Increasingly, counties across New York state are providing emergency medical services (EMS), amid a drop in EMS workers and inadequate funding, but more state action is needed to ensure localities are able to provide dependable emergency services around the state, according to a report released today by State Comptroller Thomas P. DiNapoli.

“Reliable emergency medical services can be a matter of life or death, and New Yorkers rightly expect to receive timely help when needed,” DiNapoli said. “Local governments across the state are facing staff shortages and funding issues in their effort to ensure these services are available. The state should enhance its work with counties and other local governments to coordinate services and identify sustainable, effective solutions.”

In New York state, EMS are provided by an assortment of public and private entities. These may be funded by local governments, users of the service, insurance, or a combination of these and other revenue sources. Coordination of these services is undertaken at the local, regional and state levels.

DiNapoli’s report examines the local government role, and particularly the growing role that counties are playing, in providing EMS. The report also highlights challenges EMS agencies face, as well as the lack of available information to appropriately assess the quality of EMS provision throughout the state.

Staffing

The number of active EMS practitioners has fallen in recent years. In 2019, the state (including New York City) had over 40,000 active EMS workers. By 2022, there were only 33,000, a decline of 17.5%. EMS agencies frequently cited staffing issues including declining volunteerism, difficulties recruiting qualified staff, and low pay for EMS staff compared to other occupations in health care and public safety.

Funding

EMS agencies receive inconsistent and inadequate funding streams. Ambulance services are often not fully covered by insurance and are generally not covered if a patient is not transported. Consequently, many local governments find they need to subsidize their ambulance services with other revenues. Over the past two years, some municipalities leveraged federal American Rescue Plan Act stimulus funds to support EMS functions.

Data Issues

A major obstacle to assessing the adequacy of EMS and identifying areas of need is the lack of reliable statewide data on critical metrics such as ambulance response times, dropped calls, reliance on mutual aid, compliance with licensing and credentialing requirements, and cases where patients refused transport.

Local Costs Increasing

The total number of local governments reporting expenditures for ambulance or rescue squads has remained relatively steady from 2012 to 2022. Expenditures for these services, however, have been rising, increasing by 59 percent over that period, from $105.1 million to $167.2 million.

Reported county expenditures, as a share of all reported municipal expenditures for ambulance services, is small, reflecting 1.8% and 4.9% of the total in 2012 and 2022, respectively. Still, annual financial reports show that county ambulance expenditures increased an average of 16.2% annually over that period, much faster than other classes of local government. The Office of the State Comptroller surveyed counties about their existing and planned role in providing EMS.

In response, 22 counties reported that they currently provide services, either directly, through the employment of EMS staff and ownership or leasing of ambulances (14 counties), or by directly contracting with vendors for ambulance services (nine counties – including two that also provide services directly). In addition, nine of the 22 counties already providing services reported that they intend to increase service levels from what they currently offer. None reported planning to reduce or eliminate ambulance services at the county level. Another 11 counties said they were planning or considering getting involved with ambulance services.

According to the survey results, the number of counties providing ambulance services has increased even more than is indicated by county financial data on ambulance-related expenditures. Half of the counties that provide services began doing so in 2021 or later.

DiNapoli’s report found that while Regional EMS Councils and local government providers should conduct regular needs assessments, state-level solutions are needed, including better statewide data collection, management and analysis to help EMS agencies identify where services are falling short, and options for improving response times and outcomes. In addition, better centralized guidance from the state about funding sources can help local officials make more informed decisions about how to pay for these services.

Report
The Growing Role of Counties in Emergency Medical Services