New York City's congestion pricing toll program was designed to reduce traffic and fund transit improvements. A study published Monday by six academics for the National Bureau of Economic Research provides the first rigorous evidence of an unexpected secondary benefit: it is meaningfully speeding up ambulances.
The paper found the tolls have significantly sped up ambulance response times below 60th Street since January 2025, when the MTA started charging drivers a daily fee to enter the area.
Ambulance response times dropped by 63 to 70 seconds after the introduction of congestion pricing — a drop of close to 6 percent. That improvement involves both legs of the ambulance response: travel time to the incident declined by approximately 7 to 9 seconds, while travel time from the incident to the nearest hospital fell by roughly 54 to 59 seconds — an 8-percent improvement on the hospital transport leg.
For patients experiencing cardiac arrest, stroke, or serious trauma, that reduction is not a convenience statistic. It is a survival calculation.
Why This Matters
The connection between ambulance response time and patient outcomes is one of the most well-established relationships in emergency medicine.
"In cardiac arrest, every minute reduces the chance of survival by 7 to 10 percent," said Sam Schwartz, the traffic analyst and congestion pricing advocate who first raised the ambulance response time concern. "So the fact that a minute is saved means quite a few people will survive and will survive with better outcomes."
In ischemic stroke, every 15-minute reduction in door-to-treatment time preserves approximately 1 million neurons and meaningfully reduces the rate of permanent neurological disability. In serious trauma, faster hospital transport reduces the risk of uncontrolled hemorrhage becoming a fatal outcome.
The congestion pricing study provides the first empirical quantification of a mechanism that urban policy discussions typically treat as speculative: reducing car traffic in dense urban environments directly improves emergency vehicle performance, which directly affects clinical outcomes.
What We Know So Far
- Study type : Observational, not yet peer-reviewed
- Study population : Ambulance responses within Manhattan's Congestion Relief Zone (south of 60th Street) before and after the January 5, 2025 congestion pricing implementation
- Finding : Total ambulance travel time decreased by 63 to 70 seconds (5 to 6% improvement)
- Hospital transport leg improvement : 54 to 59 seconds (8%)
- To-incident improvement : 7 to 9 seconds (approximately 2%)
- Additional finding : Cycling increased approximately 20 percent in the congestion zone , indicating some commuters switched from cars to bikes — reducing overall vehicle volume further
Prior context: Sam Schwartz's firm had documented that ambulance response times had increased nearly three minutes between 2014 and 2024, a trend attributed to the rise of rideshare vehicles. The congestion pricing improvement partially reverses that decade-long degradation.
Where the Impact Is Greatest
The ambulance time improvement is concentrated in Manhattan south of 60th Street — the Central Business District, where traffic congestion is most severe and where the toll applies. This zone includes Midtown, Lower Manhattan, the Financial District, and surrounding neighborhoods.
Cities with the highest ambulance response time concerns nationally include Los Angeles, Chicago, Houston, Philadelphia, and Boston — all cities where congestion pricing proposals have been discussed or studied. The New York evidence is directly relevant to any major U.S. city where traffic density affects emergency vehicle speeds.
What Experts and Dissenters Say
"Any increase in the time from the incident to the hospital saves lives and generates lots of cost savings," said Brad Humphreys, professor of economics at West Virginia University and co-author of the study. "Congestion pricing wasn't introduced to make it easier for ambulances to get from incident scenes to hospitals, but they do."
The study was not without dissent. The union representing FDNY's EMTs and paramedics disagreed with the findings. "On the ground, we are not seeing a 60 to 90-second reduction, especially when, for the past two years, our response time is creeping up every day," said Michael Greco, president of Local 2507, according to Gothamist.
Greco's counterpoint reflects a real limitation: the NBER study is based on aggregated data and has not yet been peer-reviewed. On-the-ground conditions experienced by individual EMTs may not fully match the aggregate statistical findings.
What the Evidence Shows — and What It Does Not
MedicalDaily Evidence Check
- Study type: Observational study of pre- and post-congestion pricing ambulance response times; not yet peer-reviewed
- Published: NBER Working Paper No. w33584, July 7, 2026
- What it found: Total ambulance travel times fell by 63 to 70 seconds (5 to 6%) after congestion pricing implementation; hospital transport leg improved 8%
- What it did not prove: Causal attribution (observational design); not yet peer-reviewed; EMT union representatives dispute on-the-ground experience
- Clinical context: Each additional minute of delay before defibrillation reduces cardiac arrest survival probability by 7–10%
- What readers should know: The finding is preliminary but directionally consistent with the expected effect of traffic reduction on emergency vehicle speeds
Who Is Most Affected?
- Patients experiencing cardiac arrest in Manhattan — where timely defibrillation is the primary determinant of survival
- Stroke patients, for whom door-to-treatment time directly determines neurological recovery
- Serious trauma patients, for whom hospital transport speed affects hemorrhage control
- All New York City residents south of 60th Street who have any health emergency requiring ambulance response
What You Can Do Now
- Learn hands-only CPR. Every 10 seconds of CPR before an ambulance arrives preserves the survival benefit that faster response is designed to compound. CPR training is available through the American Heart Association and American Red Cross.
- Know your building's address and major intersection — a common source of delay in 911 dispatch is address uncertainty, especially in large apartment buildings.
What Happens Next
The NBER paper will undergo peer review. The full peer-reviewed version is expected to be published in a transportation economics or public health journal within the coming months. MedicalDaily will report on the peer-reviewed publication and on any subsequent studies examining ambulance response outcomes in other U.S. cities with congestion pricing programs.
The Bottom Line
A new NBER study published today found that New York City's congestion pricing program cut ambulance travel times by 63 to 70 seconds in Manhattan — a finding that translates directly into improved odds of survival for cardiac arrest and stroke patients where every minute matters. The study has not yet been peer-reviewed, and union representatives dispute the findings. But the survival math — 7 to 10% cardiac arrest survival reduction per minute of delay — means that if the finding holds up, congestion pricing is producing a public health benefit its designers never explicitly intended.
