Most encounters with an ambulance are quite pedestrian: the flashing lights and wailing siren signal it’s time to pull the car over and let the members of the rescue squad pass. What’s a momentary pause in the lives of those New Paltz residents might represent a critical moment in the life of someone else, as that ambulance is bringing to their door a crew of professionals with sufficient equipment to do anything that might otherwise happen in a hospital emergency room.
Inside a steel building on North Putt Corners Road is the New Paltz Rescue Squad headquarters. The rescue squad is a nonprofit organization, and the nondescript building is owned by that organization. One portion of it is set aside as a garage for the four ambulances and other vehicles, but most of the building has two floors inside. That space is used for offices and training, but there’s also bunk rooms and social space for the crew members, paid and volunteer alike. Shifts are 12 hours long, and during downtime, they are able to sleep, eat, watch Netflix, do laundry or take advantage of the robust wireless network. No small number of rescue squad volunteers — including both lieutenants — are college students, and amenities like free snacks and laundry facilities go a long way in making it easier to commit to that work. Chief Matthew Goodnow is both chief executive and operating officer of the organization. His assistant is also paid, but the captain, like the lieutenants, is a volunteer.
The bare minimum to begin volunteering is CPR certification and ambulance driver training, which are provided; volunteers are expected to pick up two shifts a month. EMT training — six to eight months in time — is a prerequisite to undergoing squad leader training. As a squad leader, all that EMT needs is a driver to be able to “do it all,” Goodnow said. Volunteering, when the stakes can be someone’s life, cannot be a lesser commitment than what’s expected of the paid crew members.
The mission of the nonprofit is to provide emergency medical services to those in need within the Town of New Paltz, but they do go farther afield when needed. All that advanced equipment, training and salary to make that possible adds up quickly, and the rescue squad has two main sources of revenue. First, they have a contract with the town to provide this service; they also bill patients or their insurance companies. “The town [contract] is an agreement that we’ll be here,” the chief said, “and we bill the service to the insurance companies.” The latter means that the squad needs to have a full-time business administrator overseeing insurance reimbursements, but even she is a trained EMT, able to help staff a crew if the demand is high enough when she’s in the office. Any efficiency possible is needed because insurance reimbursements often come in at a fraction of what’s billed. Like most nonprofits, the New Paltz Rescue Squad operates on a tight budget. Part of the rescue squad’s tight budget could be lessened by designating emergency medical as an “essential service,” which opens the door to receiving federal aid. “Waste management gets that designation,” Goodnow said, and he considers it ironic that EMS hasn’t yet been put on that same level of importance. “It’s a new science,” he admits.
The history of emergency medical services like this one is relatively short; it was only in the 1970s that the term started to replace “ambulance service,” signaling a shift from simply transporting those in need of care to delivering that care. Chief Goodnow speaks of how ambulances were once converted hearses painted white, with room for not much more than to stabilize a patient on a stretcher for transport. The vans now used are stocked with state-of-the-art equipment and staffed by crew members trained in a wide variety of medical procedures. Perhaps one of the most dramatic shifts over the years is in cardiac care: heart-attack victims were once brought to the nearest hospital as a matter of course, but now instead the ambulance remains parked and the patient is cared for right there. A doctor is available for consult whenever it’s needed, but there’s nothing done in an emergency room that can’t be done by a New Paltz Rescue Squad crew.
Agency of the year
Marbletown resident Harriet Weber, who died in 2001, is credited with founding emergency medical services in Ulster County following a 1958 call for an ambulance she’d made for her mother. What arrived was a hearse, as there were no ambulances here yet. She founded the Rondout Valley First Aid and Rescue Squad and the Marbletown First Aid Unit, and became an early instructor in emergency medicine. Goodnow, who was first an EMS volunteer in Weber’s hometown, was recently honored with both the county and regional awards of excellence named for her. “She advocated ambulances for all, and she was near and dear to my heart. It’s an honor to get an award named for her,” he said. There’s also a state-level award with the same name, but Goodnow believes there are others more deserving of that honor than he. At the same time, the rescue squad was named agency of the year, and members took home awards for safety and service. “New Paltz really brought it home this year,” the chief said.
Locally, the New Paltz Rescue Squad was started in 1973, in response to the fact that the town doctor was cutting back on house calls. Following national trends, the first paramedic training course was given in 1987; everyone who participated in it was a volunteer. Now the squad is able to field two full ambulance crews to provide “top-notch care” at a time at any hour of the day, and they have enough equipment to send out two more ambulances if the situation warrants it. With every ambulance staffed by at least one paramedic, they’re able to administer medication, intubate and perform electrocardiography and other procedures. That makes them a frequent recipient of requests for mutual aid, when someone is waiting for assistance in an area where all the volunteers are already engaged. As long as there is one ambulance able to serve New Paltz, those calls can be answered, but the demand for mutual aid is also on the rise.
