ALBANY -- Last winter, two volunteer ambulance services covering parts of Fulton County closed abruptly, leaving officials scrambling to make sure an ambulance would be available when calls came in for car crashes, heart attacks and other emergencies.
It wasn't an isolated situation. Communities across the state have seen their ambulance services close, especially if volunteers were their primary source of staffing.
Essex County saw its slow decline in volunteer ambulance services reach the point where special state legislation was needed earlier this year to let the county step in and hire paid ambulance personnel for local ambulance corps, as part of a pilot program to address crew shortages. In Schoharie County, EMTs are also paid by the county, though they work at local emergency medical service providers.
"We were approaching, like every rural county in rural America, crisis levels for EMS services," said Shaun Gillilland, chairman of the Essex County Board of Supervisors.
In other communities in the Capital Region and elsewhere, small ambulance corps have also merged to increase their financial and operational viability.
While local officials have dealt with each situation independently, state Assemblyman Angelo Santabarbara, D-Rotterdam, believes there are common links among the cases. He is proposing that the legislature authorize a statewide study of what can be done to stabilize and strengthen rural ambulance services that rely on volunteers.
A couple of weeks ago, Santabarbara renewed his push for a bill he introduced in the Assembly earlier this year that would establish a task force to evaluate and make recommendations regarding support for ambulance operations in rural areas of the state.
"We have seen a number of ambulance services close their doors, and we can't risk seeing more do the same, not when lives are on the line," Santabarbara said. "By setting up this task force, we'll be able to see why these ambulance services are struggling both financially and operationally, and set clear goals to help."
A proposal by Gov. Andrew Cuomo during state budget negotiations earlier this year that would have cut ambulance squad Medicaid reimbursements -- an idea withdrawn in the face of opposition -- helped bring the need for a comprehensive study home, the assemblyman said.
"I think this is needed, given what we have seen in the last year," Santabarbara said. "We may see more ambulance services close their doors -- and that is a problem, because this is an essential service."
Santabarbara's idea makes sense, said Fulton County Emergency Management Director Steven Santa Maria, who managed the response when Fulton County lost the Ambulance Service of Fulton County and then the Johnstown Area Volunteer Ambulance Corps in rapid succession, primarily due to financial problems. An Amsterdam-based service has taken over most of those calls.
"We've been able to stabilize the situation in Fulton County. We have not missed a call for service," Santa Maria said. "I will tell you, the reimbursement rates for Medicaid and Medicare in particular are not what they need to be, and access to revenue remains a source of concern."
He supports forming a state-level task force. "I think it's a topic that needs to be looked into," Santa Maria said. "I know it's a problem a lot of counties are looking into at the county level, and I certainly think it needs to be looked into at the state level."
Santabarbara's plan would establish the state Rural Ambulance Services Task Force, with members appointed by the governor and leaders of the Assembly and Senate. It would operate under the state Office of Fire Control and Prevention and issue a report within one year recommending new business and revenue models for emergency medical services.
Emergency medical services collectively respond to thousands of calls each year in the Capital Region, with services sometimes provided by commercial companies and municipalities, or -- in most of the rural parts of the region -- independent non-profits that are funded through municipal contracts, tax districts, and insurance or government reimbursements for services.
Gillilland said he supports the task force idea. He said Essex County spent a couple of years doing its own study, which concluded the county should adopt a system where many small ambulance squads have county-paid EMTs on at least some shifts. The county has since received a $6 million Department of State grant to phase such a system in.
"Volunteering for EMTs and firefighting is declining precipitously," Gillilland said. "We looked at quite a large number of different counties and what they were doing. There are good ideas all over, but each county is doing this a little differently."
State officials have helped to develop responses, he said, "but I'm not sure they realize the enormity of the crisis."
Santabarbara said the financial viability of emergency medical services is a statewide issue, but rural communities face special challenges because of the spread-out populations and distances involved. "Rural communities face unique issues when it comes to emergency responses in general," he said. "We have weather, we have long distances to travel, we have to find a way to address this when there are people in need. We have a lot of elderly people. Even when weather is ideal, there are still long distances to drive."
As a member of Gov. Andrew Cuomo's EMS Council, Saratoga County EMS Coordinator Mike MacEvoy said he knows of rural volunteer-staffed squads going out of business across the state, and he thinks conducting a statewide study is a "great idea."
"I know that every year dozens of EMS go out of business. I think it's going to get worse," MacEvoy said. "I don't know that anybody has any good solutions at this point, but I think ultimately the answer to the problem is going to be municipal takeover of all these services."
Santabarbara said he hopes to see action early in the 2020 legislative session, so a report from the task force can be ready in 2021.
"Once we have this report I think we can move very quickly on some meaningful legislation," Santabarbara said. "It will a priority for me in the coming session."