A $5 million proposal to help Ulster County towns cover emergency medical services costs was delayed in the county legislature this week, even as officials and providers warn that emergency medical services (EMS) systems are nearing collapse.

The plan, introduced by Ulster County Legislator Jason J. Kovacs, chair of the Legislature’s Laws, Rules, and Government Services Committee and representative of District 3 (Kingston, Ulster and Saugerties), failed to advance in the Law Enforcement and Public Safety Committee. Lawmakers voted to postpone action until next month.

“My proposal was to allocate $5 million proportionally to all the towns in Ulster County to help defray some of the cost of EMS,” Kovacs told The Overlook. “A lot of towns, I’d say the vast majority, have had to incur additional expenses toward emergency medical services in the last year.”

County officials argue that while short-term funding might offer temporary relief, longer-term reforms are necessary to address deeper problems in the EMS system.

“The 2025 Executive Budget includes a package of initiatives to enhance EMS through recruitment, training, equipment, and support for multijurisdictional approaches to address service gaps,” a spokesperson for Ulster County Executive Jen Metzger’s office said.

Those initiatives include a partnership with SUNY Ulster to launch new EMS certification programs, a county-run EMS training unit, legal support for municipal collaborations, and grants to help volunteer agencies purchase life-saving equipment. The county also plans to establish an EMS Advisory Board and is applying for a Municipal Certificate of Need (MuniCON) to partner directly with local agencies for Advanced Life Support coverage in underserved areas.

Still, as staffing shortages and rising costs strain local systems, EMS leaders say towns cannot afford to wait.

“When I joined Olive First Aid in 2014, we were an all-volunteer agency. We weren’t answering our calls because we couldn’t find volunteers,” said David Wiswall, president of Olive First Aid. “It took us two long years to get it all together, but in 2016 we became a fully paid agency — minus the Board of Directors. We’ve now been going on nine years as a fully paid agency.”

Yet, he said, pay remains too low to attract and retain enough workers.

“The pay sucks for EMS. That’s straight up,” Wiswall said. “Retention in EMS is horrible. And it’s getting worse—not because everyone’s getting paid—but because we’re competing for the same pool of employees.”

“What you’ll find in EMS is the people that work for Olive First Aid also work for Marbletown. They also work for Kerhonkson, sometimes 24-hour shifts,” he added. “We all share the same pool of employees.”

Wiswall called for regional approaches to EMS and high school training programs to help build the workforce.

“Kids that are in high school could be going to school to become EMTs (emergency medical technicians). That’s what we’re lacking in Ulster County,” he said.

He added, “My thinking is merging those communities into regions and sharing resources. Maybe you only have three ambulances and two paramedics on duty for four towns, instead of each town trying to staff their own ambulance.”

Lisa Benjamin, CEO of Diaz Memorial Ambulance Service in Saugerties, said the staffing crisis is beyond urgent.

“People can’t afford to volunteer anymore,” Benjamin said. “So do I think the money will help? No. You need bodies. I mean, money’s always good. Nobody’s going to turn down money. But without the EMTs and paramedics, you have nothing.”

“EMS is in crisis. There’s no two ways about it,” she added. “If somebody doesn’t do something soon about the lack of EMTs and paramedics, there will be no ambulances. And that’s just a fact.”

Jason Kreisberg, a 24-year-old EMT with Woodstock Fire District’s Rescue Squad, said paid EMS is essential to ensuring reliable service.

“This kind of work, I definitely think should be paid and it should receive funding from towns just because of the type of work it is,” Kreisberg said. “You’re on your feet. You’re responding quickly. And if we want to have a timely service, they should be paid.”

Unlike Saugerties, where the town government pays Diaz Ambulance $1.5 million a year for town-wide service, Woodstock’s EMS is run by the town-wide fire district, which operates independently of the town government.

“The fire district is a separate taxing district. So if Ulster County allocates EMS funds, that money would go directly to the fire district, not to the town budget I oversee,” said Bill McKenna, Woodstock Town Supervisor.

McKenna explained that Woodstock’s fire district began hiring paid paramedics in the mid-2000s to fill gaps left by declining volunteerism.

“We have mutual aid agreements, so if there’s a call in Saugerties, Olive, or Shandaken, our ambulance responds,” McKenna said. “Woodstock taxpayers are footing the bill for that. So if the county chipped in some funds, it would help level that out — compensating each town for helping their neighbor.”

Fred Costello, supervisor of Saugerties, said his town contracts directly with Diaz to provide three ambulances exclusively to residents.

“We engage with Diaz to provide three ambulances exclusively to our residents. But we pay for that. So if our residents need help with a slip and fall, Diaz is available. If our residents need an on-site medical exam because of an accident of some sort, Diaz is available for that. And that’s why we pay the $1.5 million,” Costello said.

He added that while Diaz generates about half of its revenue from insurance billing, insurance won’t cover every call — particularly when a patient isn’t transported to the hospital.

“One of the challenges is they can only bill for transports between wherever the call took place and the hospital,” Costello said. “So if they don’t transport someone because there was a slip and fall at their house or because there was a car accident where there was some rudimentary first aid provided, they don’t have a mechanism to bill for those things. And that’s where the EMS contract steps in to fill that void.”

Still, he said, without additional county and state support, the costs are unsustainable.

“For now, it looks bleak, but I believe on the horizon there’s going to be substantial improvement,” Costello said. “The level of awareness of this problem has improved greatly over the last couple of years.”

The county Law Enforcement and Public Safety Committee is expected to revisit the proposal in April. As towns wait, Wiswall offered a final warning:

“No matter how much money you have, if you don’t have the people to do the job, it’s not going to do you any good.”

Noah Eckstein is the editor-in-chief of The Overlook. Send correspondence to noah@theoverlooknews.com.