
Threats to New York City’s EMS personnel are significant and have changed over time.
During 2022, New York City saw a paramedicine clinician brutally stabbed to death, the 100th paramedicine clinician to die as a result of the September 11, 2001, terrorist attack, and the 147th ambulance service provider to suffer an occupational fatality. Over the past five years alone, 34 paramedicine clinicians, including 23 members of the FDNY Bureau of Emergency Medical Services, died in service to the citizens of New York City.
Introduction
A horrible tragedy occurred in New York City (NYC) on September 29, 2022. NYC Fire department (FDNY) Bureau of Emergency Medical Service (BEMS) Lt. Alison Russo-Elling, was fatally stabbed while on duty.1 The lieutenant had worked for a quarter of a century with the BEMS, including as a responder to the September 11, 2001, attack on the city.2 It was a brutal, senseless murder. Her attacker was quickly apprehended3 and was reported as having a history of mental health conditions.4 She was laid to rest on October 5, 2022.5 Her tragedy evoked memories of Yadira Arroyo, a woman brutally murdered in 2017,6 and of the many other dedicated ambulance service professionals who died in service to the citizens of NYC.
In the hope that these tragedies can lead to some positive change, this paper highlights the many dangers faced by emergency medical services (EMS) personnel in NYC. Recognizing and quantifying the risks are necessary precursors to efforts to develop, test and implement risk reduction initiatives.
The first research to document occupational fatalities among EMS personnel in the U.S. determined that they have a fatality rate that is about three times higher than the rate for all U.S. workers and is comparable to the rates for firefighters and police.7 The researchers calculated that the homicide rate for paramedicine clinicians was seven times higher than the rate for healthcare workers, about twice as high as the rate for firefighters, and about 40% higher than the average rate for all workers in the U.S.7 About 8% of fatal injuries among U.S. paramedicine clinicians are homicides.8 International research has found that paramedicine clinicians in other countries have high risks of violence.9,10 Women working in EMS have a disproportionately greater risk of violence-related injuries.11
The COVID-19 pandemic also contributed to the risks faced by paramedicine clinicians. Between January and August 2020, four paramedicine clinicians in BEMS died of COVID-19.12 Nationwide, 36 paramedicine clinicians died of COVID between March and early September 2020; the calculated rate of COVID deaths for paramedicine clinicians was higher than the rates for police, firefighters, nurses and physicians.13
The NYC EMS system is an appropriate study site since it is the largest and busiest EMS system in the U.S.14 The NYC EMS system is somewhat unique in that it includes over 70 independent agencies that provide EMS in the city;15 the FDNY BEMS is one of the over 70 agencies. The BEMS paramedicine clinicians, along with the paramedicine clinicians employed by about 13 hospital-based ambulance agencies, together responded to 1,862,159 emergency medical calls in NYC in 2018: an average of 5,100 calls a day.16 During COVID, the call volume at times rocketed to over 7,000 calls per day.17,18
In recognition that the roles and training of ambulance personnel in NYC (and around the world) have been evolving since the 1800s, we use the term ambulance personnel mostly to refer to earlier generations, and the term paramedicine clinicians to describe the more contemporary emergency medical technicians and paramedics who have staffed the ambulances in NYC for about the last half century. The names of the deceased are included to honor them and their service to the citizens of New York City.
The objectives of this article are to: provide a historical perspective on the fatalities among persons working in New York City ambulance services from 1893 to present; determine the rates of fatality for paramedicine clinicians in BEMS; and to compare the calculated rates to the national average for all workers in the U.S.
Methods
Study design
This was an open cohort study.
Setting
The analyses focused on personnel who worked in New York City from 1893 to 2022.
Population
The population was defined as those individuals who met the following criteria: 1) employed by, or a volunteer for, an agency providing ambulance or emergency medical services, 2) died since 1893 from a work-related cause, and 3) worked in New York City.
Variables
The research focused on occupational fatalities.
