Congestion Pricing and Emergency Medical Service Response: Evidence from New York City

Large cities worldwide have adopted congestion pricing to reduce urban traffic, with well-documented benefits for travel speeds, accident rates, and air quality. This paper identifies a novel external benefit: faster emergency medical service (EMS) response times. We provide the first evidence on how the congestion pricing program in New York City – the first comprehensive cordon-based congestion pricing system in the U.S. that was implemented on January 5th, 2025 – affects EMS performance. Exploiting the sharp geographic boundary of New York City’s congestion relief zone at 60th Street and a difference-in-discontinuities design, we first document substantial changes in traffic and mobility near the boundary: vehicular traffic declines by roughly 18 to 21 percent, accompanied by increases in pedestrian and bicycle activity. Consistent with these first-stage mechanisms, we find that congestion pricing improves EMS performance, reducing total travel times by 63–70 seconds (approximately 5–6 percent). Effects emerged quickly and show little evidence of displacement to adjacent areas. A concurrent FDNY directive requiring transport to the nearest hospital confounds standard difference-in-differences estimates but not our boundary-based design. These findings suggest that cost-benefit analyses of congestion pricing systematically understate net social benefits by omitting emergency response improvements.