We all know that volunteer ambulance corps across the state are experiencing staffing pains; we also know that when a concerned family member or the patient himself dials 9-1-1, they expect an ambulance to get there… soon. In the rural communities of New York though, the challenges are even greater.
Keep this picture in your mind: New York State covers 47,214-square-miles and has around 19-to-20-million people, approximately 1,376,268 people live in rural New York. New York City is 468.8-square-miles and houses more than 8-million people — and then there is a town in Cayuga County, NY that has less than 1,000 residents.
What do these numbers mean to EMS? Per capita resources (tax dollars?) which help to fund ambulance corps is certainly crucial. The call volume in a big city may justify multiple ambulances, whereas the call volume in a small town may not even pay for one in patient fees. Cities such as New York City, Albany, Buffalo, Rochester, Syracuse and Yonkers most often have fully paid and municipal ambulance corps. While many of our suburbs depend on volunteer squads, the local governments are able to add some, if not all, of their funding into the town budget which may allow for some paid staff when volunteers are not available 24x7. Small towns cannot bear the cost of a paid ambulance corps and depend on volunteers and local fundraising efforts. As the local population ages, the number of volunteers able to do the job also decreases.
In a February 2019 seminar, Steven Kroll, MHA, EMT (since 1982), headed a discussion titled “Rural EMS Unraveling – A Little Known Crisis”. Kroll serves on the Executive Board of the Hudson Mohawk Regional EMS Council and Regional Emergency Medical Organization, and as Chairperson of the Council’s Budget and Finance Committee. He pointed out some of the biggest threats to rural EMS which include: a decreasing number of volunteers; the rising costs of running an ambulance corps; inequity in Medicaid, Medicare and insurance payments; and the burden on each volunteer to do more than respond to emergencies, including paperwork, fundraising, maintenance and more. He also pointed out that the state often gives huge chunks of money to infrastructure like medical centers and hospitals, but completely ignores EMS.
Since a community’s health has a direct effect on the town’s fiscal well-being, there were some suggestions to help rural EMS in keeping their neighbors safe. Community Paramedicine would impact the health of an underserved area by improving access to care, avoiding duplicating existing services, and address the specific needs of rural residents; they can also decrease non-emergency 9-1-1 calls which could put the ambulance out of service for a genuine emergency.
Another recommendation is slightly similar to mutual aid where two or more neighboring corps collaborate and share billing, training and equipment purchases, thereby reducing the stress on volunteers who would have to do multiple tasks. Another way to show support for volunteers and hopefully keep them riding would be to offer online courses for recertification, updates and in-service training, and also to increase perks such as increasing the tax deduction for volunteering.
*In regards to Community Paramedicine there is a current bill before the 2019-2020 Legislative Session, “To allow hospitals, emergency medical services, physicians and home care agencies, in joint partnership, to develop and implement a collaborative program whereby at-risk individuals living in the community can be served by EMS for care other than the initial emergency medical care and transportation to the hospital.”
You can read the text of this bill and voice your opinion by going to https://www.nysenate.gov/legislation/bills/2019/S1805?intent=support