Data sources/measurement
Co-author Scot Phelps collected the fatality data. Searching was performed over several years as part of the New York Ambulance History Project to identify ambulance worker deaths and submit their names to the National EMS Memorial; it was usually performed by year, covering 1869 through 1990.
Deaths of ambulance personnel were obtained from a thorough search of several newspaper databases, including newspapers.com (which included over 65 New York City-based newspapers covering various periods from the advent of ambulance service in NYC in 1869 to the present day), The New York Times, and FultonHistory.com, with additional searches done through the New York Public Library databases.
A variety of search terms were used. The search term referencing the vehicle was “ambulance” and sometimes “hospital ambulance” because emergency ambulances were operated by both municipal hospitals and voluntary hospitals across most of the period.
Search terms referencing the workers included: “Ambulance Surgeons;” “Ambulance Doctors;” “Ambulance Drivers;” “Ambulance Attendants;” “Motor Vehicle Operators (MVOs);” “Corpsmen;” “Emergency Medical Technician;” and “Paramedic.” The terms “Ambulance Surgeons;” and “Ambulance Doctors” were used through the later 1940s until physicians generally came off the ambulance in the aftermath of World War II, with “Ambulance Attendants” and “Ambulance Drivers” staffing ambulances through the early 1960s. Then they were replaced by the terms “Motor Vehicle Operators (MVOs)” and “Corpsmen,” followed later by the terms “Emergency Medical Technician” and “Paramedic” from the mid-1970s through today.
Search terms referencing the event included: “Crash;” “Accident;” “Flu;” “Shot;” “Stabbed;” “Fall.” Search terms referencing the outcome included: “Hurt;” “Killed;” “Dead;” and “Died.”
Since ambulance workers respond to these types of events, and the outcomes were frequently related to their everyday work, it was often necessary to tie together either the vehicle and the event (e.g., “hospital ambulance crash”) or the worker and the event (e.g., “ambulance attendant shot”), or the worker and the outcome (e.g., “ambulance surgeon killed”) in Boolean quotes to limit an overwhelming number of results. Searches were generally performed in a matrix format with each combination being searched. World War One-era searches were particularly hard to filter because of the number of volunteer ambulance companies organized and staffed by colleges, businesses, and government to serve in France prior to the U.S. entering the war.
After 1990, the New York Ambulance History Project team had either firsthand knowledge of all deaths or obtained them from social media queries of senior staff working in the NYC Emergency Medical Service System at the time. More recent deaths, particularly 9/11 and COVID-related deaths were obtained from contemporaneous media, searches, and admission into the National EMS Memorial and the New York State EMS Memorial.
Bias
The risk of bias was minimized by using all of the relevant data found during the searches. Although it is likely that these searches resulted in a significant proportion of all workplace related deaths of ambulance workers in NYC, it is probable that gaps exist especially related to exposure to infectious disease in general and specifically related to pandemic flu, environmental health deaths, and work-related suicides. Infectious disease deaths and environmental health deaths of ambulance workers may not have all been reported consistently. For example, 1918 flu and pre-1920 heat wave deaths were reported by name in the newspaper daily, but not later pandemic or heat-related deaths. In addition, ambulance workers who were not physicians were of a social standing such that their deaths may not have been reported in the newspaper, and there is a significant difference in the levels of coverage between the deaths of ambulance surgeons and the deaths of ambulance drivers.
Statistical methods
We used a formula described by the U.S. Department of Labor (DOL), Bureau of Labor Statistics: N/W*100,000 to calculate the fatality rate. In the formula, N = number of fatally injured workers, W equals the total number of workers and 100,000 is used to calculate a standard rate per 100,000 workers.19
For the ambulance service half-century homicide rate in Figure 1, the rate per half-century was estimated by taking the number of homicides in the time period, dividing by the number of years in the time period and then multiplying by 50.
For one subset of the population, during one time period, there was a reliable denominator. That allowed a calculation of the rates for fatalities among the paramedicine clinicians who were employed by the BEMS. We compared the calculated BEMS rates to the rates for all U.S. workers for 2020 (the last year available).
