City Controller Alan Butkovitz said chronically slow responses from city ambulances are leaving citizens in danger, and he thinks Council and incoming Mayor Michael Nutter should delay business tax cuts and use the money to fix the emergency-response system and other city services.

"The question is, are they willing to make a decision that a certain number people are going to die because we're just not going to get to you in time?" Butkovitz asked after releasing a scathing report on the city's emergency medical services (EMS).

The report found that in at least 40 percent of cases, ambulances fail to arrive within the nine minutes regarded as the standard by EMS experts.

Butkovitz said that his review found that response times have been slowing in recent years and that that will begin to affect the city's image.

"What does it say about a city that has to admit that, God forbid, you have a heart attack, there's only a 60 percent chance we can get to you in time to save your life?" Butkovitz said. "That's not a world-class city."

The report found the city's EMS system suffers from too few ambulances, not enough trained paramedics, too many calls, and a communications and dispatch system that is inefficient and technologically outdated.

The report mirrors criticisms raised for years by union activists, and focuses on many issues raised in a May 2006 investigation by the Daily News.

The EMS system is run by the city's Fire Department, and Commissioner Lloyd Ayers yesterday acknowledged that he's struggling to meet the demands of the public.

"What we do now is the best we can with the resources we have," Ayers said.

Ayers noted that the department brought five new ambulances into service last year, though they're "basic-life-support" units, with less medical capabilities than an "advanced-life-support" unit staffed my paramedics. He also said major improvements in the EMS dispatching system were under way.

Ayers said that ambulances aren't the only medical services his department provides.

Fire engines carrying emergency medical technicians almost always arrive quickly in response to 911 calls, he said, to administer CPR and provide basic treatment while awaiting an ambulance.

But Ayers acknowledged that he could use more ambulances. He estimated that adding those, as the audit suggests, would cost $20 million up front and another $15 million a year.

David Kearney, a former paramedic and recording secretary of the firefighters union, said the EMS system needs a top-to-bottom analysis and an infusion of resources.

"You have to be willing to see that this is worth investing in," Kearney said yesterday. "We're not playing it up when we say there are lives at stake here. That really is the truth."

The city is facing financial challenges in the coming year, and its five-year plan anticipates continued annual cuts in wage and business taxes.

Nutter ran for mayor in part on a pledge to accelerate business-tax cuts.

He deferred comment on the controller's report yesterday, adding in a statement that he is "committed to improving the business climate, while at the same time improving on the delivery of city services."

Among the other findings in the controller's report:

* Because the EMS system is under such heavy strain, ambulances and their crews are on medical runs a far greater percentage of the time than in other cities, adding stress for paramedics and their equipment.

* Morale is low and turnover high among paramedics, and many resent that while their daily workloads are higher than firefighters', they're under-represented in the department's management.

* The communication and dispatch system makes it hard to prioritize calls and efficiently dispatch crews. The dispatching system recommends the medic unit closest to the site of the emergency, but doesn't take into account that the unit may be miles away on another run.

* The Fire Department's published response times are unreliable, because they don't include time spent processing calls and dispatching units, and because their response time clock stops when any unit arrives on the scene, whether it can transport someone to a hospital or not.

* The EMS system is flooded with calls that aren't true emergencies. The report recommends a 3-1-1 system to handle those. *