ITHACA, N.Y.—Data shows it takes 12 minutes and 48 seconds on average for a Tompkins County resident to receive emergency medical attention after calling 911. Nationally, the average response time is 4 minutes, which raises concerns about the efficiency and effectiveness of local emergency services.
The Town of Enfield reported an average response time of 20 minutes and 3 seconds in 2021. The same year, data collected by the county, in collaboration with researchers at Cornell University, revealed that residents in the Town of Newfield waited an average of 23 minutes before any type of emergency service vehicle arrived at their doors.
These figures show the length of time callers have to wait to receive any sort of in-person response to their emergency, which could include police, an ambulance or a community-based fire squad.
Only four EMS agencies remain open to service all of Tompkins County, spanning about 475 square miles: Bangs Ambulance, which responds mainly to calls from the City and Town of Ithaca, Dryden Ambulance, Groton Ambulance and Trumansburg EMS.
The agencies are stretched thin and struggling to keep up with a growing population in the county, which is also contributing to a significant increase in call volume. At the same time, the agencies are reporting record-low staffing figures in both paid and unpaid EMTs.
Many of the calls agencies are dispatched to are far from their stations. which contributes to the rising response times in the county. Despite their best efforts, response times are increasing at an alarming rate, particularly since 2015 when Slaterville Ambulance, after 57 years of service, was forced to close due to lack of volunteer interest.
The remaining agencies are gasping for air and doing what they can with the resources they have to respond to emergencies as effectively and quickly as possible.
Tompkins County takes action
The Tompkins County Council of Governments (TCCOG) formed the Emergency Medical Services Task Force in 2016 to find ways it could lend a hand to the struggling EMS agencies to relieve some of the pressure.
The task force recommended that the county take a more active role in recruiting and training practices for EMS. In response, TCCOG formed an Emergency Response and Planning (EMRP) Subcommittee in 2020. The subcommittee included 19 community members, experts and local officials.
As a result of the subcommittee’s work, a new EMS program director position was created in the Tompkins County Department of Emergency Response (DoER), and was filled shortly thereafter in March of 2022 by Joe Milliman.
Over the past year, drawing from his experience as the former EMS supervisor in the Village of Groton, Milliman worked to craft a practical and cost-effective strategy for establishing a rapid medical emergency response team.
Other counties in the state, like Essex and Wayne County, have implemented similar EMS programs known as “Fly Car” programs, while counties like Niagra and Warren County are currently in the process of doing so.
The project’s creators chose to pursue a rapid medical emergency response team specifically because it helps address Tompkins County’s primary shortcomings contributing to long response times.
Data shows that in Tompkins County, most 911 calls made are classified by dispatchers as “omega” or “alpha” calls, which are low-level calls that are not life-threatening, and do not require immediate medical attention to address.
For example, when an elderly person calls 911 to report they’ve fallen without injury and request a helping hand to get them back on their feet, dispatchers classify that as an omega call.
Low-level calls come mostly from outside of Ithaca in rural municipalities and rarely require an ambulance for trained EMTs to respond effectively. These rural areas are where response times are longest, which is partially because the majority of agencies choose not to take low-priority calls due to staffing shortages.
The team would be instrumental in filling that gap, directing the new response vehicles to those low-level calls first, freeing up ambulances needed for emergencies where transport is needed.
Or, in the case of life-threatening, time-sensitive emergencies like a stroke or a heart attack, the response vehicles would be able to get to that scene before an ambulance to start life-saving treatment till the ambulance arrives.
Milliman had help from Michael Stitley, director of the Tompkins County DoER, as well as the dedicated subcommittee members in creating what is now known as the Rapid Medical Response Pilot Program.
Milliman and Stitley presented the program to the Tompkins County Legislature’s Public Safety Committee on Oct. 4.
It suggests hiring a team of fully trained EMS responders to reduce unusually long response times by arriving at emergency scenes ahead of ambulance services. If the county legislature votes to approve the two-year pilot program, an early 2024 launch is expected.
