Tompkins officials consider expanding Rapid Medical Response as ambulance staffing falls short

Tompkins County legislators and emergency-response leaders on May 27 discussed a proposal to expand the county’s Rapid Medical Response (RMR) program and add transport ambulances and paramedic coverage to address persistent ambulance shortages and long rural response times.

The proposal, developed by the county Department of Emergency Response after a Tompkins County Council of Governments (TCOG) EMS subcommittee request, would add a 24/7 paramedic-level unit, a fourth county vehicle staffed during peak hours, and a three-ambulance transport fleet to back up local agencies. County staff described several staffing models and cost estimates and asked the committee to direct further study and community coordination, including work with the Center for Governmental Research (CGR).

County emergency staff said current gaps leave parts of the county effectively underserved. The presentation cited data showing RMR—operational since April 2, 2024—averages about 95 calls per month (weekday daytime), and that the county had 114 incidents in which a rescue was not available and 34 occasions in 2025 when crews waited more than 10 minutes on scene for a transport ambulance. Presenters said roughly half of RMR calls require paramedic-level care.

Tompkins County proposals and numbers

Joe (Department of Emergency Response presenter) described three staffing models. Model 1 would rely more on part-time staffing to allow existing EMTs/paramedics to keep primary jobs while taking county shifts; Model 2 increases full‑time hires; Model 3 reduces payroll by using non‑certified drivers paired with certified EMTs and paramedics. County staff presented ballpark payroll and startup estimates: a roughly $2,000,000 annual payroll projection in two of the staffing approaches, a startup estimate (excluding existing RMR) of about $2,500,000, and a projected local share around $2,300,000 after a low-end Medicaid reimbursement estimate. County staff also described Medicaid reimbursement assumptions used in modelling ($250 per BLS call; $296 per ALS call; plus about $3.02 per transport mile) and noted private insurer rates would be higher.

County staff stressed recruitment and training as part of any plan—working with TC3, Upstate and local colleges and hosting an EMS academy and continuing education days locally to build a pipeline of EMTs and paramedics.

Local providers caution about unintended consequences

Representatives of Bangs Ambulance and other local providers told the committee the RMR program has delivered some benefits but warned that a county-staffed transport service risks drawing scarce providers away from volunteer and private agencies and could reduce volunteer turnout. Tim Bangs of Bangs Ambulance said when RMR started he raised a concern that the program could “rob Peter to pay Paul,” by drawing staff from agencies that already serve the county. Brian August, a paramedic with long service in the area, said he’d seen a trial of driver-only crews fail: “I can’t do everything with just a driver assisting me. It’s just not gonna happen.”

Bangs and others urged stronger support for local first‑response and volunteer units—rebuilding rescue squads and improving incentives for town-level agencies—so that local units can stabilize while county options are explored.

Stakeholders and next steps

TCOG representatives urged urgency: “doing nothing is not an option,” said a TCOG speaker, adding that New York State is not providing an emergency funding program and local solutions will be necessary. Paul Bishop of the Center for Governmental Research (CGR) outlined how CGR would analyze the system, emphasizing use of 9‑1‑1 and dispatch data to map where ambulances go, how often crews leave the county for mutual aid, and how quickly high‑priority calls are reached. Bishop recommended focusing on a 90th‑percentile response metric for the most serious calls rather than averages.

Committee members directed staff to refine scope and indicated support for engaging CGR to produce a comprehensive costing and options analysis, while asking the county to look for ways to avoid harming existing local providers or shifting revenue away from towns that already fund ambulance service.

The committee did not take a formal vote on adopting the county’s staffing plan at the meeting; members asked staff to return with a refined scope and suggested bringing a county resolution to the legislature to authorize a study and possible procurement steps.

Community perspectives and trade‑offs

Speakers agreed on the shared goal—getting life‑saving care to residents quickly—but disagreed about the most effective path. Small rural communities and existing private and volunteer providers expressed worry about losing staff and revenue, while municipal representatives and the TCOG EMS subcommittee emphasized county coordination to reduce inequities in access. The discussion also flagged long lead times and equipment shortages: a county official said ordering a new ambulance today could take two to two‑and‑a‑half years to arrive.

What to watch next

Committee members indicated they will seek a formal study by CGR to quantify options and costs and that budget season will factor heavily in decisions. County staff said the next round of work will focus on refined cost estimates, workforce development steps (training and academies), and precise dispatch and mutual‑aid flows so that any policy changes can be designed to minimize harm to existing providers.