Thousands of emergency medical technicians in New York City have been enlisted in the fight against the new coronavirus. Granted anonymity, one of them shares the frustrations and fears, the tough decisions, and the devastating realities of a single tour.

“It’s a war zone,” they said.

As an emergency medical technician in Brooklyn I’d heard this phrase tossed around the media since the COVID-19 pandemic struck New York City a few weeks back, and thought it was a bit dramatic. After all, during the first few days working on the ambulance during the outbreak, many of the calls flooding the 911 system were not what we in the Emergency Medical Service would consider “real emergencies,” meaning life-threats. They were patients reporting being sick, along with a new call type coming over the radio that prior to the pandemic didn’t exist: the ominous “fever cough.”

On scene, my partner and I repeatedly exposed ourselves to the coronavirus only to find patients who were mildly ill. Their emergency was emotional: fear and panic. Wearing the single N95 mask we get for each tour—which we have to return when we log out—we’d take our patients’ vitals, find them stable, and give them the advice recommended by the CDC: isolate, call your doctor, and call 911 if your fever spikes or if you’re having difficulty breathing. In a normal world, we take anyone to the hospital who wants to go, no matter how minor the complaint.

This is not the normal world. And we need New Yorkers to understand that.

In New York City, the EMS call volume has nearly doubled in recent days, spiking to record-breaking levels of over 7,000 calls a day, surpassing the volume reached on 9/11. EMTs and medics riding on commercial, FDNY, private hospital, and volunteer ambulances are working tirelessly across the boroughs to respond to this surge in calls. The city government has been blasting pleas to the unlistening public: “Help first responders assist those most in need: Only call 911 during a real emergency.” So far this hasn’t exactly worked. Last week I ran into a unit who had just transported a patient complaining of gas who demanded to be taken to the ER.

What’s happening now is that the sick and “worried well” patients continue to flood the 911 system but added to the mix is a tsunami of life-threatening emergencies triggered by COVID-19 complications. Many “fever cough” patients are now having difficulty breathing; the diff breathers are going into cardiac arrest. There are more DOAs. More suicides. More Members of Service getting sick. Listening to the radio for 20 minutes is enough to trigger more anxiety than anyone can bear: sick, arrest, diff breather, fever cough, cardiac diff breather, arrest, arrest, arrest. On top of this, the typical medical emergencies continue to pour in: motor vehicle accidents and strokes, allergic reactions and heart attacks.

“It’s a war zone,” my partner said. And this night on the ambulance her words struck a chilling chord. We had just transported a feverish elderly woman in respiratory distress to the ER where she was found to have an oxygen level so low she was immediately isolated and prepped for intubation. She had a medical history of diabetes and asthma and was so short of breath she could barely speak. Our patient was a kind woman. Very soft-spoken, very thankful. She reminded me of my grandmother, whom I adored, and it crushed me to see her alone, gasping for air.

As our patient was being intubated, I apologized to the ER nurses for bringing in another COVID-19 patient who needed to be ventilated. There were weary EMTs standing behind us in the triage line with a stretchered patient who had the hacking, stomach-churning cough we have all come to recognize as the coronavirus. I heard someone call my name and turned to see my favorite ER nurse. She was worried because she hadn’t seen me in a while, and we were both relieved to find each other healthy—or at least asymptomatic. We usually hug, but those days are gone.

So are the smiles and laughs. There’s always a lot of humor at play in the first responder world. The laughter is salvational. It’s how we cope. Now everything has turned quiet and grave. “I don’t want to die,” a cop friend texted me the other night. The police have even less personal protective equipment than we do, and because EMS is so overextended, cops have at times been transporting patients to the hospital while wearing little to no protective gear. I see first responders, nurses, and doctors with the blank stares and blown-out gazes of combatants.

This is war.

As EMTs, we know we are going to get sick. Many of us are already sick, or presumed positive and asymptomatic, or we tell ourselves we’ve had it already and now we’re somehow magically immune. But we worry that’s not true. We worry for our families. What are we bringing home to them?

It’s not just COVID-19 patients who are alone in this disaster. First responders at all levels are also being asked to operate with substandard PPE and no real backup. In a normal world, we would’ve had paramedics with us on scene to provide Advanced Life Support and intubate our patient in the field, since EMTs, as Basic Life Support units, can’t perform invasive procedures. But all night we had heard the overwhelmed dispatcher inform EMTs there were no medics available. “I have no medics,” the dispatcher said again and again to units calling for backup. “No ALS available.” I have never heard a dispatcher say this in my years as an EMT.

