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Study recommends hospital‑affiliated supplemental ambulance to address Lewis County EMS shortfalls
Summary
A consultant told Lewis County legislators that volunteer shortages and rising costs left the county’s EMS strained; the study recommends a hospital‑based supplemental ambulance focused on interfacility transports and peak coverage, funded partly by billing revenue and county tax support.
Paul Bishop, principal at CGR, presented the final report of a months‑long Lewis County EMS study, saying the county’s emergency response system is concentrated in one provider and under pressure from volunteer staffing losses. "Lewis County Search and Rescue did 75% of the responses," Bishop said, summarizing four years of call data (2022–2025). He told the committee the search‑and‑rescue agency handles most advanced life support and that out‑of‑county providers carry roughly 9% of incidents.
Bishop identified staffing as the study’s principal challenge. "The number of volunteer EMS providers has continued to thin," he said, and added that even Lewis County Search and Rescue has difficulty recruiting and retaining personnel. The study found interfacility transports declined roughly 30% from 2022 to 2025 while 911 responses rose, leaving transport needs unmet at times and requiring out‑of‑county resources.
To address the gap, CGR recommended that Lewis County General Hospital consider starting a supplemental ambulance service affiliated with the hospital. Bishop said hospital affiliation allows personnel to perform clinical tasks between calls and that billing could cover "more than half of the operational costs." The consultant presented two models: a supplemental single‑ambulance model (paramedic staffing 24/7 with an additional peak‑time ambulance) estimated at about $1.7 million in operations with roughly $931,000 in annual billing revenue, and a larger full‑scale model that would essentially double those costs and staff levels.
Bishop emphasized capital and implementation costs, noting ambulances and associated equipment are expensive and that the hospital‑based option would require a municipal operating certificate and a Certificate of Need from New York State. "A certificate of need would be required," he said, and he described the municipal operating certificate pathway that gives a county two years to validate need before conversion to a permanent certificate.
The presentation also flagged a recent local proposal from Lewis County Search and Rescue to become the county’s sole EMS provider and to seek tax support; Bishop said that proposal created "friction" with volunteer squads and raised questions about long‑term viability and workforce impacts. Committee members asked clarifying questions about regulatory steps and operational details; Bishop said municipal conversion requests historically have been approved but stressed the need for careful fiscal and transition planning.
The committee did not take a formal vote on the report. Bishop said CGR will hold a more detailed stakeholder session that evening and that the full report (about 100 pages) is available for local review.