The paper follows the STROBE guidelines for structure.20
Results
Table 1 shows all ambulance service personnel who died in service to the people of New York City since 1893.
Table 1. Date of death, person’s name, employer, and position with cause of death and notes per case. 1893 to 2022. Note that over the decades, ambulance personnel have had many job titles including diver, surgeon, attendant, technician and paramedic.
Date | Name | Hospital/Employer | Position | Cause | Notes |
05/15/1893 | Dennis J. Ward | Riverside Hospital | Ambulance Driver | Typhus | First Ambulance Worker Death, First Infectious Disease Death |
09/04/1898 | John Gerry | Bellevue Hospital | Ambulance Driver | Heat Exhaustion | First Environmental Death |
07/07/1901 | Paddy Travers | Bellevue Hospital | Ambulance Driver | MVC-firetruck | First MVC Death |
08/09/1905 | John Wallace | St Johns LIC | Ambulance Driver | Pneumonia | First Voluntary Hospital Death |
11/27/1905 | Clarence W. Barrow | Roosevelt Hospital | Ambulance Surgeon | MVC | First Ambulance Surgeon Death |
11/14/1916 | Thomas Kress | Bellevue Hospital | Ambulance Attendant | MVC | |
10/24/1918 | Margaret Deneve | Red Cross Motor Corps | Ambulance Driver | Spanish Flu | First Volunteer Ambulance Worker Death, First Female Ambulance Worker Death |
02/13/1919 | Mrs Charles Meyer | Women’s Motor Corps of America | Ambulance Driver | MVC-trolley | |
07/29/1919 | John Leddy | LICH | Ambulance Attendant | MVC | |
07/24/1927 | Roger W. Ogburn | Bellevue Hospital | Ambulance Surgeon | MVC | |
03/13/1938 | Harry T. Mesh | Harbor Hospital | Ambulance Surgeon | MVC | |
04/11/1938 | Robert Morton, Jr. | St Vincent’s Staten Island | Ambulance Surgeon | MVC | |
08/24/1943 | Morris Linker | Reception Hospital | Ambulance Driver | MVC into water | |
08/13/1944 | John F. Houy | Fort Hamilton Army Hospital | Ambulance Driver | MVC | First Military Ambulance Worker Death |
12/25/1945 | Abraham Millman | ABC Ambulance | Ambulance Driver | Stabbed by EDP IFO Ambulance Hq Building | First Private Ambulance Worker Death |
07/29/1946 | Nathan Rabison | Unity Hospital | Ambulance Surgeon | MVC-trolley | |
02/06/1953 | Peter J. Kelly | Methodist Hospital | Ambulance Driver | CVA | |
12/03/1954 | Hannah Callahan | Kings County Hospital | Ambulance Attendant | GSW | |
08/23/1975 | Frank Libraro | Glendale VAC | Ambulance Attendant | MVC into building | |
12/09/1985 | David T. Hoover | Astoria Volunteer Ambulance | EMT | MVC into subway support | |
04/25/1987 | Kirby McElhern | NYC*EMS | EMS Lieutenant | MI | First Paramedic Death |
06/17/1994 | Christopher Prescott | NYC*EMS | EMT | MVC/homicide | |
06/09/1996 | James Lawrence | Little Neck-Douglaston VAC | EMT | Heart Attack | |
09/24/1997 | Tracy Allen Lee | NYC*EMS | EMT | AIDS | |
01/21/2001 | Barbara Poppo | FDNY | EMS Lieutenant | MI | |
07/13/2001 | Gaylette Drummond | Midwood Ambulance Company | Paramedic | MVC into subway support | |
09/11/2001 | Andre Fletcher | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Bob Cirri | PAPD/Hackensack Medical Center | Paramedic | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Brian Bilcher | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Carlos Lillo | FDNY | Paramedic | Terrorism/homicide | |
09/11/2001 | Charles Laurencin | US Air Force | Paramedic | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Clive Thompson | Summit VAC | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Cynthia Mahoney | No Affiliation | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | David Lemange | PAPD/Jersey City Medical Center | Paramedic | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Frank Spinelli | Short Hills VAC | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | George Howard | PAPD | Paramedic | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Glenn Winuk | Jericho Fire Department | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Hector Tirado | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | James Coyle | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Je Jung | No Affiliation | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Jean Peterson | Madison Ambulance Squad | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Jeff Simpson | Triangle Resc Sqd | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Joe Henry | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Joe Lovero | Jersey City FD/JCMC | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | John D’Allara | NYPD | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | John Skala | PAPD/ Clifton Passaic MICU | Paramedic | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Karl Joseph EMT | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Kathy Mazza | PAPD | RN | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Keith Fairben | NY Presbyterian Hospital | Paramedic | Terrorism/homicide | |
