By TED MEBUST for AllOstego.com
In December of 2021, the Otsego County Board of Representatives, at the recommendation of its Public Safety and Legal Affairs Committee, implemented a 24-hour, county-based advanced life support ambulance service, buying two ambulances and staffing 16 full-time and 10 part-time paramedics. Previously, pre-hospital emergency medical services had been largely carried out by the 17 volunteer-based EMS agencies serving the county, most associated with local fire departments. However, these first responders had reached a breaking point and were the first to sound an alarm.
“After COVID-19, I had a number of squad captains calling me, begging us to do something because they couldn’t handle the load anymore. Essentially, you’ve got the same six, seven people who are pulling all the work. They’re spread thin and they just can’t do it anymore,” said Dan Wilber, chair of Otsego County PSLA, District 10 representative, and 47-year EMS volunteer. “EMS was receiving calls from people who were dying on the phone when they were calling for help because we could not get them emergency medical care.”
Though the pandemic exacerbated many issues within Otsego County’s EMS system, various strains had been building long before. A recent report commissioned by the New York State Emergency Medical Services Council, titled “New York State 2023 Evidence Based EMS Agenda for Future,” opened with the following statement:
“The New York State EMS system has markedly deteriorated over the past several years due to declining volunteerism, lack of public funding to cover costs of readiness, inadequate staffing, rising costs, insufficient insurance reimbursement, rising call volumes, a lack of performance standards, poor understanding of the EMS system by elected officials and the public, NYS home rule and lack of transparency and accountability for EMS agencies.”
Many of these issues, the report said, stem from EMS not having “essential service” designation from the state.
“EMS not being named an essential service is a significant challenge for agencies to justify the cost of readiness or staffing measures to meet the needs of emergency and non-emergency calls,” the report stated.
A 2009 study from the “Journal of Public Health Management and Practice,” examining recruitment and retention in rural and urban EMS through a national survey, raised these points over a decade ago.
“Aging of the population has the potential to increase both the volume and intensity of emergency calls and, as a result, the need for emergency personnel… EMS work is physically and emotionally stressful, the hours and schedules can be undesirable, injury and disease exposure are an ever-present risk, compensation and benefits are unexceptional, and training and continuing education requirements are extensive. These realities of the EMS profession can deter new recruits and lead to high levels of burnout among emergency response personnel,” the report read, noting that rural agencies were more likely to lose staff due to burnout or education requirements than their urban counterparts.
While the stresses of the job are felt primarily by EMS personnel, cumulative effects of declining EMS capabilities impact the entire modern healthcare system. As hospitals increasingly rely on ambulance crews for transfers, emergency care, admissions and discharges around the clock, the crews are less available for 911 responses.
Additionally, inpatient beds are turned over less frequently in hospitals, leading to patient overflow in emergency departments and higher wait times for patients to be admitted.
Robert O’Brien, Otsego County 911 and EMS director and an 18-year volunteer EMT, described waiting for over an hour on one occasion in the parking lot of an emergency department, giving life support to a patient while his crew waited for a bed to open.
Admitting that change was necessary, the Otsego County PSLA formally addressed the situation in 2021.
“Maybe we waited too long to implement it, but we went all around the county, saying, ‘How can we help you?” said Edwin Frazier, District 1 representative and PSLA Committee member.
The county’s ambulance service was originally funded through the American Rescue Plan Act, and an additional grant allowed the PSLA to employ Matt Zavadsky, an EMS subject matter expert at the technical services consultant group Center for Public Safety Management, LLC, from August 2021 to July 2022 to observe the county service’s effect and determine sustainability options. Zavadsky’s team also spoke to volunteer-based agencies around the county to understand their perspective during the year-long observation period.
“Agencies are struggling but committed to the communities they serve,” he said on February 9, 2023, while presenting results to the PSLA. “Despite all their best intentions, getting ambulance crews has really become an issue.”
Zavadsky’s report determined that the county service became the second largest EMS provider in Otsego County, “decompressing reliance on mutual aid greatly between volunteer agencies” and “working as designed.” The system led to a reduction in average response times of 10.8 percent, from 23.3 minutes prior to the start of the service to 20.7 minutes after its implementation, according to Zavadsky. Additionally, activation times—the time between receiving 911 calls and an ambulance crew heading out—decreased from 9.0 to 5.0 minutes. A full report to the Otsego County Board will take place on March 1, 2023.
“With both county and volunteer crews responding to calls, we’re starting care sooner,” said O’Brien.
The paramedic service, Otsego County Deputy Director for 911 and EMS Casey Eckler explained, provides a level of care that was in decline prior to its implementation.
“You have your first responders, or people who are not EMTs, who are qualified for basic CPR and first-aid only. Then we go to BLS, or basic life support, which requires an EMT training course that is updated every three years… then you have ALS, which are your critical care techs and your paramedics, which is really extensive training,” said Eckler. She has also served as a volunteer EMS provider for 20 years.
While emergency calls in the state require at least a BLS-level response, oftentimes ALS personnel employed by the county will aid volunteer crews on calls to provide the appropriate level of care.
Despite its successes, the county’s service brought a new set of challenges to the existing system. As a relatively new institution, the county’s paid ambulance service has, at times, caused friction with existing EMS services. And while volunteer and paid services continue learning to coexist in Otsego County, the NYS EMS Council is processing recommendations which suggest an overhaul of the current system may be looming.
“New York State is about to seal the fate of the volunteers,” said O’Brien.
This is part one of a three-part story on Otsego County EMS. Next week’s edition will examine the analyses and recommendations of two major reports on EMS in Otsego County and New York State, respectively, and their subsequent impacts. Read more on: www.allotsego.com.