Rensselaer County Emergency Medical Services is facing a crisis, as highlighted in a presentation by Warren Hayashi, MD, NRP, CCEMTP from Albany Med Health Systems at the Poestenkill Fire Department on February 20, 2025. Dr. Hayashi emphasized that the views expressed in the presentation were solely his own and did not represent the positions of Rensselaer County Bureau of Public Safety, Albany Med Health System, or the Town of Colonie. Through comprehensive data and analysis, Dr. Hayashi has shed light on the collapsed emergency medical services (EMS) system in Rensselaer County.

Warren Hayashi’s presentation showcased a well-structured and cost-effective plan to fund Rensselaer County’s EMS system, using detailed financial data to illustrate various funding models. His analysis provides a range of options that balance service coverage with fiscal responsibility, ensuring that municipalities can make informed decisions about EMS funding. This is just one of many meticulously crafted plans he has developed, demonstrating his deep understanding of emergency medical services and financial planning. Warren has invested countless hours into these proposals, making him an invaluable asset to Rensselaer County as leaders navigate the complex challenge of sustaining high-quality EMS services. His expertise and dedication continue to play a critical role in shaping the future of emergency response in the region.

Currently, Rensselaer County is served by several ambulance services, including Bruen Rescue Squad, Castleton Volunteer Ambulance Service, Grafton Volunteer Ambulance, Hoags Corners Ambulance, Hoosic Valley Rescue Squad, North Greenbush Ambulance Association, Nassau Ambulance, Petersburgh Rescue Squad, Pittstown Volunteer Emergency Corps, Sand Lake Ambulance, Stephentown Ambulance, Taconic Valley Ambulance, Town of Hoosick Rescue Squad, and the Troy Fire Department. Additionally, three municipalities—the Town of Brunswick, the Town of Poestenkill, and the City of Rensselaer—rely on Mohawk Ambulance Service. As a for-profit company, Mohawk Ambulance Service does not have a contract with these municipalities and will only answer calls if they have available crews, prioritizing their paid contracts with other agencies. Empire Ambulance has gone out of business, and Ambulnz by DocGO has purchased its Certificate of Need but has done very little call volume in Rensselaer County, currently only servicing the City of Cohoes until their contract expires.

In 2024, there were 12,809 EMS calls outside the City of Troy, with a mean ambulance dispatch-to-arrival time of 14 minutes and 18 seconds for high-priority calls. Alarmingly, in one out of every ten medical emergencies, an ambulance took 24 minutes or longer to arrive. Paramedics were present 76% of the time they were requested, but response times varied significantly by location. In Poestenkill, the mean response time for high-priority calls was an alarming 27 minutes and 52 seconds, with ambulances arriving in 20 minutes or less only 30% of the time. In one out of ten emergencies, an ambulance took over 37 minutes to arrive, when every minute counts.

Paramedic response times also showed severe delays across various towns. In Schodack, paramedics arrived 52% of the time they were requested, with a mean arrival time of 22 minutes. In Petersburgh, this dropped to 40% with an arrival time of 28 minutes. Nassau saw paramedics only 27% of the time, with an average response of 29 minutes, while in Stephentown, paramedics arrived just 23% of the time, with an average wait of 33 minutes. Berlin, Grafton, and Pittstown fared even worse, with paramedic arrival rates of 19%, 17%, and 16%, respectively, and wait times ranging from 26 to 37 minutes. In one out of ten emergencies, an ambulance took 26 minutes to arrive in Nassau, 28 minutes in Grafton, 30 minutes in Brunswick, 34 minutes in the City of Rensselaer, and 37 minutes in Poestenkill. Paramedics arriving in extreme cases took over 30 minutes in Schodack, 33 minutes in the Town of Hoosick, 35 minutes in Brunswick, 36 minutes in the City of Rensselaer, Petersburgh, and Pittstown, 38 minutes in Poestenkill, 39 minutes in Nassau, 40 minutes in Grafton, 44 minutes in Stephentown, and a staggering 49 minutes in Berlin.

The EMS system in Rensselaer County suffers from a reliability problem due to inadequate paramedic resources, poor inter-agency collaboration, and severe delays in paramedic response. EMTs and paramedics often leave for better-paying jobs in Albany, Greene, and Columbia counties, where salaries, benefits, and retirement plans are more competitive. Delays in mutual aid responses result from unequal EMS resource investments between jurisdictions, minimal oversight and accountability within the EMS system, and slow adoption of new technology, medications, and best practices.

Understanding the difference between EMTs and paramedics is essential. EMTs can perform CPR, use an Automatic External Defibrillator (AED), perform basic airway maneuvers, ventilate with a bag-valve mask (BVM), administer oxygen, check blood glucose, provide limited medications, apply tourniquets, and apply splints. In contrast, paramedics have a much broader scope of practice, including establishing IVs, administering IV medications and fluids, transfusing blood products, placing breathing tubes, performing surgical airways, interpreting EKGs, conducting electrical cardioversion and pacing, and performing needle decompressions. Paramedics are crucial in life-threatening situations such as cardiac arrest, intractable seizures, severe asthma attacks, anaphylaxis, shock, collapsed lungs, and severe pain from fractures or burns. A large amount of the time when advance life support is on scene and helping a person it increases survivability and recovery time for the person receiving the care.

The question remains: where does Rensselaer County go from here? Establishing a county-run municipal EMS service is not feasible, as it is the responsibility of towns, cities, and villages to provide EMS services for their taxpayers. A dedicated Rensselaer County Sheriff’s Office EMS Division is also not viable due to funding and staffing constraints. While sheriff’s deputies are EMT-certified and provide first-response care, law enforcement agencies struggle with recruitment and cannot take on additional EMS responsibilities. A new not-for-profit EMS agency in Rensselaer County would also face significant challenges, including a lack of available EMTs and paramedics, competition with better-paying jobs in hospitals and urgent care centers, and financial constraints due to the 2% tax cap and budget restrictions.

Other sources of funding must be explored, including state and federal grants, but ultimately, municipalities must take financial responsibility for their own EMS services. Relying on neighboring towns, cities, and villages that already fund their own emergency response systems is unsustainable. When an agency provides services to a community without its own EMS system, this is not "mutual aid" but rather a burden on taxpayers who are already funding their own EMS. Residents need to contact their community leaders and advocate for properly funded EMS services or paid commercial services. Without adequate support, towns, cities, and villages that do not pay for EMS services will face dangerously long wait times or may not receive emergency medical assistance at all. Currently, EMS services are still not required by law in New York State, further complicating the crisis.

A potential solution lies in shared services and mergers between existing agencies. This approach could lead to more efficient and cost-effective EMS operations, greater control over response variables, improved oversight and accountability, and increased investment in new technologies and procedures such as blood administration, video laryngoscopy, rapid sequence intubation (RSI), transport ventilators, and telemedicine. However, merging EMS services would require municipalities to agree on fair cost-sharing models based on population, call volume, or total market value. Additionally, the relationship between paid and volunteer EMS providers would need careful negotiation. Without immediate action, the EMS crisis in Rensselaer County will continue to escalate, putting countless lives at risk.