09/11/2001 | Kenneth Swenson | Chatham Emerg Squad | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Kevin Pfeifer | FDNY | Paramedic | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Lauren Grandcolas | No Affiliation | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Linda Gronlund | No Affiliation | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Marc Sullins | Cabrini Medical Center | EMT | Terrorism/homicide | |
09/11/2001 | Mario Santoro | NY Presbyterian Hospital | Paramedic | Terrorism/homicide | |
09/11/2001 | Mark Schwartz | Hunter Ambulance | EMT | Terrorism/homicide | (Mutual Aid Response System) |
09/11/2001 | Maurice Barry | PAPD/ Rutherford, NJ Amb Corp | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Michael Kiefer | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Mitchel Wallace | NYS Courts/Bayside VAC | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Ricardo Quinn | FDNY | Paramedic | Terrorism/homicide | |
09/11/2001 | Richard Pearlman | Forest Hills VAC | EMT | Terrorism/homicide | (Mutual Aid Response System) |
09/11/2001 | Richard Rodriguez | PAPD | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Rodney Gillis | NYPD ESU | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Sean Tallon | FDNY | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Stephen Huczko | PAPD | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Thomas Jurgens | No Affiliation | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Vincent Danz | NYPD | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
09/11/2001 | Yamel Merino | Montefiore Medical Center/Metrocare Ambulance | Paramedic | Terrorism/homicide | |
09/11/2001 | Zhe Zeng | Brighton Amb | EMT | Terrorism/homicide | Not working in primary 911 EMS role |
01/08/2002 | James Kay | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
04/18/2002 | Andre Lahens | FDNY | EMT | MVC | |
06/07/2002 | Daniel Stewart | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
10/23/2005 | Felix Hernandez | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
06/23/2005 | Timothy Keller | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
08/28/2005 | Roisin Coohill | Midwood Ambulance | EMT | Terrorism/homicide | Post-9/11 Death |
10/23/2005 | Felix Hernandez | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
03/15/2006 | Deborah Reeve | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
04/23/2006 | Brendan Pearson | FDNY | EMS Lieutenant | Injury with complications of surgery | |
11/26/2007 | Brian Ellicott | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
05/14/2008 | Rene Davilla | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
09/26/2008 | Ryan McCormack | UMDNJ/Verona Rescue | Paramedic | Terrorism/homicide | Post-9/11 Death |
09/26/2008 | Ryan McCormick | UMDNJ | EMT | Terrorism/homicide | Post-9/11 Death |
04/12/2009 | Clyde F Sealey | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
12/22/2009 | Carene A. Brown | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
05/30/2010 | Paula Rodriguez | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
06/15/2010 | Freddie Rosario | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
02/06/2012 | John McFarland | FDNY | Dept Asst Comm | Terrorism/homicide | Post-9/11 Death |
06/15/2012 | Anthony Ficara | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
08/27/2012 | David Restuccio | Staten Island University Hospital | Paramedic | MVC | |
12/09/2012 | Joseph V. Schiumo | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
12/10/2012 | Ruben Berrios | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
03/07/2013 | Tyrone Rogers | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
05/02/2013 | Walter J. Nelson | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
05/28/2013 | Douglas Mulholland | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
