Two weeks ago, as the Adams administration was beginning its implosion, New York City’s health commissioner, Dr. Ashwin Vasan, announced that he would step down in January. Although his resignation did not suggest any entanglement with the federal investigations surrounding Eric Adams — or the news that the city’s former Covid czar, Jay Varma, was “just being naked with friends” when he invited about 10 people to a hotel room during the height of the pandemic — it reveals another sinkhole in the ground of functional governance.
Among his accomplishments, Dr. Vasan established HealthyNYC, an initiative to extend the life expectancy of New Yorkers to 83 by the end of the decade, in part by decreasing the number of deaths related to heart disease and diabetes by 5 percent. While, on the face of it, a modest goal, it inevitably bumps up against the realities of an overburdened emergency-care system that further reveals the deficiencies of the city’s transportation policy in all of its life-or-death consequence.
The release of the annual Mayor’s Management Report last month pointed to two convergent and unsettling trends. The document, a 558-page evaluation of how well, or not, key city agencies are serving New Yorkers, indicated both a 5 percent increase in life-threatening emergency calls between the fiscal years 2023 and 2024 and a slower response time in handling them.
During that same period, dispatch and travel times for both ambulances and Fire Department vehicles during dire medical emergencies increased by 20 seconds, for an average response time of 7 minutes 23 seconds. Every minute someone having a heart attack goes without CPR reduces the chance of survival by 10 percent.
If we go back further, the relationship between traffic patterns and emergency-response times becomes even more startling. Last month, State Senator Brad Hoylman-Sigal and the traffic engineer Sam Schwartz issued a report titled “Speed Kills,” inspired by an experience the senator had in which he waited with a writhing stranger in Chelsea for 37 minutes before emergency medical technicians arrived. The report indicated not only that New York was the most congested major city in the world but also that over the past decade, E.M.S. response times to life-threatening situations had increased by 29 percent; for Fire Department vehicles tending to medical emergencies, the lag was up by 72 percent.
To put it more emphatically, if you are having a cardiac event in a 16th-floor apartment in a busy part of Manhattan and you don’t find yourself in the company of someone who can competently administer CPR, you will very, very likely die — more likely than if you lived in a ranch house in, for instance, New London, Conn. Over the past year, the Fire Department responded to 30,038 reports of cardiac arrest or choking; only 20 percent of the cardiac patients were revived.
In February during a public safety briefing, Laura Kavanagh, the Fire Department commissioner at the time, identified traffic as the “primary” cause of rising response times. But the department, however paradoxically, never pushed for congestion pricing, which was designed to alleviate traffic problems in Manhattan. In fact, four weeks after the briefing, firefighters spoke out against the plan at a public hearing. They were asking the Metropolitan Transportation Authority to exempt them from the toll they would be asked to pay if they were driving to work below 60th Street. Gov. Kathy Hochul later tanked congestion pricing as opposition, particularly from labor unions, escalated.
In the aftermath of the pandemic and during a fit of midlife redirection, a friend of mine, Nelson Hancock, a photographer with a doctorate in anthropology from Columbia University, became an E.M.T. In light of the recent data, I asked him what it was like in the driver’s seat of an ambulance, what he was seeing when he and his partners were headed toward a call.
“One of the things that is interesting when you’re driving an ambulance is the number of people who just don’t get out of the way,” he told me. In training, he said, you’re warned that most people don’t drive well and just freeze. Once, he was merging on the F.D.R. when a woman in front of him slammed on her brakes. He swerved around her and noticed that she just looked bewildered and terrified. Midtown, in his view, was the worst and most stressful place to drive.
He also talked about the ongoing problem of false alarms: “You get to a call and you get to the person and he says: ‘I’m fine now. I just ate six sandwiches and felt weird.’” As Michael Fields, the chief of Emergency Medical Services Operations for the Fire Department put it, “We really need the public to be aware of what true emergencies are.” To illustrate the matter, he pointed to the 911 call volume on a recent Tuesday. Of the 4,394 calls made, only about 1,500 were legitimately urgent.
In terms of solutions, the Fire Department is looking toward more effective messaging — particularly a public service campaign that would seek to educate people about when it’s appropriate to call 911 — and, in conjunction with the Tandon School of Engineering at New York University, a more precise analysis of traffic patterns. Doctors, however, envision a more intimate and immediate approach contingent on ordinary good will rather than a stream of bureaucratic interventions.
For seven years now, Dr. Holly Andersen, a cardiologist affiliated with the Ronald O. Perelman Heart Institute at Weill Cornell Medical Center, has been campaigning for the widespread use of hands-only CPR, which involves chest compression. In her view, it is better than the conventional oral method, which can take a long time because people tend to need to work themselves up psychologically before they can start.
“You don’t have to be certified,” she said. “You don’t have to do mouth-to-mouth.”
And most states have good Samaritan laws that aim to protect people trying to help from litigation. More defibrillators in public places, especially parks, where people are often working out, could also reduce the reliance on the emergency system.
In her 30 years as a heart specialist, Dr. Andersen has remained frustrated by everything that has gotten in the way of saving more lives. She feels confident that “waiting for E.M.S. is not the answer.”
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