paramedics came from around the country, deployed to NYC to manage a daily call volume above 7,000 a day. All services took casualties, everyone was thanked for their service. The pandemic moved to other parts of the country. Some we saved, many we did not. 

Sometimes a civilian friend or a pretty girl at the bar will ask, “What’s the craziest thing you’ve ever seen.” And then, no matter what you say or don’t say, they change the subject. It’s just so dark what we actually have to do. Show up over and over again as people get sick or die. Over the course of the Pandemic a lot of people died one after another.

Recently, as the smoke began to clear the from Covid-19 Pandemic which killed over 22,872 New Yorkers; the Emergency Medical Services counted our own dead. 

So far there have been at least 17 active duty deaths, and 9 amid EMS retirees. Thirteen died from line of duty Covid-19 exposure. Three were from out of town. Several were 9.11 Responders, men and women with over 20 to 30 years in EMS. Several worked at Voluntary Hospitals. Most people in EMS with or without a pension can’t actually afford to ever retire.

Four didn’t die from Covid-19 directly. They died from the bullets of a gun and from drug addiction. Two from overdoses.Two commited suicide off the clock.

John Mondollo was a 23 year old probationary EMT at the FDNY EMS at Bathgate Station 18 with less than 3 months on the job. Matthew Keene was an FDNY EMS Lieutenant, an experienced EMS Officer at Station 17, the Highbridge Outpost. Which is to say one was brand new and one was quite experienced. 

Alexander Raso, a 24 year old FDNY EMT from Station 59 died from a drug overdose in the very beginning of the Pendemic. Brandon Dorsa, a 36 year old FDNY EMT was critically disabled when his ambulance was struck and flipped over in a collision in 2015. He was permanently disabled, developed serious depression and subsequently transferred to Dispatch. His death,  another an alleged suicide was reported on Wednesday 7/15.

The NAEMT published results from a survey indicating that, compared to the general public, EMS professionals had a tenfold higher rate of suicidal thoughts and attempts.

Perhaps the greatest unquantifiable stress associated with the Emergency Medical Services is the feeling that you and your partner have been trained well and tasked to save lives, but over and over again you must watch people die right in front of you. That is in essence a serious part of our job, we must day after day, night after night be there for the worst moments of your lives, realistically speaking, statistically speaking. We are only going to save a certain portion of the lives we are thrust into, called into at the very worst moment to effect. 

The very best EMT or very best Paramedic is only going to be successful some small part of the time, but on varying levels, in varying ways your traumas seep right into us.

The vast majority of people who go into cardiac arrest in a prehospital setting do not come back, and when a combination of early CPR, intravenous epinephrine and defibrillator shocks do bring them back only a tiny percentage of a percentage are neurologically intact, walking out of that hospital to see their families. Over 90%, they just die and they stay dead. They might die in an ER, or spend months or years on life support, but most do die. 

These are very unnerving, intimate moments. We are physically pumping the heart of your dead loved one. We are pushing medications, placing a tube down the airway, we are for about twenty or thirty minutes, with fire men hovering around us, angels of life and death. In the park, trains, six floor carry down tenements, 5 star hotels and housing project towers.

In moments like these, a whole family screaming and crying, your partner advancing a laryngscope blade and ET tube down the trachea of your loved one, who had just been having dinner with you. While you watch the EKG screen flicker out the signals showing what is happening in this person’s heart. You tie off, you insert an IV, you spike a bag of normal saline and begin pushing the appropriate variants of drugs or shocks per signal, the EMTs do CPR, and you try not to get blood, vomit or feces on your uniform. It’s very stressful work trying to bring people back from the dead. It also doesn’t pay the bills consistently in New York City.

So we all have 2, 3 or 4 jobs. We all work 50, 60 or 70 hours a week. A lot of the Medics are in Nursing or PA school too. It is that combination of high stress, chaotic draining interactions, lack of any respect and long long work weeks that does people in. People abandon this field the very minute they can. Most quit this field after only 4 years. 

Some go crazy from it. The rest, it changes us probably for the very worst. The saying goes “Don’t lose your civilian friends”, but you do. And for some, 10 times the national average, they give up. They take their own lives in one way or another. Like Lt. Matthew Keene and EMT John Mondello with guns. Like FDNY Paramedic Lenny Joyner who went alone up a mountain in 2012. Like EMT Alexander Raso who overdosed in March of 2020. Like many that never even made the news.

The parity issue is larger than EMS. It has to do with a wider issue of the public paying for two systems. One that’s mostly white and one that’s diverse, but the diverse system always gets less and inadequate service.

EMS “deserves more” not because it is stressful, or dangerous or how well we did during the Pandemic. We deserve more because of supply and demand. More because we generate profits. More because we do so much every day for New York.

For the sixteen Martyrs we lost, that we know about, for the nine old time EMS members who just passed for all the 13,500 men and women out right now on the trucks as we speak, let’s renew our demand for parity. Let’s be united as a service that is resourceful, resilient and diverse as the city we serve. We do as much or more as any other uniformed civil servant. We’d like to be paid like adults, to live in the city we come from. The city we serve.

Rest in Power:

FDNY Lt. Matthew Keene 

FDNY EMT Brenden Dorsa

FDNY EMT John Mondello

FDNY EMT Idris Bey

FDNY EMT Gregory Hodge 

FDNY EMT Douglas Gertz

FDNY EMT Richard Seaberry

FDNY EMT Alexander Raso

FDNY EMT-D John Redd

FDNY EMT-D Michael Lalima 

FDNY EMT-D Emilio Navedo

Paramedic Marlene Picone/ Maimonedes 

Paramedic Anthony ‘Tony’ Thomas  (HHC/FDNY EMS), NYU Langone

CCEMT-P, RN Brian Saddler/ Northwell

Paramedic Paul Carr/ Ambulnz

EMT Mike Field/ VSFD

EMT Salvatore Mancuso/ BGFD

17 Active Duty EMS Deaths

Retired MOS

FDNY Chief Edward Gabriel ®

FDNY Lt. Trudel Hiller ®

FDNY Lt. David Stone ®

FDNY Lt. Richard Dunn ®

FDNY Paramedic Robert Gibbs ®

FDNY EMT Jim Geraci ®

FDNY EMT Robert Hudson ®

FDNY EMT Robert Hudson ®

EMT Sy Collins ® 

9 Retiree Deaths

Author Bio:

Paramedic Walter S. Adler is a 16 year veteran of the Emergency Medical Services and a Native New Yorker. He served the FDNY EMS for 4 years and has served overseas in Israel, Palestine, Egypt, Haiti, Iraq and Syria. He is currently a 911 Paramedic with Montefiore EMS and BronxCare EMS in the Bronx.