06/01/2014 | William C. Olsen | FDNY | Captain | Terrorism/homicide | Post-9/11 Death |
06/25/2013 | Roland Coyne | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
06/28/2013 | Irene Gremmert | Newburgh VAC | Paramedic | Terrorism/homicide | Post-9/11 Death |
07/09/2013 | Rudy Havelka | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
08/27/2013 | Francis Charles | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
09/08/2015 | Harold McNeil | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
09/24/2013 | John W. Wyatt | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
10/07/2014 | Thomas V. Giammarino | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
11/07/2013 | Luis de Peña | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
12/02/2013 | Michael Cavanagh | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
12/14/2013 | Lou Angeli | New Castle County CERT | Paramedic | Terrorism/homicide | Post-9/11 Death |
02/17/2014 | Linda Ohlsen | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
08/24/14 | Steve Skipton | UMDNJ | EMT | Terrorism/homicide | Post-9/11 Death |
01/06/2016 | Norman Valle | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
02/08/2017 | Edith Torres | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
02/15/2017 | Rose Scott | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
03/16/2017 | Yadira Arroyo | FDNY | EMT | MVC/homicide | |
04/01/2017 | Mario Bastidas | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
05/13/2017 | Mark Harris | FDNY | Paramedic Captain | Terrorism/homicide | Post-9/11 Death |
10/17/2017 | Michael G. Guttenberg | Northwell Health | Physician | Terrorism/homicide | Post-9/11 Death |
01/10/2018 | Steven Shenkman | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
01/19/2018 | Joseph Sanamarina | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
03/05/2018 | Joeddy E. Friszell | FDNY | Deputy Chief | Terrorism/homicide | Post-9/11 Death |
08/19/2018 | William Ryan | Bay Community VAC | EMT | Terrorism/homicide | Post-9/11 Death |
10/10/2018 | Felipe A. Torre | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
11/18/2018 | Martha Stewart | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
11/23/2018 | Joseph A. Rodriguez | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
02/26/2020 | Joseph Braganza | NYU Langone Hospital | Paramedic | COVID Death | |
03/24/2020 | Yakkov Meltzer | Hatzolah of Queens | PA | COVID Death | |
03/25/2020 | Yitchok Zylberminc | Hatzolah of Far Rockaway | EMT | COVID Death | |
04/12/2020 | Tony Thomas | Lutheran Hospital | Paramedic | COVID Death | |
04/12/2020 | Greg Hodge | FDNY | EMT | COVID Death | |
04/21/2020 | John Redd | FDNY | EMT | COVID Death | |
04/22/2020 | Idris Bey | FDNY | EMT | COVID Death | |
04/23/2020 | Marlene Picone | Maimonides Hospital | Ambulance Dispatcher | COVID Death | |
04/24/2020 | John Mondello | FDNY | EMT | COVID Death | |
04/26/2020 | James Villecco | FDNY | Mechanic | COVID Death | |
04/27/2020 | Richard Seaberry | FDNY | EMT | COVID Death | |
04/27/2020 | Thomas Ward | FDNY | Mechanic | COVID Death | |
04/30/2020 | Paul Cary | Ambulanz | Paramedic | COVID Death | National Ambulance Task Force detailed to NYC |
05/08/2020 | Brian Saddler | Staten Island University Hospital | Paramedic/RN | COVID Death | |
08/16/2020 | Edward McEvoy | Underwood Memorial Hospital/NJ EMS Task Force | Paramedic | Terrorism/homicide | Post-9/11 Death |
09/16/2020 | Rene Sanchez | FDNY | Paramedic | COVID Death | |
11/20/2020 | Donnell Ben-Levy Ford | Brookdale Hospital | EMT | Terrorism/homicide | Post-9/11 Death |
12/22/2020 | Evelyn Ford | FDNY | EMT | COVID Death | |
02/07/2021 | Paige A. Humphries | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
08/16/2021 | Stephenson McCoy | FDNY | Paramedic | Terrorism/homicide | Post-9/11 Death |
09/23/2021 | Mark A Weiner | FDNY | EMT | Terrorism/homicide | Post-9/11 Death |
10/23/2021 | Charles Harris | FDNY | Captain | Terrorism/homicide | Post-9/11 Death |
12/07/2021 | Alvin J Suriel | FDNY | Asst Chief | Terrorism/homicide | Post-9/11 Death |
12/27/2021 | John P Raftery | FDNY | Lieutenant | Terrorism/homicide | Post-9/11 Death |
01/27/2022 | Michael Early | FDNY | Captain | Terrorism/homicide | Post-9/11 Death |
10/29/2022 | Alison Russo-Elling | FDNY | Lieutenant | Homicide |
Table 1 shows that 147 paramedicine clinicians died due to work-related causes since 1893.
