MADISON COUNTY — In recent years, Madison County has been exploring options for filling gaps in emergency medical services (EMS) coverage across the county.

Most recently, officials have been looking to provide county-operated EMS and ambulance services to ensure sustainable EMS remains available on a consistent and ongoing basis.

In a Nov. 10, 2022, press release, Madison County EMS Coordinator Jenna Illingworth explained that current EMS concerns are “the result of increased costs, stagnant insurance reimbursements rates, provider availability, and a diminishing rate of volunteerism.”

“Madison County’s EMS agencies are working hard day in and day out,” Illingworth said. “But the environment that they operate in makes it extremely difficult to thrive. Additionally, some insurance companies send the reimbursement payments directly to the patient and not to the EMS agency providing the service, forcing the agency to seek out payment from the patient. This often leads to EMS agencies using debt collection services, legal options, or simply writing off the debt and not receiving any payment.”

According to the Madison County Office of Emergency Management (OEM), its plan is not to put existing services throughout the county out of business but to work with them to ensure that if someone needs emergency medical attention, a first responder will be available to answer the call.

On Nov. 17, 2022, the Madison County Board of Supervisors authorized the OEM to apply for a county-wide certificate of need (CON), and on Dec. 1, 2022, the board authorized the purchase of an ambulance.

The CON resolution “Authorizing the Establishment and Operation of an Advanced Life Support Transporting Service Within Madison County” states that the county recognizes existing ambulance and EMS resources supported by local jurisdictions and aims to develop resources to further enhance local systems already in place. The resolution also states that the county will not infringe upon the territories of established ambulance services “unless such assistance is requested by the primary service, assistance is requested pursuant to the mutual aid plan as approved by all participating agencies, or in the event that a primary service ceases in its emergency response operations.”

According to the OEM, it has held regular meetings with EMS providers prior to the November and December meetings and since to discuss the goals of the Madison County ambulance program and the need of those agencies.

The program is currently funded through American Rescue Plan Act funds, and the board of supervisors is considering other future funding mechanisms. One of those funding sources, according to the OEM, will be insurance reimbursements for services provided.

The county-wide ambulance service will be rolled out on top of the Faster Advanced Life Support Fly Car program, which was launched last year.

Equipped with top-of-the-line equipment and experienced paramedics, fly cars provide mobile, non-transporting services to care for patients who call 911.

The program is intended to help fill any gaps in the county for coverage by EMS providers. Sometimes a fly car is covering an area because an agency may not have an advanced life support provider available. On other occasions, they cover an area because an agency has their ambulances already out on calls.

The first county-run fly car was put on the road in February 2022. There are now two cars on the road seven days a week.

The fly cars are scheduled 12 hours a day from Monday through Thursday, and from 8 a.m. Friday through 8 p.m. Sunday.

The schedule is based on need and is adjusted as new needs are identified, the OEM said.

“Madison County is a rural community with limited resources,” said Madison County Board Chairman John M. Becker in a Feb. 17, 2022, press release announcing the program. “The ALS Fly Car is a way to provide more resources to our residents, especially in their time of need. The topic was on our radar prior to COVID-19, and the pandemic made it even more apparent that our community would benefit from a program like this. I am proud of the work the Office of Emergency Management has put into creating this service for our residents.”

According to the OEM, EMS across New York State are facing many challenges — a fact that has not been overlooked by Governor Kathy Hochul.

During her 2023 State of the State Address on Jan. 10, Hochul laid out plans for broadening the availability of medical transportation options and increasing the number of emergency medical technicians (EMT), specifically in rural areas, where access can be limited.

Hochul stated that the number of EMS agencies in the state declined from 1,200 pre-pandemic to fewer than 1,000 post-pandemic, while the number of new EMTs declined by 30 percent over the same time period.

“As a citizen of Madison County, when you dial 9-1-1 you expect that your phone call will be quickly answered, and the appropriate help is on the way,” the OEM said in a Nov. 10, 2022, press release. “That reality is becoming more and more difficult to guarantee in counties, like Madison County, across the state. Membership and staffing at both paid and volunteer emergency agencies has been dwindling for years. Recently the stress of the COVID-19 pandemic on the workforce and the entire health care system has only exacerbated that issue.”

In her State of the State Address, Hochul outlined some initiatives to broaden the availability of ambulance providers. These proposed initiatives will:

Ensure emergency transportation providers are appropriately reimbursed for trips, increasing payment for more complex patients.

Establish a working group to recommend ways to expand access to non-emergency medical transportation.

Establish nine regional EMS organizations that can better coordinate all the EMS agencies and providers operating within their region and a statewide EMS disaster response system that can rapidly deploy personnel and equipment when and where it is needed during an emergency.

Allow EMS providers to perform expanded clinical care in the community.

Permit EMTs to treat patients in place or take patients to urgent care clinics without sacrificing payment for the trip, decreasing the number of unnecessary emergency room visits.

According to the OEM, Madison County believes more needs to be done, such as increasing pay for EMTs and paramedics.

Without proper reimbursement from insurance agencies, many providers are not able to pay a competitive rate, the OEM explained. Many rely on volunteerism, which across the country is dwindling.

According to the Bureau of Labor Statistics, EMT is one of the lowest-paid jobs in health care. On average, they make 30 percent less than other working Americans, with most making less than $37,000 a year.

Another step the county hopes the state will take is to classify EMS as essential services.

The essential service status would mean that EMS would become a service that a local government is responsible for providing, such as law enforcement and fire protection. Currently, there is no such mandate to provide EMS. Additionally, the essential service designation would allow all EMS agencies in the county to be eligible to seek state grants and additional funding sources that they are currently ineligible to receive.

On Nov. 10, 2022, the board of supervisors unanimously passed a resolution declaring that it believes EMS to be essential and that it is taking steps to ensure its success in Madison County.

“Giving our EMS providers the recognition they deserve is not the only thing the County can do,” said Becker in a press release that same day. “The Madison County Board of Supervisors is looking for ways to not only support our local EMS providers, but also ensure residents that their safety and health is a top priority. That is why everything right now is on the table. We are asking our EMS providers what do you need to not only survive, but to thrive. Is it assistance with education, equipment, money for wages, or other ideas? The Board agrees, that they cannot wait another year or two to try and see if things get better. The time to act is now to ensure failure is not in the future for Madison County or Madison County’s EMS providers.”

According to the OEM, the future of EMS is not a new priority for the county; the board of supervisors has been focused on it for several years.

In 2015, Fitch & Associates LLC conducted an EMS study in Madison County. The firm released its findings in 2016.

Their report included suggestions along with projections as to what would happen if no action was taken.

At that time, the board of supervisors decided to make no changes.

The OEM said the projections presented in the study are now coming true. The county has lost a volunteer firefighter ambulance and a lot of volunteers, and many agencies are unable to sustain themselves without financial support from their municipalities.

According to the OEM, the county program to support EMS delivery in Madison County is in development and will continue to evolve over the coming years.

For more information on Madison County EMS, visit madisoncounty.ny.gov/1487/Emergency-Medical-Service.