DiNapoli: More State Involvement Needed to Address Local Emergency Medical Services Challenges

Report Conclusions:

Reliable ambulance services are a public health imperative – literally a matter of life or death. New
Yorkers expect to receive timely and capable emergency medical services when needed, without
having to worry about all the things that need to be in place to make it happen.

The number of EMS personnel has decreased due to low wages and a strained labor market, and
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. In an attempt to fill the
resulting ambulance service gaps, 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.

Stakeholders are taking steps to address some of the challenges. For example, an amendment
to the General Municipal Law enacted in 2022 authorizes cost recovery for fire entities that were
previously unable to bill for ambulance services. However, this provision is slated to sunset in 2026.37
Other recently enacted State legislation that will take effect in 2025 allows ambulance companies
to bill insurance companies for ambulance service regardless of whether they have an agreement
with the insurance company. These changes are indicative of a recognition of the funding problems
facing these emergency services providers, but they are just one of the many challenges that local
governments face in ensuring their residents have adequate EMS.38
The stakes are too high and the issues too complex for counties and other local governments to
have to address on their own. The current circumstances call for direct State involvement to support
the efforts of counties and other local governments to turn fragmented and ad hoc responses into
comprehensive solutions.

While Regional EMS Councils and local government providers should conduct regular needs
assessments, solutions need to start at the State level and include better statewide data collection,
management and analysis to help EMS agencies identify where services are falling short and
provide options for improving response times and outcomes. Better centralized guidance from the
State about funding sources can help local officials make more informed decisions about how to pay
for these services.

OSC Full Report: "The Growing Role of Counties in Emergency Medical Services" with case studies
                                                (click to view, print or download)


Ulster County, NY   (March 26, 2024)

Ulster County Executive Jen Metzger Announces Release of EMS Study Report

KINGSTON, NY- Ulster County Executive Jen Metzger today announced the release of the  “EMS Services Delivery Report,” prepared by the Center for Public Safety Management, LLC, a
consultant selected to assess EMS services in Ulster County and recommend options for
improving service delivery. The report, initiated by former County Executive Pat Ryan in 2021,
presents survey data collected from Ulster County ambulance and first responder agencies
throughout the County, assesses the current state of EMS and ambulance service delivery,
identifies challenges faced by the County’s EMS providers, and presents a range of options for
the County and its stakeholders to consider for future EMS and ambulance service

In all, the study examines data from 43 EMS service providers, including 21 ambulance
agencies and 22 first response agencies, and identifies gaps in service and EMS service
provider needs. While focused on Ulster County services, the report notes that service delivery
challenges are not isolated to Ulster County but are part of a larger national crisis.

The County report comes at a key moment as the Governor and Legislature negotiate the 2025
State Budget, which includes legislation that would designate Emergency Medical Services as
an essential service,
like fire and police, and create a pathway to bolster recruitment and
sustainably finance EMS services for the long term.

                      (click to view, print or download)



Proposed legislation would designate “Emergency Medical Services as an essential service”  in NYS  [editors note: as of March 18th, the one house assembly budget bill rejects the Executive proposal to classify EMS as an essential service and require county-based responses to emergency calls]

NYS Senate Bill S4020C (Shelley Mayer (D)  –  Senate District 37 (White Plains)
NYS Assembly Bill A3392C (Stephen Otis (D) – Assembly District 91(Westchester)

S4020A / A3392A (2023): Referred to Local Government
S8432A/ A9509A (2021-22): Referred to Local Government


Section 1
amends the opening paragraph of subdivision 1 of section 122-b of the general municipal law to declare that general ambulance services are an essential service; requires that every county, city, town, and village, acting individually or jointly, or in conjunction with a special district, ensure that emergency medical service, general ambulance service or a combination of such services are provided for; exempts cities with a population of one million or more from the requirements. This section also adds a new paragraph (g) to subdivision 1 of section 122-b to allow a county, city, town, or village, acting individually, or jointly with any other county, city, town and/or village, to establish a special district for the financing and operation of general ambulance services by following the procedures in town law as are required for establishment of fire districts.

Section 2
amends section 3000 of the public health law to clarify that emergency medical services and ambulance services are essential services that must be available to every person in the state in a reliable manner.

Section 3
amends section 3001 of the public health law to expand the definition of emergency medical services.

Section 4
creates a new section 3019 of the public health law providing that the state emergency medical services council, in collaboration with the department of health, shall develop and maintain a statewide comprehensive emergency medical system plan to improve coordination, accessibility, and delivery of services, coordinate development of alternative delivery models, and conduct and promote education and training of emergency medical service practitioners; that regional emergency medical services councils develop and maintain regional comprehensive emergency medical system plans; and that counties develop and maintain comprehensive county emergency medical system plans.

Section 5
creates a new section 3019-a of the public health law establishing the emergency medical systems training program, and provides that the state emergency medical services council shall make recommendations to the department of health for the implementation of standards related to the establishment of emergency medical systems training programs, curricula, and requirements for emergency medical system educational institutions. This section further provides that the department of health shall ensure compliance with such standards.

Section 6
amends section 3020 of the public health law to provide for the creation or adoption of additional standards, training, and criteria to become an emergency medical service practitioner credentialled to provide specialized, advanced, or other services, and for emergency medical service agencies to become accredited in specific areas to increase system performance.

Section 7
sets forth the effective date. [This act shall take effect six months after it shall have become a law].
Minimal fiscal impact to the state.

[Editor comment: this statement usually means that NYS government indicates that the legislation can be enacted without major financial concerns or the need for additional funding in the state budget. However, the financial liability for providing EMS ambulance service will be locally taxpayer funded.]