Outcome data
Table 2 illustrates the 147 fatalities arranged by the fatality type and by employer.
Table 2. Fatalities by type and agency. FDNY/ BEMS is the NYC fire department’s bureau of emergency medical service. “NYC*EMS” is the NYC EMS agency before it became BEMS. NYC is other NYC government agencies. Government is other than NYC government (e.g., the FEMA task force). Hospital is those non-government hospitals in NYC. Volunteer is members of volunteer ambulance services providing service to the city. Outside NYC is personnel employed by, or volunteers for, agencies outside NYC. Other includes agencies such as the Red Cross. (N = 147)
FDNY/ BEMS | NYC* EMS | NYC | Govern-ment | Hospital | Private | Volunteer | Outside NYC | Other | Grand Total | |
Post-9/11 | 47 | 1 | 2 | 1 | 2 | 3 | 1 | 57 | ||
9/11 | 11 | 3 | 8 | 4 | 1 | 4 | 7 | 5 | 43 | |
Transportation | 1 | 3 | 8 | 1 | 2 | 1 | 16 | |||
COVID | 9 | 1 | 4 | 2 | 16 | |||||
Homicide & Homicide/MVC | 2 | 1 | 1 | 1 | 5 | |||||
Infectious disease | 1 | 2 | 1 | 4 | ||||||
Cardiovascular | 1 | 1 | 1 | 1 | 4 | |||||
Exposure | 1 | 1 | ||||||||
Strain | 1 | 1 | ||||||||
Grand Total | 72 | 3 | 8 | 10 | 21 | 4 | 11 | 10 | 8 | 147 |
Figure 1 shows the 147 fatalities arranged by time period and by case type. The homicide rate shows how the number of fatalities estimated per half-century has changed for each of the time periods.
Terrorism
In 2022, the 100th paramedicine clinician died due to the terrorist attack of September 11, 2001; 43 died on September 11, 2001, and 57 died of post-September 11 illness complications.
Transportation
Sixteen of the 147 (11%) died of transportation related injuries (this does not include the two who were victims of vehicle-related homicides).
COVID
There were 16 COVID-related fatalities in 2020. Of them, nine were employed by BEMS.
Homicide
Five of the paramedicine clinicians were victims of homicide; two of those were vehicle-related homicides.
Other
Twenty died of other causes including: ten died of medical conditions; four of cardiovascular disease; four from (non-COVID) infectious disease; one from surgical complications secondary to an on-the-job hernia; and one due to exposure (heat exhaustion).
Fatality Rate in BEMS
There are no data describing the number of workers at the NYC hospital ambulances or volunteer agencies. However, a precise number of workers has been documented for those employed by BEMS. In addition, the BEMS personnel tend to be full time employees.
To determine the most reliable fatality rate in the FDNY BEMS, we focused on just those deaths occurring over the past five years (October 2017 to October 2022). There were 4,408 paramedicine clinicians employed by the BEMS during the study period.21 The data in Table 1 show that there were 23 fatalities among BEMS personnel since October 2017. Three of the 23 clinicians were women.
