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Public Safety Committee weighs county role in EMS as rapid-response gaps grow
Summary
Tompkins County's Public Safety Committee discussed growing strain on emergency medical services, Department of Emergency Response plans to pursue a municipal Certificate of Need to expand Rapid Medical Response billing and capacity, and public commenters urged clearer local coordination for fly‑cars and mutual aid.
Tompkins County Public Safety Committee members on Feb. 25 focused on growing shortfalls in emergency medical services and the county’s options for responding, including pursuing a municipal Certificate of Need.
The committee heard public comment from paramedic James Smith, who urged caution about moving “fly cars” into Ithaca without exhausting mutual aid and raised fiscal questions about who would pay if the county provided rapid-response vehicles while the city contracted its fire department to stop responding to certain medical codes. “I’m not in favor of the fly cars coming into the city unless all mutual aid resources have been exhausted,” Smith said.
County Department of Emergency Response staff stressed that Tompkins has already established a Rapid Medical Response (RMR) program and is exploring a municipal Certificate of Need, which would allow the county to bill for some services and to test expanded models. “There’s two basic types of municipal CONs: one for RMR‑style services and one for transport ambulances,” a department staff member said. With a municipal CON the county would have up to two years to demonstrate need; private applicants must show need at the time of application.
Why it matters: Committee members said the county faces a statewide workforce and capacity problem for EMS and ambulance services, driven in part by hospital crowding, increasing mental‑health and substance‑use calls, and fewer volunteers. Speakers warned those pressures could force counties to take on more operational responsibility or funding for EMS.
Discussion and details: Legislators and staff debated whether New York State designation of EMS as an “essential service” (a concept discussed elsewhere at the New York State Association of Counties meeting) would shift statutory responsibility to counties and how funding and tax‑cap rules would apply. Lee noted proposed legislation that would permit joint municipal taxing jurisdictions for EMS, which could be countywide or partial countywide.
Committee members agreed to include EMS capacity, RMR monitoring and potential next steps among the committee’s 2025 priorities. Staff said an application for a municipal CON is time‑consuming and that having a county CON would position Tompkins to act if local volunteer and for‑profit capacity declined further.
Public comment and follow up: The committee invited James Smith and others with frontline EMS experience to discuss operational details at a future meeting and asked Department of Emergency Response staff to report back on RMR outcomes, any CON application plans, and the state guidance for billing RMR services.
Ending: Committee members requested more data and a clearer system map of EMS and related services to clarify where county action could be effective and what financial tradeoffs would be required. The topic will remain on the committee’s 2025 work plan.
