In response to mounting demographic and economic pressures, Ulster County Executive Jen Metzger and other county leaders have announced a plan that would give a short-term boost to a variety of emergency medical service agencies while local leaders are asked to create special taxing districts to ensure ambulance coverage over the long haul. The county contribution would be on par with the $5 million plan that was pitched by Jason Kovacs, a legislator representing portions of the towns of Saugerties and Ulster. Unlike Kovacs’ proposal, which would have money from county coffers directly to local governments, Metzger’s plan involves county contracts — which means that it can’t fully be implemented until a certificate of need is issued through state bureaucracy. That’s already in process, and state officials were on hand to express their support.
This new scheme was rolled out at a presser last Thursday, held at the headquarters of New Paltz Rescue Squad, which is considered one of the county’s anchor agencies, because through it advanced life support services are provided, and also because the staff there are able to respond to 95% of dispatched calls. Advanced life support means that a paramedic, who is trained to perform a wide variety of medical procedures, as well as administer drugs; someone suffering a heart attack, for example, could be treated right in their driveway. About two in three medical 911 calls require advanced life support. The 95% response rate means that only one in 20 emergency calls might need to be routed to someone else, and is considered the gold standard. There are half a dozen agencies anchoring the county’s emergency services in this way.
In this new funding plan, $2.8 million would be used to support anchor agencies like the New Paltz Rescue Squad to “support their cost of readiness,” which is paying people to be on duty and ready to roll out at a moment’s notice, all day, every day. While entirely staffed by volunteers 50 years ago, the cost and complexity of training has made especially the paramedic role a full-time occupation. Another $1.6 million will be for “reliability funding,” which will support the contractual costs of local governments — based on need — to ensure that there is someone to call. That money can be sent to those nonprofit agencies like New Paltz’s squad, but in places like Saugerties where the contract is with a business, it will be run through the town’s accounting process. The final half-million dollars of this $4.9 million plan will be distributed as grants to support training and equipment. Officials are also working to establish EMS certification at SUNY Ulster and advanced training through the county’s emergency services department. Paramedics and emergency medical technicians — who are trained in the techniques of basic life support, including CPR, treatment of many illnesses and injuries, assisting with childbirth and administering oxygen and automated external defibrillators — will also be able to take continuing medical education courses required for their recertification through the county department, as of later this year.
Cost pressures for emergency services are manifold. Metzger explained that the percentage of residents who utilize Medicaid is growing, and that the rates paid through Medicaid are relatively low. The county also has a growing elderly population. While their medical needs tend to be more frequent, insurance payments for those and other calls are often triggered by transportation to a hospital. That’s part of why readiness is a costly affair. Matthew Goodnow, the chief of the New Paltz Rescue Squad, observed that “our mission hasn’t changed, but our coverage area has grown.
Gardiner’s supervisor, Marybeth Majestic, was one of several elected leaders who spoke. The situation in Gardiner, as Majestic described it, is precisely why this regional approach is being orchestrated at this time. Majestic recalled being told last fall that the response time in Gardiner is “less than ideal, and that our backup in Plattekill is worse than ours.” While someone in the audience shouted “that’s wrong!” in response to that assertion, the map provided by county officials does suggest that Plattekill has most of the areas of greatest concern. Town council members in Gardiner have contracted with the New Paltz Rescue Squad as a backup provider, and are already working on creating an ambulance taxation district to pay for this readiness long-term.
County officials are pushing for this type of special district in every town. At the same time, there’s a proposal at the state level that would allow for the creation of a county-wide ambulance district, as part of a broader plan that would designate this an essential service which must be provided to all residents. If that were to be passed, it could make it easier for county officials to enter into contracts with various emergency service agencies, and to coordinate responses to ensure that all county residents get the same level of responsiveness when they are in need to medical treatment. This would be a step up from the current system of mutual aid, under which a call goes out and, if a response is not received, is sent to the mutual aid agency five minutes later. Central coordination would make it easier to dispatch a crew that’s not in the midst of transporting a patient to a hospital, or otherwise unavailable.
“We have a strong team at the Department of Emergency Services that has been diligently addressing critical EMS challenges, including the significant shortage of paramedics and EMTs, insufficient cost of readiness funding and increasing call volumes,” said Everett Erichsen, Ulster County Department of Emergency Services director. “Ultimately, the EMS Coordinated Coverage Plan is more than a funding mechanism — it is a comprehensive strategy to transform emergency medical services in Ulster County. Our end goal remains unwavering: to create an emergency medical services system that is patient-centered, accountable and sustainable. By addressing workforce challenges, providing strategic financial support and creating innovative coordination mechanisms, we offer a forward-thinking solution to the complex challenges facing emergency medical services in the modern healthcare landscape.”
For additional information on the EMS Coordinated Coverage Plan, visit participate.ulstercountyny.gov/ems-plan.
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