The multifaceted plan would deliver funds to local EMS providers, bolster training and recruitment, and allow the county to better coordinate supplemental coverage in areas that need it most. Speaking at the headquarters of the New Paltz Rescue Squad, Metzger says local agencies are struggling to stay afloat amid rising demand, falling recruitment, and low Medicaid reimbursement rates.
“Volunteer agencies have historically been able to make it work through a combination of local fundraising and an abundance of volunteers. And there used to be more people on private insurance and fewer people on Medicaid, covering more of the costs," Metzger explains. "None of this is the reality anymore."
According to a study commissioned by Ulster County, six of its 17 ambulance agencies responded to less than 70 percent of their calls in 2022. That year, the average total response time for EMS calls in the county was nearly 14 minutes.
There are two main types of EMS service in the county: basic life support (BLS), for your typical falls, injuries and illnesses; and advanced life support (ALS), where trained paramedics administer medication and handle life-threatening situations, like heart attacks or strokes. Metzger says 65 percent of Ulster County’s calls are for ALS, and that’s where a lot of the shortages lie.
Richard Miller, a certified instructor coordinator with the county, helps New Paltz Mayor Tim Rogers navigate a map highlighting some of the most stressed areas over the past year. Towns like Plattekill, Gardiner and Ulster are dotted red to notate they have the worst gaps in service.
“When we see population density, we start to look at an increased demand for EMS services," he explains. "If you look up here in the Town of Ulster in particular, you see these hot spots. What occurs in the Town of Ulster that’s unique to the county? It’s the biggest hub of commercial area that you have: you have the mall, the movie theater, all the restaurants that are up 9W."
Higher population doesn’t always mean more stress, though. Kingston, for example, is colored a light shade of pink, despite being the county seat. That could have to do with the Kingston Fire Department launching its own ambulance service last year. Rogers’ village of New Paltz is also shaded light pink, despite its proximity to the busy campus of SUNY New Paltz.
“Look at that. There’s very little distress," he points. "Why is there very little distress? Because of you. You guys invest in your EMS infrastructure continually and enhance it, and then you have New Paltz Rescue Squad.”
Metzger says the county has applied for a Municipal Certificate of Need with the State Department of Health that would allow it to contract with local EMS agencies and send them over to red zones for supplemental ALS service. Her short-term plan includes $4.4 million for agencies countywide, especially “anchor” ALS agencies, that have demonstrated a response rate of at least 95 percent in their primary jurisdictions. It also includes a $500,000 grant program to help purchase new equipment.
Long-term, though, Metzger wants to see regional tax jurisdictions drawn up to better fund EMS service. This is something municipalities would have to take the lead on, as Ulster County doesn’t have the authority to create tax jurisdictions.
At least one municipality has already moved on it. Gardiner Town Supervisor Marybeth Majestic says the town recently contracted New Paltz Rescue Squad for supplemental ALS service, and while she didn’t give a number, she says they’re working on a town-wide ambulance district that residents would be taxed on.
“When people in Gardiner or any other town in the county call 911, they expect a response," says Majestic. "And we’re happy to work together with the other players to make that happen.”
