Local officials see documentary detailing challenges in EMS

County looking to do study for short-term, long-term options locally

Photo by Tom Rivers: The Orleans County Association of Municipalities last week at the Clarendon Rec hall watched the documentary, “Honorable but Broken: EMS in Crisis.” The film is about an hour long and explores the world of EMTs and paramedics, and the collapse of the EMS system, while offering ways to save it.

CLARENDON – Officials in Orleans County last week watched the documentary, “Honorable but Broken: EMS in Crisis,” and could relate all too well to the film.

The county in 2022 experienced the end of COVA Ambulance and the volunteer ambulance through the Kendall Fire Department.

Seven towns in central and eastern Orleans County in 2023 started paying Monroe Ambulance in a contract for ambulance services. Medina Fire Department is the primary provider on the western end of the county. Medina often loses some of its paid staff to larger departments that offer bigger paychecks.

The documentary shows a profession with a high burnout rate due to low pay, the emotional toll of many traumatic and stressful calls, and danger through exposure to Covid and people overdosing on fentanyl and other drugs.

“This is a national issue, not just a New York or Orleans County issue,” said Justin Niederhofer, the county emergency’s management director.

He screened the documentary for the local officials last week and also for the community on June 20 at the Carlton Rec Hall. Niederhofer wants the local officials to keep discussing the issue, and the public to be aware of the challenges in providing the service.

EMS providers have a challenging business model, especially in poorer communities where there is a higher mix of patients on Medicare and Medicaid, where the reimbursements may only be 20 to 30 percent of the bill.

EMS providers also tend to only be paid of patients are transported, and not for responding to a scene where there isn’t a transport.

The documentary said ambulances should be able to bill for providing care, and not just for transports. If there was more revenue for the businesses, non-profit organizations and municipalities providing EMS, staff could be paid a living wage, and not have to juggle two or three jobs, with some living out of their cars, the documentary said.

Orleans County may do a study of the local EMS system, and consider alternatives for how to best provide the service in the short-term and long-term. That study could look at what reimbursement rates are needed to make the service more viable, with more ambulances based locally so there is a better response time throughout the county.

The study could also look at a scenario where there are ambulances run by the county with staff who are county employees, looking to fill some gaps or augment coverage with the current system.

The county Emergency Management Office is applying for a grant to do the study, Niederhofer said.

“This is an issue that won’t go away,” County Legislator Ed Morgan said. “We can’t stick our heads in the sand.”

Medina is the only fire department with paid career firefighters in the county. They are cross-trained as both firefighters and for EMS services.

The Medina model could be looked at as an option around the county, not only for EMS, but also to shore up the firefighting response. Niederhofer said many of the departments have a shrinking base of volunteers who are getting older.

Legislature Chairwoman Lynne Johnson said she sees the county taking a bigger role in the challenge, with EMS and the fire service possibly becoming a county-run issue.

But Morgan said a feasibility study, looking at many options, will be an important first step to help the local officials with a plan for providing the services.