Faced with an ongoing Emergency Medical Services crisis due to poor ambulance response times — caused by a combination of an underpaid workforce, declining volunteerism, and rising costs — the Dutchess County Supervisors and Mayors Association sent a letter on Oct. 15 proposing a county-coordinated system to County Executive Sue Serino and the Dutchess County Legislature. The association includes 30 town leaders, including supervisors from Pine Plains, Milan, and Stanford.
The town officials wrote, “The Association has reached a clear conclusion: the only effective and efficient way to ensure consistent, sustainable, and high-quality EMS service across Dutchess County is through a County-coordinated system.” This approach “would allow for the strategic allocation of resources, improved staffing and training, and equitable funding mechanisms that benefit every community.”
The document addressed the fragmented nature of the current system, which has led to disparities in service levels, response times, and financial burdens. Municipalities relying on all-volunteer EMS have struggled to achieve national performance standards for ambulance on-site arrivals — and sometimes have difficulty responding at all. The latest available Dutchess Emergency Response data revealed that Red Hook EMS was unable to respond 66% of the time, Milan 35%, and Pine Plains 26%. Third quarter 2025 results, which include the months of July, August, and September, have not yet been released.
Because it hired Northern Dutchess Paramedics to serve the town in 2024, Stanford missed no calls. But the cost of that service — $850,000 annually — is unsustainable, according to Town Supervisor Wendy Burton, who said she was among the association’s overwhelming majority in support of a regionalized plan. “At our next monthly meeting, we’ll discuss what to do further,” she said.
Brian Walsh, the Pine Plains Supervisor and Fire Department Chief, and Jeff Galm, Second Assistant Chief, a 40-year veteran of the Milan Volunteer Fire Department, said the county’s statistics overlook the fact that their volunteer EMTs attend the scene quickly in town fly cars — despite large geographical catchment areas — armed with oxygen and defibrillators. “We begin care until our ambulance or a paid service arrives,” Galm said. “That quicker response time is not reflected in the county’s stats.”
Walsh previously told the Herald he was concerned that a county-funded commercial ambulance service would push out volunteers. In a phone interview this week, Walsh said he was aware of the Oct. 15 letter —which was signed by the association’s four executives — suggesting a countywide solution. “I’m always willing to listen to any plan,” he said. “We do have a shortage of ambulance personnel, both paid and volunteer.”
The Ulster Example
Of the 62 counties in New York, 22 provide EMS services, either by contracting with commercial ambulances or by using county vehicles and staff. But inadequate health insurance reimbursement and skyrocketing costs have caused budgetary shortfalls in many of these counties — ranging from $300,000 to $664,000 — forcing them to scramble for alternative financing. Often taxpayers have to make up the difference.
Unwilling to wait any longer for help, the Ulster County Legislature approved a $4.7 million EMS Stabilization and Enhancement Plan in May, developed by the county’s Director of Emergency Services, Everett Erichsen. A pool of $2 million will provide financial assistance to existing EMS agencies, rewarding those that respond to calls at least 95% of the time. The other $2.7 million will be used to contract with local EMS agencies to provide advanced life support to historically underserved Ulster communities. (The New York State Department of Health granted a Municipal Ambulance Service Operating Certificate of Need to allow ambulances to travel outside their jurisdictions.)
Erichsen said the county has chosen six emergency “anchor” agencies with the best response times to cover service gaps. Each will get half of its county funds up front; the rest to be paid after a performance reassessment. Ulster will do the billing, launch staffing initiatives, and collaborate with struggling EMS providers to improve response times. “The county’s approach is like what EMS does: infusions and healing,” Erichsen told the Herald. “We’re infusing money, now the system needs to heal a bit.”
He acknowledged that regionalization may impact volunteerism. “This will require some self-reflection,” Erichsen said. “Things are evolving. We must know if an ambulance is rostering or not. Volunteers must respond: If they’re unable, we’ll know. We’ll help them find a way, help them develop a plan [to succeed]. We need to provide appropriate care.”
County, State, or Federal — How Much Support Is Needed?
Advocating a county-coordinated approach to the EMS crisis is not new: Former County Executive Marc Molinaro’s 2017 EMS Task Force report and the 2021 “Profile of Dutchess County EMS and Options for the Future” (sponsored by Dutchess County Emergency Services) both recommended that the county organize an effort to regionalize EMS. Dutchess would provide financial support (though neither report specified how) as well as coordinate ambulance coverage, set initiatives to recruit and train a volunteer and paid workforce, and collaborate with local EMS agencies to establish and monitor response time targets.
Dutchess County Emergency Response Commissioner William Beale said the county encourages discussion about regionalization. “Rather than having individual contracts for coverage, towns and villages should be collaborating on coverage to help make it financially sustainable,” he wrote in an email to the Herald.
Beale said that all-volunteer municipalities, such as Pine Plains and Milan, can’t continue to expect neighboring communities to absorb ambulance service costs; they must make a commitment to contracted coverage. “Expanding regional collaboration would also allow for standardized service expectations, cost-sharing models, coordinated planning, and improved patient outcomes,” Beale wrote.
In a bid to improve response times, in January 2024 Dutchess County purchased three emergency vehicles to serve as backups when local ambulances are unavailable: an advanced life support (ALS) fly car and two basic life support ambulances (one recently upgraded to ALS). But northeastern Dutchess local and county officials have complained that the supplemental vehicles preferentially served densely populated areas of southern Dutchess — a criticism supported by the county’s quarterly EMS response times.
“I haven’t seen a supplemental county vehicle this side of Route 44/82,” said Walsh. Galm agreed: “We haven’t seen [one] yet. There have been a couple of times we were on calls and there was no [county] ALS [vehicle] available.”
New York State Comptroller Thomas DiNapoli recommends that the state should provide funding and oversight. In his March 2024 audit, “The Growing Role of Counties in Emergency Medical Services,” DiNapoli wrote, “The stakes are too high and the issues too complex for counties and other local governments to have to address on their own. The current circumstances call for direct state involvement to support the efforts of counties and other local governments to turn fragmented and ad hoc responses into comprehensive solutions.” Gov. Kathy Hochul’s 2026 state budget omitted language that would have designated EMS as an essential service, crucial to securing funding.
Dutchess County Executive Sue Serino has sought help from the federal level: In September she sent letters to New York’s members of Congress, asking them to work with the Department of Transportation to establish a dedicated federal EMS funding stream.According to the National Institute of Health, EMS regionalization should be the standard of care in the United States. “Dutchess County will continue to lead this conversation, recognizing this is a significant change in the status quo for many communities,” Beale wrote. “And change does not always come easily or immediately.”
Yes, something should be done. Currently, as a taxpayer I’m paying three different expenses for an ambulance. One, our department has an ambulance including all the supplies. Two, paying taxes for the counties three vehicles. BTW, they are needed. Three, an NDP contract which is an additional taxpayers cost.
This can’t be done overnight but planned and implemented for the benefit of all taxpayers.