The occupational fatality rate for BEMS paramedicine clinicians is 104.4 (95% CI = 61.7, 147.0). The fatality rate for all workers in the U.S. in 2020 was 3.4.22
There was one reported homicide among the 4,408 paramedicine clinicians employed by the BEMS over the past five years; the one case over five-years or 22,040 person-years, equals a homicide rate of 4.5. The DOL reported 392 homicides among approximately 140,117,647 workers in 2020 (the most current year available) for a rate of 0.28.
A total of nine BEMS clinicians died of COVID in 2020. The BEMS COVID fatality rate is 204.2. The annual COVID fatality rate for all workers in the U.S. for 2020 was 35.6.23
Figure 2 shows the fatality rates of COVID, homicide and overall, for BEMS personnel compared to all U.S. workers in 2020 and the relative risk for BEMS personnel.
Figure 2 shows that the overall fatality rate for BEMS personnel is about 35 times higher than the national average, the COVID fatality rate was about six times the national average and the homicide rate was 16 times higher than the rate for all U.S. workers.
Other EMS Agencies
In addition to the nine members of BEMS, seven other paramedicine clinicians working in NYC died of COVID. They included four clinicians working for hospital-based ambulance services and two who worked for volunteer ambulance services. One additional clinician, Paul Cary, was one of the 500 paramedicine clinicians in the FEMA task force who came to help NYC through the COVID crisis.24
For the approximately 70 other EMS agencies in NYC there are no reliable denominator data, so it is not possible to calculate fatality rates. Table 2 shows that 21 of the 147 fatalities (14%) were members of NYC hospital-based ambulance services, 11 (7%) were members of NYC volunteer ambulance services and 4 (3%) were employed by private ambulance services. Eleven (7%) of the victims were members of agencies outside NYC.
Limitations
The lack of a national data set documenting the fatalities and injuries for paramedicine clinicians means that there is no reliable way to identify all of the many clinicians who are injured or killed in the line of duty. We are confident that these 147 should be included here but we realize that there could be many who should be here but who were not identifiable.
The number of BEMS personnel is accurate for one point during the specified time period but there are no data on how the number may have fluctuated over time.
The calculation of rates based on small numbers of cases must be interpreted with caution. It is a reasonable approach to identifying risks, and often, such as here, the only way to identify risks, but should always be followed up with new calculations as additional cases occur or as time passes between cases.
Discussion
Since 1893, 147 ambulance personnel have died in service to NYC. We honor their service and the sacrifices of them and their loved ones.
The September 11 terrorism attack on New York City continues to claim the lives of paramedicine clinicians. Table 1 shows that 43 paramedicine clinicians died on September 11, 2001, and 57 have died since of 9/11 related diseases. Today, many paramedicine clinicians continue to suffer from the illnesses caused by their response to that event and many have been denied support for the illnesses they now suffer as a result of responding to the attack.25
Since 1893, eleven percent of the fatalities were personnel who died in transportation related events. Nationwide research found that 74% of fatalities among paramedicine clinicians were secondary to transportation events.7 In the U.S., the paramedicine clinician’s risk of transport related fatality is about five time higher than the rate for all workers.26 Although it is not always included in occupational risk research, due to the nature of their work, it is appropriate to also evaluate all transportation events that occur coming to or going home from work. Richie Gomez was just one of the possibly many paramedicine clinicians who died on their way home from work.27
Methods to reduce ambulance crashes have been described.28 Recently, the National Highway Transportation Administration announced a goal of zero transportation fatalities nationwide,29 that is a critical goal for paramedicine clinicians in NYC and across the country.
