Experience certainly plays a crucial role, particularly within the Fire Department of New York City (FDNY), where expertise in emergency medical services (EMS) has become increasingly important. As the department’s responsibilities evolve, the emphasis on EMS experience is more significant now than ever before.
Today, the FDNY’s primary focus extends beyond firefighting. Statistics reveal that approximately 70 to 85% of all 911 calls relate to medical emergencies, such as heart attacks, strokes, drug overdoses, respiratory issues, and psychiatric crises. Firefighters are routinely called upon to address these situations. This shift in focus is not a matter of debate; it is a reality supported by numbers. Notably, FDNY’s newly appointed commissioner, Lillian Bonsignore, brings a wealth of experience from her background in EMS.
This transformation has been developing over several decades, highlighting a critical imbalance within the department. While EMS handles the lion’s share of the FDNY’s workload, it remains the most understaffed, underfunded, and underpaid branch among its uniformed services.
Demographic differences between the FDNY’s uniformed branches also contribute to these disparities. The EMS workforce is predominantly composed of people of color and women, while the firefighting division is largely male and predominately white. Despite EMS personnel responding to the majority of emergencies, they constitute only a small portion of the workforce and receive an even smaller slice of the budget. Investment in EMS has not kept pace with the increasing demand, resulting in a growing gap between resources and call volume.
This situation poses a genuine threat to public safety.
What’s often overlooked in discussions about the FDNY is the link between respect, value, and operational outcomes. The department’s persistent failure to regard EMS as an equal uniformed service has serious repercussions. This oversight contributes to low morale, high turnover, reduced service quality, unequal treatment, and jeopardizes the lifesaving care provided to New Yorkers. These issues are reflected in record-long emergency response times and chronic staffing shortages.
Up until now, EMS has never been properly resourced. The predictable result has been burnout, forced overtime, a discriminatory work environment, and a system stretched thin precisely when the city now needs it most. When people die waiting for help, it is not because the fire commissioner lacks firefighting credentials — it is because the medical side of the house has been under resourced and allowed to lag far behind the reality of modern emergency needs.
Bonsignore’s appointment represents the first meaningful acknowledgment, at the highest level, of the importance of the EMS uniformed service within the department. It is a first step toward recognizing, valuing, and properly resourcing EMS first responders — which will ultimately save lives.
Understanding this requires understanding the role of the fire commissioner.
The commissioner is a civilian executive — always has been. The job is not to command scenes or run suppression tactics. It is to manage a 17,000-person agency with a multibillion-dollar budget, set strategic priorities, secure funding, and navigate City Hall. Operational authority runs through the chiefs of fire operations and EMS operations, as it does in every large paramilitary organization.
Elon Musk claiming that “people will die” because the new commissioner comes from EMS reflect a fundamental ignorance of both history and governance. No one serious is suggesting that Bonsignore’s appointment will result in more lives lost. Most past commissioners were not firefighters, not first responders, and in some cases not public-safety professionals at all — and those appointments did not provoke panic about mass casualties, or even comment.
The FDNY is confronting a reality in which its primary mission is medical care, operating alongside a health care system under immense strain. Leadership that understands EMS from the inside, while also possessing the administrative experience required to run a massive agency, is not a liability. It is a necessity.
Given its long history of bias and challenges with discriminatory employment practices, it is no surprise that much of the opposition to Bonsignore has defaulted into accusations of “DEI,” despite her decades of uniformed service experience. This bias must also be remedied for the FDNY to properly meet the needs of the 21st century.
And to be clear, addressing these inequities does not diminish the heroic work of firefighters. Their service must continue to be recognized, valued, and rewarded. Including EMS in that recognition only helps all members of the FDNY, which if properly structured and resourced for modern emergency response would strengthen fire operations and deliver better outcomes for everyone — most importantly New Yorkers.
Almojera is an FDNY EMS lieutenant and vice president of Uniformed EMS Officers Union Local 3621 and author of “Riding The Lightning: A Year in the Life of a New York City Paramedic.”
