Can this private ambulance provider solve NY's EMS crisis? It's complicated

As one commercial emergency medical service is positioning itself to become the main provider of ambulatory services in Dutchess County, the county is working on its own plan to meet a growing need for reliable and faster response times to 911 calls.

The onset of the COVID-19 pandemic in 2020 exacerbated a nationwide EMS shortage . In Dutchess County, 911 calls — close to half of which involve life-threatening situations — have increased, and the county's emergency call center has at times dispatched multiple ambulances before finding one that's available. Response time has consequently lagged, sometimes over an hour.

Enter Empress Emergency Medical Service , a vast Yonkers-based provider serving municipalities within New York City, as well as Westchester, Putnam, Rockland, Orange and Ulster counties, and providing non-emergency transport for Poughkeepsie hospitals Vassar Brothers Medical Center and MidHudson Regional Hospital.

Through its acquisition of EMStar and Mobile Life , Empress' coverage has spread farther north in the Hudson Valley, currently serving roughly 80% of southern Dutchess with hopes of growing business north of Poughkeepsie.

In Empress, some municipalities have found a solution. They have contracted with about a dozen municipalities in Dutchess County to provide dedicated services and fill the gap created when ambulances may otherwise not be immediately available nearby.

"This whole area seems to have solved this crisis of not getting an ambulance," said Robert Stuck, executive director of Empress Ambulance Service North, "because they have some level of dedicated resource whether it's (Empress), fire, volunteer fire or paid, volunteer ambulance corps and then that's pretty significant."

The city of Poughkeepsie has a contract with Empress for over $600,000 a year, but smaller municipalities are having trouble absorbing the cost of dedicated EMS service, which is done either by allocated funding or creating special tax districts. The Village of Wappingers Falls saw an increase of $110,000 in its contract with Empress for next year.

"How do we sustain paying this?" said Lori Jiava, village treasurer.

Downside of contracted ambulance service in Hudson Valley

Village of Wappingers Falls leaders are still talking with Empress regarding their contract and are considering creating a special ambulance tax district, a lengthy process the town of Wappinger took on to pay for a dedicated ambulance service through Empress. The expected revenue from its ambulance district for 2024 is $570,377, according to the town's 2024 budget.

The city of Poughkeepsie contracted with Empress for three dedicated ambulances at $634,000 a year in January. According to reports the city receives on-call volume and response time, there were nine mutual aid requests in January before signing on with Empress, in which it took more than one call to find an available ambulance, in one day in the city. By February, an ambulance was always available.

Poughkeepsie's fire department also continues to respond to priority 911 calls, those that are lifesaving or involve severe injury, and are sometimes the first on the scene.

"There are always many challenges (the city has) to deal with, and right now, that's not one of the challenges that we're facing," said Interim City of Poughkeepsie Administrator Ron Knapp.

The city of Kingston went another route. Empress had taken over the city's contract after purchasing Mobile Life. It then increased its contract, asking the city to pay more than $500,000, according to Kingston Mayor Steve Noble, who said the city had also been receiving complaints about the service. Kingston chose to purchase its own ambulance instead.

"Extending our services to include transport was a logical next step in light of the privatization and consolidation efforts in the ambulance industry in our region," Noble said. The city's fire department already had trained paramedics and technicians.

Empress did not respond to the Journal's inquiry into its agreement with Kingston.

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Patients 'found another way to get to the hospital'

Unlike police and fire departments, EMS has historically not been considered an essential service in New York . This means local governments are not required to provide or fund them and the service is instead covered by a patchwork of providers, many of them volunteers.

"Last year, due to extended response times, over 400 times an ambulance we dispatched never reached the patient. That patient found another way to get to the hospital, and we know it wasn't under medical care," said Dana Smith, commissioner of emergency response, during a presentation to the county legislature earlier this year.

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A particular challenge, according to Stuck, who works at Empress' Poughkeepsie location, is in northern Dutchess, which is more rural and less populated than the southern part of the county. Call times there are exacerbated by long stretches of roads and fields, and the distance to a hospital. Those areas are also less populated and do not field as many calls, which is makes service less cost-effective.

Dutchess County is looking to add an extra layer of service by contracting with a commercial provider for staffed ambulances at the county level, supervised and paid for by the county and supplementing the region's rescue squads, fire departments and those providers already contracted by individual municipalities.

Empress was one of three agencies that responded to Dutchess County's request for expressions of interest — a first step for the county to determine how to shape its request for proposals to contract with an operator. The other two agencies that applied to the RFEI were Northern Dutchess Paramedics and American Medical Response.

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The county is also working with municipalities to facilitate their own contract agreements, like they are doing with the towns of Amenia, North East and Dover, and is exploring the option of offering telemedicine for less serious calls to the 911 center.

"If the county is really trying to push for some sort of regional-based ambulance service, great, I totally support that," said Jiava. But in the meantime, Jiava would like to see the county provide grant incentives to local governments to work on agreements for shared resources.

Saba Ali: Sali1@poughkeepsiejournal.com

This article originally appeared on Poughkeepsie Journal: Can this private ambulance provider solve NY's EMS crisis? It's complicated