Initially, nine employees would need to be hired in order for the county to launch the program, with three assigned to each of the three SUVs— a full-time EMT, a part-time EMT and a third, paid hourly.
The responders would be positioned in three strategic locations around the county where response times are the longest, like Enfield and Newfield, with SUVs capable of performing in inclement weather.
Discussions to decide where to station the vehicles are ongoing, and according to Milliman, no final decisions have been made.
“With this industry, things change day to day. So especially in the first year [of the two-year pilot program], there will be a lot of playing around with where we position those vehicles,” Milliman said in an interview.
These vehicles are not ambulances and are not meant to transport patients to nearby hospitals. Milliman said the subcommittee didn’t flag transport services as a shortfall, crediting the four “very strong” transportation services in operation locally.
The faster-moving SUVs aim to address what he called “our biggest need”— bridging the gap in initial response times for the most critical and time-sensitive cases, as well as those classified low-priority.
EMTs would arrive at the scene within minutes after the caller dialed 911, ideally before the ambulance, faster than the county’s 2021 average time of just over 12 minutes and closer to the national average of four minutes.
Milliman, Stitley and the subcommittee emphasized cost-effectiveness in their decision-making process and suggested officials outfit county-owned vehicles not in use to avoid purchasing new ones.
Stitley also mentioned in an interview that, in case the program isn’t extended beyond the two-year pilot period, repurposing vehicles would help mitigate the financial impact on the county.
Should we split the bill?
Conversations surrounding ways to fund the project are contentious. While the majority of county legislators, town and village officials recognize the addition of three vehicles with EMTs would speed up initial response times, especially in rural areas, no one seems particularly thrilled to foot the bill.
Stitley and Milliman presented five different scenarios to county legislators last month as options for funding the program, from startup costs to estimated annual costs.
In four of the five models, municipalities would be responsible for covering part of the bill. The included municipalities being Caroline, Danby, Dryden, Enfield, Groton, Lansing, Newfield, Ulysses and the Town of Ithaca.
On top of start-up costs, which are calculated at approximately $314,396 per response unit and at $699,795 for all three, municipalities may be obligated to contribute annually to the program for the duration it exists, which seems unjust for elected officials representing their constituents.
Officials in rural communities like the Town of Enfield and the Village of Trumansburg say they can’t afford to contribute any amount to the program, and if taxpayers in struggling municipalities were able to scrounge up more for better EMS, they would have done so already.
The Village of Trumansburg already allocates $1.4 million to support its own EMS service, Trumansburg EMS, out of their yearly budget. It services around 250 square miles, while the village has a total area of 1.2 square miles.
Trumansburg Mayor Rordan Hart said paramedics at Trumansburg EMS are overwhelmed as is, being one of the last holdouts for 911 dispatchers trying to disperse an increasingly high call volume to fewer services.
So oftentimes, emergency calls miles away are dispatched to Trumansburg EMS, even if it’s a 30-minute drive. This scenario is familiar to EMS workers at the four remaining agencies. It’s most notable at Bangs Ambulance, which takes calls outside their jurisdiction of the city and town of Ithaca quite often to help the system fill gaps.
Dan Lamb, Town of Dryden deputy supervisor, professor and researcher at Cornell University, said the town’s rescue service, Dryden Ambulance, reported that 25% of all calls go outside their jurisdiction, and they go primarily into the town and city of Ithaca.
The further away a municipality is from the county’s population center, which is Ithaca, the longer it takes for emergency service vehicles to arrive. And the longer it takes for residents in those areas to receive medical attention.
In these places, elected representatives are adamant their constituents are incapable of handling an increase in taxes that would be necessary to cover costs. But according to response time data, that’s where the emergency medical response program is needed the most.
Tompkins County Legislature’s Public Safety Committee Chair Rich John, who represents city taxpayers in District 4, said he believes municipalities should contribute to the costs, with the exception of those with existing EMS agencies, like Trumansburg and Dryden.
John thinks municipalities likely to benefit the most from the program should help pay for it.