In a normal world we transport sick and injured patients to the hospital along with their concerned family members, for comfort. But due to the highly contagious nature of COVID-19 and our overburdened hospitals, we now load patients into the ambulance alone. Dying alone has to be one of the most pressing terrors of any human being, a fate so grim it’s beyond imagining. As EMTs we’re placed in the heartbreaking and hazardous position of trying to save lives while offering our patients the same level of consolation a family member might provide, all the while trying to protect ourselves from catching the virus with our rationed, dwindling PPE. We’re anxious that any day, the singular N95 mask we have for our tour will be gone.

Like the public, we are also struggling to understand the coronavirus as we move along. Protocols and resources change daily. Last week there were so many buses clotting the ERs it was difficult to park anywhere near the ambulance bay. Now there are no ambulance bays. They’ve all been converted into tented field hospitals and refrigerator trucks being used as makeshift morgues for the dead. Just seeing the white field hospitals and trucks brings back haunting memories of 9/11. One of the most shattering aspects of the terrorist attacks was that hospitals in NYC were braced for a flood of patients, and none came. There were no bodies. Now we have bodies. But we lack resources. And at times, hope.

“Do you think our patient is going to be on the refrigerator truck?” I asked my partner as we decontaminated the ambulance with the one container of disinfectant wipes we have on the truck. “This is so sad,” she said. I understood what that meant.

EMS in New York City has been in crisis for years, and the COVID-19 pandemic has only exacerbated the understaffed, underfunded system. FDNY EMTs start at the unsurvivable salary of $35,254 a year—far less than any other first responder makes, despite the fact that the burden of medical emergencies in the Fire Department falls on the backs of EMTs and medics. FDNY EMTs are given a mere 12 sick days; other first responders get unlimited.

The mayor has rationalized the enormous pay disparity by claiming “EMS work is different,” meaning less dangerous than firefighting, police work, and sanitation. It’s hard to imagine, but in New York City saving lives is less valuable than collecting trash. We would love to see the mayor take a ride on the ambulance with us now. When this is over, we expect to have a little powwow about pay parity.

Like all first responders, I consciously chose to work a high-risk job and signed away my rights to a safe life. As EMTs and medics we’re constantly exposed to infectious diseases, violence, and death. This pandemic hasn’t changed that math; it’s only made the public more aware of it. Along with the fear of running out of PPE, all first responders are scared of bringing this ghastly disease home to our families. We signed up for this. They didn’t.

“ In a normal world, we take anyone to the hospital who wants to go, no matter how minor the complaint. This is not the normal world. ”

With the increasing number of critically ill patients, struggling hospitals, lack of protective equipment, makeshift morgues, and waning supply of ventilators, what we’re seeing is horrific and heartbreaking. Post-traumatic stress will hit the EMS and hospital community hard when this is over, and we hope the city will be there to help us. In recent days, when EMTs call the dispatcher requesting medics and are advised that none are available, we’re simply told, “Do your best.” We are doing our best. But we need New Yorkers to do their best, too. You’re not stuck at home, you’re safe at home. If you have gas, take an Alka-Seltzer.

There is a tremendous amount of unity and tenderness at work in the hospitals and on the streets these days. It’s a privilege to wear an EMT uniform and I feel blessed to be able to serve the community and city I love. I’m relieved when I hear people doing their part: friends staying home; others sewing masks for the nearing day when we run out of N95s and surgical masks; restaurants offering meals to first responders and health-care workers; hotels considering sheltering us so we don’t infect our families. The people bagging groceries, driving buses, manning pharmacies and banks—all of them are on the front lines, too.

When I got home at the end of my last coronavirus tour, I stripped, bagged my uniform, and wept. I wept for my patient who was unlikely to survive and is probably now inside that godawful refrigerator truck. And for all the patients coming our way who will share the same hideous fate. I wept for all my first responder friends who are out sick, including my partner, and for our families, who are being directly exposed to the virus because of our work.

Unlike many catastrophes, there is no one this pandemic doesn’t touch. We are all in this together. It’s going to get worse, we’ve been told, and then it’s going to get better. And meanwhile we are here for you, New York City. We are sad, and we are exhausted, and we are doing our best.