In a Daily News opinion piece, FDNY EMS Lt. Anthony Almojera argues that appointing an EMS veteran as commissioner reflects today’s medical-first reality

NEW YORK — Experience matters in emergency medical services, which now accounts for most of the FDNY’s workload — a point Anthony Almojera, an FDNY EMS lieutenant and union leader, highlights in a recent Daily News opinion piece.

Medical emergencies account for an estimated 70% to 85% of 911 calls, including heart attacks, strokes, overdoses, respiratory distress and psychiatric crises, according to Almojera. Those calls place EMS and firefighters on the front lines of the department’s daily workload.

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Almojera, vice president of the Uniformed EMS Officers Union Local 3621, said the appointment of new FDNY Commissioner Lillian Bonsignore, an EMS veteran, underscores that reality. The move comes as the department’s call volume has become increasingly medical-driven over decades, a trend that Almojera said has exposed longstanding staffing and resource imbalances, with EMS handling the majority of calls while remaining the most understaffed and least resourced uniformed branch.

FDNY’s EMS and firefighting branches also differ sharply in workforce demographics, which Almojera and other critics argue helps explain long-standing disparities in pay and resources. EMS personnel are more likely to be women and people of color, while the firefighting force is overwhelmingly male and predominantly white, Almojera says. Even as EMS responds to most emergencies, it represents a smaller share of the department’s workforce and budget, and investments in staffing and equipment have struggled to keep pace with rising call volume.

Bonsignore’s appointment, Almojera said, represents a high-level acknowledgment of EMS’s central role in the department and a first step toward better recognition, resources and support for EMS responders.

The fire commissioner is a civilian executive role focused on managing a 17,000-person agency and a multibillion-dollar budget, setting priorities, and navigating city government. Day-to-day operational command runs through the chiefs of fire operations and EMS operations.

“Elon Musk claiming that “people will die” because the new commissioner comes from EMS reflects a fundamental ignorance of both history and governance. No one serious is suggesting that Bonsignore’s appointment will result in more lives lost,” Almojera wrote. “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 now operates in a medical-first reality alongside a strained health care system, and leaders with deep EMS experience and the administrative skills to run a major agency are increasingly essential.

“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,” Almojera said. “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.”

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