“They should pay more than somebody in the city who’s not really going to see any change in their response times,” he said.
But Hart disagrees with using this logic, citing the interconnected nature of the EMS network, where threats anywhere within that network impacts the health of the system as a whole. He supports the county funding the program fully.
Because of how the system functions, he said he thinks it’s very likely the more populated areas of the county John represents may actually benefit more, since their services won’t have to travel to rural calls.
“I think the beauty of the county-funded version is that every county resident will be contributing to the service that will shore up the system that benefits every county resident,” Hart said.
Lamb, who was involved in researching efforts and was part of the Emergency Medical Services Task Force, said he thinks the “only viable solution” is for the county to run the program.
He also said the committee that designed the proposal feels strongly the county needs to take on the program, without cost sharing.
“It’s too messy,” Lamb said. “When you try to get into how many calls went to one area versus another, you’re getting into a very inexact science. You just can’t achieve fairness in that system, and it gets complicated. That’s going to drive a number of municipalities away from wanting to support this.”
For Enfield Town Supervisor Stephanie Redmond, the problem lies not in taxpayers’ unwillingness to pay more, but their inability to do so.
“It’s not that residents don’t think it’s important, it’s that they’re priced out of their homes,” she said.
She said Enfield is “the last hamlet in Tompkins County for low income residents” and one of the last “relatively affordable” places to live. Enfield also experiences, on average, the second longest recorded response times since 2016.
Redmond worries if legislators vote to launch the program, there’s a chance her constituents could be stuck paying for something they didn’t agree to.
“We’re not going to have any input in it, no vote, but we’ll be stuck with the bill. And that seems unfair. That’s taxation without representation,” Redmond said.
Lamb said back in 2019, when the Town of Dryden board announced it had to double the ambulance tax, no one complained.
“I just think this is the year to do this,” Lamb said. “This is something I think the public is behind, and if they inform the public of it, they will support it.”
Lamb said Tompkins County needs this model because “there’s no other choice.”
“Our first response system, light rescue and ambulance service in Upstate New York is collapsing. And we don’t have the volunteers to sustain it,” he said. “Some companies do, but it’s not consistent across the county.”
Work is also being done on the state level to improve the health and efficiency of all existing EMS networks. But according to researchers at Cornell’s School of Public Policy, regulation for the EMS industry in New York State is fragmented and divided, and funding is nearly nonexistent. The result is local taxpayers being increasingly responsible for bearing “the inequitable burden” of providing essential life-saving care and transport.
Assemblymember Anna Kelles wants to change that. She’s organized officials and experts in the county to work to introduce legislation to address the shortfalls in rural EMS services.
Last year, Kelles and Sen. Michelle Hinchey introduced legislation that would implement state aid for emergency medical service, modeled after the Consollidated Local Street Highway Improvement Program (CHIPS).
Established in 1981, CHIPS provides direct funding to local municipalities in the state for road maintenance based on a formula that accounts for road type and mileage.
“For this bill, we’re using the logic that EMS is no longer just transportation or an ancillary service to our statewide system of health care,” she said. “It’s become the first step of our healthcare system and has become an integral part of it.”
Kelles said in an interview that getting the state to recognize EMS services as essential is the first step in pushing for financial support from the state to support municipalities that traditionally shouldered the burden of funding this critical service themselves.
“Our healthcare system is accessible to anyone,” she said. She explained that regardless of where an individual pays taxes, if they call 911 in Tompkins County, an ambulance or other emergency service agency is dispatched to help.
So like road maintenance subsidies, which are calculated based on the aforementioned formula, the state should support EMS services in a similar manner, using a formula as well.
She said this one solution she’s proposed is only part of a “larger package” of legislation from her and other elected officials to improve the situation.
Hart said to his knowledge, ambulance agencies, paramedics and EMS providers alike think the Rapid Medical Response Program will strengthen the local services for residents.
“People on the inside understand very well what the strains to the network are, what’s causing them and what the implications are if they continue,” Hart said. “So anything that can be done to alleviate any of that strain is a benefit.”