By Luke Mosseau
The Post-Star
WARREN COUNTY, N.Y. – Low retention rates and increasing costs have tightened EMS operations around New York State, with Warren County now ready to undergo a $100,000 study to see what the county can do to help improve local EMS stability.
“The purpose of the project that we applied for was to develop a long-term plan for our various EMS districts across Warren County,” Warren County planner Ethan Gaddy said. For the study, Warren County was awarded $50,000 through the New York Department of State Local Government Efficiency program; the county will provide the other $50,000.
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“During the Warren County 2040 planning process and public engagement, we asked residents what some of the top priorities for Warren County government could be, and one of the fundamental things that people viewed as a role of government is providing for public safety,” Gaddy added.
A 2024 report from New York State Comptroller Thomas DiNapoli’s office found that the number of EMS personnel has decreased over the years due to “low wages and a strained labor market,” while the cost of providing emergency services has increased. “Much of the responsibility for determining how to meet the changing needs of New Yorkers ultimately falls to local government officials, who must monitor conditions in their jurisdictions and be ready to make adjustments when agencies downsize, close or are otherwise unable to meet the demand for services,” the report states.
Since that report was issued, the problem has only grown, with town budgets across Warren County wrestling with the burden of necessary EMS costs, typically in the millions. “This is a big number for us towns to field [EMS] services. It’s a large percentage of my Lake Luzerne budget, so any way we can figure out how to save our costs by efficiency with studies like this... I’m strongly in favor,” Lake Luzerne Town Supervisor James Niles said.
“We’ve heard a lot about our EMS districts struggling,” Gaddy explained to the county’s economic growth committee. “The Local Government Proficiency Program allows for counties to provide the glue between various local entities to understand where we could have some efficiencies, where there’s opportunities to collaborate, while at the same time recognizing the autonomy of each one of these groups.”
Over the past five years, counties across the state have begun to embark on a more proactive approach to EMS departments within their communities. For instance, in an attempt to fill ambulance service gaps, several counties have ramped up the amounts they are spending on ambulance and other EMS delivery, and increasingly they are participating directly in providing emergency care to their residents — either as primary responders or as back-up providers to the local government EMS agencies within their borders, according to DiNapoli.
Based on financial reports filed in 2024 with the Office of the State Comptroller, it does appear that counties are taking on an increasing role in EMS spending. Greater county involvement statewide led Comptroller DiNapoli to survey counties about their roles and potential funding for EMS. The result of that survey showed the amount being spent by counties varies widely, ranging from less than $1 per capita in seven counties to nearly $45 per capita in Livingston County. Schoharie, Essex and Schuyler counties all spent over $25 per resident, according to the report.
Warren County’s Planning Department has already begun collaborating with Warren County Director of Emergency Services Ann Marie Mason to take a deep dive into the intricacies of EMS operations and the financial ramifications of these services.
“We’ve been working closely with Anne Marie Mason and her team on this one. There’s an unfunded state mandate to develop a countywide EMS plan, which is really a lot of data gathering,” Gaddy said. “Anne Marie and her staff are in the process of that right now, and we have some flexibility with this work plan with the Department of State to make sure that we capture value from that effort that Anne Marie is undergoing.”
However, evaluating EMS adequacy is often challenging. “Reliable statewide data on EMS response times, ambulance availability, staffing levels, reliance on mutual aid and other factors that would guide local officials in making critical decisions for their residents is often either not available or extremely difficult to obtain,” DiNapoli stated. “As a result, counties are increasingly taking it upon themselves to assess the need for additional services and to supplement EMS in various ways.”
Gaddy says that the advantages of pursuing this EMS study through the Local Government Efficiency Program include the potential to open subsequent rounds of funding for implementing strategies derived from the study. “Those grants are way more attractive from a local share perspective. It’s only 10% local share, with a 90% state share,” Gaddy said.
According to the state mandate, counties have a formal role in coordinating local EMS systems by virtue of county EMS coordinators’ participation as ex-officio members of the Regional Emergency Medical Services Council, or REMSCOs. Therefore, counties have natural insight into issues with services. That insight goes deep enough for the State EMS Sustainability Technical Advisory Group to recommend that New York State formalize reliance on counties to manage EMS delivery.
“Authorize and fund county EMS coordinators to facilitate coordination of EMS within their counties, to maximize economies of scale, and ensure the timely delivery of EMS. Increase statutory authority of county EMS coordinators for managing EMS responses,” the recommendation states.
Given their expertise in the field, most EMS agencies value their independence and autonomous decision-making. “We’re not at the stage of the planning process where we jump in to say, ‘Hey, the solution here is a countywide system,’” Gaddy explained. “I’m not a subject matter expert, but what I have heard is that there is a desire for some autonomy locally, and if this [study] was approached as a project that was simply looking for a way to have a countywide EMS district, I don’t think there’d be a lot of buy-in [from local EMS agencies].”
Instead, there may be opportunities for the county to take on a more hands-on role in training and education, or in billing and administration. “We’re going to see where the planning process goes, if that’s the most efficient way to deliver these services, and if there’s buy-in from the stakeholders, then [county involvement] would probably end up as a recommended strategy to plan,” Gaddy said.
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