Lifetime Citizen Portal Access — AI Briefings, Alerts & Unlimited Follows
Consultant outlines options for countywide EMS; recommends operating certificate, training and bridge service
Loading...
Summary
Paul Bishop of the Center for Government Research told the Tompkins County Council of Governments on Dec. 11 that the county’s fragmented EMS system could benefit from a county operating certificate, expanded training and targeted funding. He gave cost estimates (roughly $1.7m–$2.5m for expanded county services) and urged short-term steps including nurse triage, better dispatch data and an expanded RMR safety net.
Paul Bishop, a consultant with the Center for Government Research, presented findings and recommendations from a year‑long study of ambulance and emergency response in Tompkins County at a special Tompkins County Council of Governments meeting on Dec. 11.
Bishop said the study examined transports and calls between August 2024 and July 2025 (about 15,000 call records) and found that response volume is concentrated in population and village centers while smaller municipal providers regularly provide mutual aid outside their home districts. "There are enough ambulances and close to enough EMS providers to staff the system today," Bishop said, "but this would be a dramatic paradigm shift" to consolidate into a single countywide provider and that county subsidy would still be needed.
Why it matters: the study flags reliability and equity risks in the current mix of municipal, nonprofit and for‑profit providers. Smaller services reported high shares of out‑of‑area responses to the city and to neighboring towns, and most providers told the consultant they have trouble hiring and retaining staff. Bishop told the council that those dynamics can leave gaps in coverage and create fiscal pressure on towns that subsidize local service.
Key findings and recommendations
- Distribution and staffing: Bishop said Bangs Ambulance handles the majority of dispatched calls in the county and is the largest single provider. Smaller municipal or volunteer services shoulder a disproportionate share of mutual aid to population centers.
- Training and workforce: The county lacks local paramedic training and has limited EMT education capacity (one initial EMT class per semester). Bishop recommended a centrally located, low‑cost hybrid EMT/paramedic training program and expanding Advanced EMT (AEMT) opportunities.
- Operational recommendations: Bishop urged allowing agencies to hold low‑priority calls using telephone triage, to adopt nurse triage and alternate transport options for nonemergency cases, and to track mutual‑aid and out‑of‑service events more consistently in the 911 data system to measure system performance.
- Oversight and contracting: The consultant recommended requiring status‑sharing with dispatch from all providers, establishing response‑time targets for high‑priority calls, and pursuing written agreements with providers so municipalities can hold contractors accountable.
- County operating certificate and RMR expansion: Bishop recommended obtaining a county ambulance operating certificate as an initial, safety‑net step and expanding the county RMR program rather than replacing existing providers. "This is not to replace any of the existing services. It is to serve as a safety net to fill gaps," he said.
Costs and potential models
Bishop presented headline cost figures and cautioned they exclude startup capital expenses. He said the current patchwork system costs roughly $684,000 a year in direct system support. A bridging county ambulance service with 24/7 paramedic coverage and additional first‑response vehicles was estimated at about $1.7 million a year; a fuller model with multiple paramedic ambulances and 24/7 ALS first‑response resources could approach $2.5 million a year. Bishop noted ambulances cost at least about $250,000 each and supply lead times can be 12–18 months.
Funding options Bishop listed included subsidizing the service from the general operating budget, creating a dedicated vehicle registration fee (example: nearby counties raise roughly $320,000/yr at $5–$10 per vehicle), allocating a portion of sales or visitor taxes, or charging municipalities that choose to rely on county service.
Reaction from members
Municipal representatives raised concerns about cost distribution and fairness. Pierre said he doubted a TCAT‑style shared nonprofit model would gain city buy‑in: "I suspect that a TCAT model system would be a no go for the city." Several members noted that some towns already pay substantial amounts to maintain local service and worried about double taxation if the county added a new levy.
County administration (Corson) told the council the county is exploring next steps and that conversations are underway about submitting an operating‑certificate application and potentially ramping up the RMR program. Bishop said he expected to complete and share the written report soon.
What comes next: Council members indicated the matter will go to the public safety committee and to the county legislature for further consideration in 2026. The consultant and county administration recommended incremental actions (contracting, better data, triage options, and a temporary certificate/rental ambulance strategy) as early measures while longer‑term funding and governance choices are developed.
