Dear Commissioner Bonsignore:

Congratulations on your appointment and for being the first FDNY commissioner who has worked among the rank and file of New York City EMS.  We are paramedics and EMTs who work in that system too.  Each and every day, we respond to thousands of calls throughout this city, and are privileged to care for so many people.

Based on this experience, we feel that the “closest hospital” mandate implemented on March 12th, 2025 under your predecessor is not only ineffective but counterproductive.  We strongly urge you to rescind this misguided policy.

Since the policy was implemented, average scene-to-hospital transport times have decreased by a mere 26 seconds when compared with the prior year.  This marginally shorter transport time has had no meaningful effect on end-to-end call times or on-scene times, which are both now slightly longer.

Even worse, the overall average EMS response time has actually increased by three minutes under this policy and responding to life-threatening emergencies now takes 39 seconds longer than it did before.

For these reasons, it is clear to us that the policy has failed.

It is also deeply unfair to our patients.  Patients often have legitimate reasons for going to a particular hospital rather than the closest facility, especially those who have complex medical conditions.  Continuity of care and the concept of a medical home must be balanced against the system’s operational needs.

While we do not know from public data why patients refuse transport, we do know that the percentage of calls that end as RMAs has increased since the policy was enacted and we believe this likely reflects patients who refuse transport solely due to destination.  As paramedics and EMTs, we strongly feel that shaving 26 seconds off a transport is not worth the inherent risk that patients must accept by refusing transport altogether.

Finally, this policy is especially unfair to our city’s veterans.  These men and women served their country and have a right to use the city’s VA hospitals.  While transporting to these hospitals has always required medical control authorization, such transports are now almost never approved.

We agree that EMS response times must be addressed but there are better solutions than this.

Please consider:

1. Ten Minute Rule    Revise the department’s transport policy to reflect the “ten minute rule” found within NYC REMAC General Operating Procedures.  Response times, scene times, and end-to-end times were better under the old policy.
2. Proactive Field Supervision    While we appreciate our field supervisors and their hard work, we feel that they are underutilized.  One in ten EMS responses is ultimately unfounded.  Such calls tie up ambulances that should be available for true emergencies.  Whenever possible, supervisors should be proactively responding to calls that may be unfounded in order to cancel responding units that are not needed.
3. Dual Response Pilot    Many neighborhoods, several colleges, and Central Park have their own dedicated volunteer ambulance corps.  These providers freely give their time to support their communities.  Many such agencies have been around for decades yet have never been integrated into the 911 system.  FDNY EMS should select one or two volunteer agencies and dispatch them as co-responders in their catchment areas, along with the assigned 911 units. Inevitably the volunteers will be able to cancel some of those 911 units, keeping them available for other calls at minimal cost to taxpayers.
4. Category “V” for Veterans   Let’s make things easier for NYC veterans on America’s 250th Anniversary.  These men and women deserve our gratitude and respect, and have certainly earned the right to go to a VA hospital if they choose.  It is not difficult to verify their status (no need to call medical control to check an ID) so allow crews to select these hospitals as a destination for veterans who do not need specialty care by picking a new Category V on their MDT.

Notes: Statistics compiled from EMS Incident Dispatch Data by comparing 3/1/2024-3/1/2025 with all calls since 4/1/2025.