A year-long, countywide study of the habits of emergency medical services in Ulster County released March 26 paints a picture of an understaffed, overstressed emergency response operation in need of comprehensive reform.
Performed in 2022 by the Center for Public Safety Management, LLC (CPSM), the report presents seven solutions to address failings in the system, ranging from the wholesale adoption of a completely private provider model to doing nothing at all.
As budget discussions take place in Albany this week among the fabled three-leaders-in-a-room, local political leaders haven’t been shy in bombarding the state-level decision-makers with recommendations, suggestions and threats. Among these was a five-page missive to governor Kathy Hochul from Ulster County executive Jen Metzger highlighting the provision of emergency medical services as one of the seven major issues confronting the state’s communities. (The other six are housing, climate and the environment, transportation, food security, childcare, and hospital funding.)
“Ulster County, as elsewhere in the state,” wrote Metzger to the governor, “has seen a decline in coverage, especially in certain geographic areas, due to the well-documented challenges of recruiting and retaining EMS volunteers.”
A national staffing crisis
The CPSM report considers increased subsidies for the existing patchwork of public, private and volunteer-run agencies. It discusses a centrally-run county-operated model. Hybrid systems — one in which the county staffs the agencies but doesn’t maintain the vehicle fleet — are trotted out for examination.
In one option, described as “the fly-car model,” a paramedic who would lack the ability to transport a victim to a hospital would nonetheless provide advanced life support. That model, notes the report, fails to resolve the fundamental issue which provoked the creation of the report in the first place — unreliable ambulance response to areas within the county.
Emphasizing the regional crisis as part of a larger trend, CPSM points to what they say is a national staffing crisis. A database maintained by the American Ambulance Association containing over a thousand media reports cites claims that 59 percent of those stories involve EMS system delivery. Articles from news outlets cited in the report make their point.
Of course, media fixation on reporting problems rather than positive outcomes is well known. Describing the challenge of serving the Ulster County population — 183,000 residents spread out over 1161 square miles — CPSM noted that six of the 17 ambulance agencies audited were responding to less than 70 percent of their calls.
The Kingston experience
The report holds the City of Kingston responsible for reduced mutual-aid resources in the county through its choice to initiate its own emergency ambulance services within its fire department in early 2024. Rather than stick it out with its private provider, the report notes, Kingston “essentially [ended] a long-term relationship with its prior ambulance provider, Empress EMS.”
The report’s representation of a long-term relationship between Empress and Kingston is an error. Empress bought Mobile Life Services, the ambulance company which previously served Kingston for decades, in May 2023. No reference was made in the report of the 100 emergency medical calls which the city was forced to respond to itself during the six months after that acquisition was transacted — this while the privately managed ambulance company had announced it would be expecting additional money – anywhere from $500,000 to a million dollars, according to mayor Steve Noble.
“We feel like we could provide a higher level of service and a more compassionate level of service to our residents,” said Noble at the time, “being able to be both the firefighter/first responder, but then also to be able to help transport those patients to the hospital.”
The report does note that Kingston’s fire department may be willing to become one of the regional services referred to later in the report.
Unsatisfactory response rates
Following the City of Kingston’s example, the county government could operate its own service, at first targeted to underserved municipalities, which the report identifies as “communities that are served by an ambulance agency that is unable to muster a crew for a response of more than 30 percent of their responses.”
If local services appeared on the scene after all, the county response could be canceled.
The CSPM report does note that a county-operated service “would likely operate at a deficit of $800,000 or more annually.” For the option of a privately operated contractor offering the same countywide services, “a subsidy amount in excess of $500,000 annually would likely be required.”
Compared to emergency services workers in the private sector, according to industry news media outlet EMS1, county workers would receive higher pay and more generous benefits, likely contributing to the higher costs associated with the county operation. Choices, choices.
What Metzger has suggested
The increased costs of achieving sufficient service countywide, Jen Metzger wrote in her letter to Hochul, would be prohibitive without changes in state law. She supported a bill designating EMS as an essential service, which would allow the creation of special taxing districts to fund it. A law providing an exemption from the state tax cap for five years would be essential for such a proposed new tax.
In addition, Metzger supported inclusion in the state budget of paramedic urgent care, as the governor had proposed. Proposals for the licensing and credentialing of practitioners would also have a meaningful impact in addressing the EMS crisis, she noted.
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