Task Force report shows rural EMS in crisis in NYS
Medina fire chief highlights report – ‘The funding model is broken’

Photos by Tom Rivers: Medina Fire Chief Steve Cooley shows a slide detailing a 21 percent in ambulance calls for the Medina Fire Department from 2008 to 2025. He also provided an overview of a 90-page report from the New York State Rural Ambulance Services Task Force. Cooley spoke during Tuesday’s meeting of the Orleans County Association of Municipalities at the Fair Haven Inn. About 25 attended the meeting.
ALBION – It’s a recipe for a crisis: more calls for service and a declining numbers of responders. And it’s a situation that could get more dire without changes in the funding model for emergency medical services.
A 90-page report from the New York State Rural Ambulance Services Task Force paints a grim picture for EMS services in rural areas. Many agencies have been run by volunteers, but many of those ambulance squads have gone out of service or are not able to respond to a growing number of calls.
In Orleans County, Kendall Fire Department was the last volunteer-run ambulance. It ceased operations after on Dec. 31, 2022. COVA also went out of business in late 2022 after 44 years of service in central Orleans County.
Now the Medina Fire Department and Mercy Flight EMS are handling most of the calls in the county. Those organizations face high operational costs, with low reimbursements from Medicaid and Medicare.
The Rural Ambulance Services Task Force released a report earlier this month calling for immediate state action to increase reimbursement rates and provide grants for rural ambulance services.
The Task Force said a state-level public health emergency should be declared to direct resources to areas struggling to provide timely service to residents in crisis.
Medina Fire Chief Steve Cooley highlighted the report as well as data for the Medina Fire Department during a presentation on Tuesday evening. Rural areas have seen many of their hospitals close or shot down services such as maternity. Locally, hospitals have closed in Albion and Brockport, and Medina no longer delivers babies.
Those changes have ambulances driving farther out of county. That ties up ambulances often for several hours, and can result in overlapping calls where there are delays because ambulances are all in service.

A Medina Fire Department ambulance is shown on East Center Street on Thursday at the Main Street intersection. The ambulance headed to Route 63 and out of Orleans County. The Medina FD responds to over 2,000 calls a year.
Cooley started as a volunteer in 1990 at age 16 with Tri-Town Ambulance in Gasport. He has worked with Medina Fire Department as a career firefighter/paramedic since 2010, and has been the fire chief since last year.
“Volunteers were once the backbone,” Cooley said about the local ambulance service. “But there are no volunteer transporting agencies left.”
He said the Task Force report was a five-year effort and it makes 38 recommendations to strengthen rural EMS care.
“This is not a future problem,” he said. “It is already impacting response times, coverage and patient outcomes in communities like ours.”
Orleans County had 5,521 ambulance calls in 2025, which was up from 4,965 in 2024, according to the Orleans County Emergency Management Office. Medina responded to 2,416 of those calls, with most in western Orleans – Village of Medina and towns of Shelby, Ridgeway and Yates.
Orleans County is working on its own EMS and fire services report, which is expected to be complete next month.
County Legislator John Fitzak said he expects there will be conversations among officials throughout the county once the report is out about EMS and the fire service in the county.
“Everybody is thinking about this and we’re looking for answers,” he said during Tuesday’s meeting of the local officials.
Cooley said “the funding model is broken” for EMS, with the reimbursement rates too low with Medicaid and Medicare. The ambulance providers also can’t bill unless there is a transport, and many people receive care at the scene but decline to be transported.
“We should be paid for care and not just transportation,” he said.
Cooley said EMS should be classified by the state as an essential service, on par with police and fire service.
Cole Hardenbrook, a member of the Kendall Fire Department, takes the radio out of the Kendall ambulance in this photo from Dec. 31, 2022. The fire department ceased providing service at 11:59 p.m. that day after 54 years. Kendall was the last volunteer-run ambulance squad in the county that did transports. Kendall responded to 9,700 calls over those 54 years.
It recent years it was getting harder and harder for volunteers from to meet the training requirements and give up the time to respond to a call and then make the transport to a Rochester hospital. Often the ambulance would have to wait at the hospitals to drop off patients. It could take five hours to go on some of the calls.
“In New York State, the reliability of the EMS system has significantly declined in recent years due to various challenges,” the EMS report states in the executive summary. “These challenges include a decrease in volunteerism, insufficient and lack of public funding to cover readiness costs, staffing shortages, escalating operational expenses, inadequate insurance reimbursement, increased call volumes, absence of performance standards, limited awareness of the EMS system among elected officials and the public, the influence of NYS home rule, and a lack of transparency and accountability for EMS agencies.
“In some instances, these systems receive public funding, but in many communities, they are not financially supported. This results in a patchwork system with local municipalities or fire districts throughout the state opting for different approaches to provide EMS coverage.
“EMS response is often at the mercy of time of day, day of week, proximity of an ambulance within a geopolitical boundary, and the availability of staff. Response times vary from minutes to more than an hour in many locations.”
Click here to see the full report from the Rural Ambulance Services Task Force.

