The BEMS has a homicide rate 16 times higher than the national average for all workers. Nationwide, paramedicine clinicians have an occupation homicide rate 30% higher than the rate for all U.S. workers and seven times higher than the average rate for all health care workers.7
The homicides in NYC are only the tip of the iceberg when looking at the risks of violence among these personnel.30 Fifty-two BEMS clinicians were assaulted in the first 10 weeks of 2021 alone.31 But even this high number is likely much lower than the actual number of assaults since, as the BEMS union president noted: “Many of our assaults go unreported due to our members knowing the prosecutors won’t do anything to the offenders.”31 The BEMS president noted that the clinicians “face ‘day-to-day assault,’ but get no safety, self-defense or de-escalation training and are outfitted with 20-year-old bulletproof vests — which expired five years after production.”30
About 400 clinicians a year report attacks in the U.S. and women have a higher risk than men.11 A survey of over 600 paramedicine clinicians who had been victims of assault found that many noted that they had no training to protect themselves from attack.32 The current training for protecting paramedicine clinicians from violent attacks should be evaluated for opportunities to improve it and make it available to all paramedicine clinicians working in NYC. Protective equipment should be tested for efficacy, deployed to all personnel and maintained. Much more must be done to protect paramedicine clinicians from violent attacks.
Suicide is often not considered an occupational fatality and is not included in this study. However, it should not be overlooked when evaluating occupational risks for paramedicine clinicians. The CDC wrote a report in 2018 that stated that the occupational suicide rate in the U.S. in 2016 was 17.3 per 100,000 workers.33 Although there is no systematic collection of EMS suicides, there were at least three suicides documented among BEMS personnel in 2020 alone.12 The resulting rate of 68.1 for BEMS personnel is a rate about four times higher than the national average for all U.S. workers. The facts that at least three employees committed suicide in one year and that the rate is so much higher than the national average, indicate an urgent need for suicide prevention interventions. Capturing suicides should include off-duty events.34 A successful intervention by the Department of Defense may provide insights to potential methods that could help to reduce risks in NYC and for paramedicine clinicians worldwide.35
The research highlights the critical importance of a national database dedicated to capturing and documenting occupational injuries and fatalities among paramedicine clinicians. Although we applaud the efforts of the U.S. DOL Bureau of Labor Statistics, and are very grateful for the important data they do provide, a critical precursor to any reliable risk reduction interventions will be a much more robust and tailored dataset than the DOL provides. Such a dataset must be able to capture and link data from medical records, personnel files and ambulance service operational records. A working database that could be used as a model is the Defense Medical Epidemiology Database.36
As noted, the NYC EMS system does vary in considerable ways from other EMS systems in the U.S. and internationally. However, we expect that many of the risks are common to all personnel and that the findings are largely generalizable to paramedicine clinicians worldwide.
Conclusions
In total, one hundred and forty-seven dedicated personnel died in performance of their mission to provide ambulance services to the citizens of New York City. Over the past five years alone, 23 paramedicine clinicians employed by the BEMS and 11 paramedicine clinicians from other EMS agencies providing services to NYC, have suffered occupational fatalities. The occupational fatality rate for paramedicine clinicians employed by the FDNY BEMS is 35 times higher than the national average for all workers in the U.S. and their rate of homicides is 16 times higher than the national average.
Call them ambulance workers, EMS professionals or paramedicine clinicians, the title does not matter. What matters is that they dedicated themselves to providing a critical service, they died committed to saving the lives of others, and we must do more to protect these valued emergency medical services professionals.
The research shows that the threats to our personnel are significant and have been changing over time. Although ambulance designs have been improving, we still have a high threat of transportation related fatality, we face new threats from terrorism and contagious disease, and the homicide rate may be rising dramatically. The research also highlights the critical importance of having a national database that tracks occupational injuries and fatalities among paramedicine clinicians; such a database is an essential precursor to any efforts to reduce the risks of occupational fatality and injury.
Immediate efforts are needed to protect these clinicians from the many hazards they face every day in their service to the citizens of New York City.
It will take a dedicated effort to ensure that Alison Russo-Elling is the last paramedicine clinician who dies in service to New York City.
—
Disclaimer: The views expressed in this paper are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense nor the U.S. Government.
Conflicts: The authors have no conflicts of interest. Funding: There was no funding for this project.
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