Costs and demands for volunteers weigh on rural ambulance services

For nearly 30 years, Kathy Mix has proudly supported her neighbors outside of Ithaca as an Advanced Emergency Medical Technician for Slaterville Ambulance.

But when her shift ended at midnight on December 31, 2015, Mix made the ambulance’s final call to local dispatchers: “Fifteen-Fifty-One signs and will be out of service indefinitely,” she said. by radio.

Rising costs, difficulty recruiting volunteers, and increasingly stringent certification requirements have led officials to disband the all-volunteer service — a difficult scenario for rural communities in upstate New York and across the country. Beyond that, warns new research from Cornell.

“What’s happening is really a slow-moving train wreck when it comes to one of the basic functions of our society,” said Ben Carver, a student at the Cornell Institute for Public Affairs (CIPA) and deputy mayor of the village of Trumansburg, where he oversees EMS operations. “People usually expect an ambulance to come if you call one.”

Carver led a team of CIPA students — part of the Cornell Jeb E. Brooks School of Public Policy — that analyzed rural EMS services on behalf of municipalities in Tompkins County.

Ben Carver, center, CIPA student and Deputy Mayor of the Village of Trumansburg, meets with Trumansburg EMS staff Christopher Baker, Joel Fey and James Wheal.

Their report highlights “unsustainable” cost increases — up nearly 80% in Tompkins County since 2016 — rising call volumes and “alarming” trends in response times. Recommendations range from county action to bolster the pipeline of EMTs and paramedics to, most importantly, financial support from the state.

The work raises awareness among local and state policymakers of the pressures on rural communities where limited ambulance service and half-hour response times could be a matter of life and death.

“The report has helped bring more people’s attention to the challenges that rural emergency services are currently facing,” said Justin Vann, emergency services and fire coordinator for the Department of Emergency Services. County of Tompkins Emergency Response, which provided call data for CIPA analysis.

Assemblywoman Anna Kelles (D-125th Dist.), former Tompkins County Legislator, said the CIPA report provided valuable data and informed her proposal to establish a state grant for services Rural EMS, modeled on the one that helps communities maintain roads.

“I love data, I love analytics, and I have it now,” Kelles said. “We need to think about EMS differently.”

Previously, the research team encouraged local leaders to pass resolutions supporting a proposal by State Senator Michelle Hinchey ’09 that led to the creation of a state task force on ambulance services. rural.

The new report updates and expands on work done by CIPA students in 2018 for a local task force created after Slaterville Ambulance closed. The engagement took place as part of “Consulting for Government and Nonprofit Organizations,” a course taught by Dan Lamb, assistant supervisor for the City of Dryden, which saw its EMS tax double in 2020.

“Research shows that there is a real disparity between the viability of ambulance service in heavily populated urban areas and in rural areas,” Lamb said. “The financial model isn’t working – and we’re not alone in Tompkins County.”

“The resilience of our EMS network is really happening on the backs of individual providers who are being asked to deliver more and more.”

Ben Carver

Going forward, according to the study, EMS, long seen as a transportation function, must be redefined as a frontline health care service. Local EMS budgets have grown alongside national health care costs, the report says. Modern ambulances are extensions of emergency rooms – requiring more expensive and time-consuming equipment, training and certifications to acquire and maintain. This results in an “inequitable and regressive burden” on rural communities that rely on volunteers or try to pay competitive salaries, according to the research.

The analysis also highlights the interdependence of highly fragmented local EMS agencies that support each other through mutual aid agreements. After the Slaterville ambulance closed, the Tompkins County Network redistributed resources to support this area. But the countywide average response time increased by about a minute — and nearly 10 minutes in one community — as call volume increased.

“The resilience of our EMS network is really happening on the backs of individual providers being asked to deliver more and more,” Carver said in a presentation to the Tompkins County Council of Governments, which commissioned the research.

In addition to Carver, the CIPA team included Rebecca McDonald, Yiqun Song, Jiade Wang, and Qiuyu Wu.

Ahead of her expected graduation this spring, Carver continues to study EMS funding models outside of New York State. It also tries to determine the population density at which for-profit commercial ambulance services are viable — or where state support could provide rural agencies with a lifeline.

He said the issue had broad bipartisan support and was “uniquely solvable”.

Mix, the former critical care EMT volunteer, said she was encouraged to see momentum building toward solutions that could keep more services like Slaterville Ambulance going.

“I got into it because I wanted to support my community and help my neighbors,” she said. “If you look at any of the local agencies, they’re all struggling to get help.”

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