Goodnow remembers when the rescue squad was fully volunteer, like the fire department. He understands the importance of volunteering, and is in fact a volunteer fire chief in Gardiner. The camaraderie which develops among such volunteers is clearly something they all value highly, but it’s difficult to quantify, even explain. The decision to volunteer, which in many cases was once a family tradition, is now more an economic decision. “People don’t have the time” to volunteer as much, he laments, as families have come to rely on more than one member working full time. When New Paltz and surrounding communities were more agrarian, emergency volunteers often were leaving their fields to help their neighbors. Now, more people work farther away from home, and are unable to drop everything for that call. “It’s a bedroom community,” he said. “People just aren’t around.”
Volunteerism, in general, is on the wane, and the rigorous training necessary to become a paramedic makes it too expensive for most people to perform this service for free. That isn’t to say that volunteers aren’t welcomed into the fold: a full crew should include one volunteer among three members, although right now only ten of the weekly 28 shifts have a volunteer in that third slot. Every crew includes one paramedic, who is always paid; as the certification requirements and as liability concerns have risen, it’s become an oddity for someone to volunteer their paramedic services. This blended model is effective, but Goodnow acknowledges that if a volunteer misses a shift, “there are fewer repercussions.” On the other hand, maintaining volunteer opportunities strengthens ties between the squad and the wider community in which it operates.
Goodnow believes the decline in volunteering is clear, and he’s hoping that more people start focusing on solutions rather than simply studying and acknowledging the trends. There’s a bill under consideration to give considerable tax breaks to volunteer firefighters, for example, and he’d like to see that expanded “across the board” to include other emergency volunteers. He’d also like young people to get a firmer push to consider careers in emergency medicine, which are among those which require a non-college education path.
College or not, rescue squad volunteering is a “good stepping stone” along a medical career path, believes the chief. “Many doctors and physician assistants start here,” he said, with two doctors at Vassar and one at Mid-Hudson Regional being former New Paltz volunteers. SUNY students often ask to ride along to gain patient contact hours; they are always encouraged to expand that into volunteering: “it’s good for them, and good for the community.” Together with the free snacks and laundry, the tactic has proven effective enough that both lieutenants are students at this time.
To make the most of those trained crew members, the rescue squad also has two “fly cars,” SUVs which can get a single person to the scene to respond while the ambulance is on the way, or can be taken to follow an ambulance to the scene. If a patient needs to be transported, either the paramedic or emergency medical technician will ride along in the ambulance, depending on the level of care which might be needed en route. The other person can then return to headquarters in the fly car, to be available should another call come in right away.
Emergency services hub
Just a few hundred feet from the rescue squad building is a similar steel-frame structure; town officials are planning on purchasing it as a new home for the justice court and police. The move is lauded for again bringing police and the court under one roof, but Goodnow sees other benefits, as well. Together with plans to soon break ground on a new firehouse right next door to the proposed police and court building, this would create an emergency services hub that Goodnow believes can only improve an already solid working relationship among the three agencies: village firefighters, town police and private rescue squad. It also could strengthen an argument to allow a “crash gate” onto the Thruway directly from the rescue squad property. This request has been turned down by Thruway Authority officials in the past, but Goodnow believes with the other two emergency services headquartered within a few hundred feet, the argument is much more compelling. The crash gate would allow them direct access to the Thruway instead of getting on and off at official entrances and exits.
Before, during and after an emergency
Whether the dream of a crash gate is realized or not, Goodnow promises that the New Paltz Rescue Squad will be there “before, during and after an emergency.” “During” is the obvious part of that work, when a crew of trained emergency professionals provide medical care and transport as needed. What comes “after” includes follow-up calls to check on the patient’s progress, as well as advice about safety and care. The chief recalled one patient who had a very long line hooked up to an oxygen machine; at that length the patient wasn’t getting as much O2 as the doctor had ordered. “Before” emergencies, they distribute “vials of life” to senior citizens; these are containers for medication that can be used to both secure and manage prescriptions. Rescue squad members frequently are on standby for events ranging from parades to the county fair. They keep a stock of canes, crutches and other medical devices on hand to lend out to those in need. There are also regular training sessions open to community members, such as for CPR and the administration of naloxone, the drug which can stop an opiate overdose. Scouts can also complete their first-aid badges with rescue squad members.
The siren is a signal that one must pull over to yield to an emergency vehicle, but it’s also a reminder that a considerable amount of this lifesaving work is done by volunteers who just want to help their neighbors. The siren is a call to action. Who will hear it?