HomeMy WebLinkAboutCGR Report on Emergency Services in Tompkins County June 2026 www.cgr.org 1 South Washington Street, Suite 400, Rochester, New York 14614
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Improving Emergency Medical Services
in Tompkins County
An Evaluation of Existing Conditions and
Recommendations for the Future
February. 2026 – Revised June 2026
Prepared for
Tompkins County Legislature
Prepared by
Paul Bishop, MPA, NRP
Project Director
Wiley Little, PE, MSc
Project Manager
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Summary
Background
The Emergency Medical Services (EMS) system in Tompkins County has been undergoing
substantial changes that have led to concern from elected officials and agency leaders that
the EMS system is not sustainable in its current form over the next five to ten years. To better
understand the changes, existing conditions and identify options for the future, the Tompkins
County Legislature at the urging of the Tompkins County Council of Governments
commissioned this analysis.
This report is structured with Key Findings and Recommendations upfront with the Supporting
Information (including several appendices) following for those interested in a greater
understanding of the situation.
Vision for the Future
Throughout the engagement there was a clear message from informed stakeholders that the
current emergency medical services system in Tompkins County needs to be redesigned to be
more sustainable and responsive to the needs of community. Transitioning from the current
model will require disrupting the status quo and the investment of public funds.
A single EMS provider that was adequately staffed, well led, and properly funded covering the
whole County would lead to better patient outcomes for the residents and visitors to Tompkins
County. There are enough ambulances and almost enough EMS providers to staff this system.
However, this would be a dramatic paradigm shift. The revenue from transports would cover a
significant portion of the operating expense, but there would still be the need for financial
support from the County to fund it.
This single provider could be either municipal or non-profit, but the population density does
not favor a for-profit entity without a subsidy. This is dramatically different from today’s system
and will take difficult or unpopular decisions to get to this type of system. However, this will
likely be the EMS system in Tompkins County by 2050.
Methodology
CGR requested and analyzed one year’s worth of data on EMS calls and responses, spanning
Aug. 1, 2024 to July 31, 2025. This included the four ambulance providers serving Tompkins
County, which responded to 17,082 calls in that time frame. The Tompkins County Rapid
Medical Response program responded to 341 incidents during that time. The providers serve
22 municipalities, with the City and Town of Ithaca making up 53% of all calls.
In addition, we interviewed more than 20 individual stakeholders representing the ambulance
services and communities they serve, participated in a Fire Advisory Board meeting, and
conducted a survey of EMS providers to develop a thorough understanding of the challenges
and successes in the EMS system.
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Key Findings
System Functioning
∞ Rather than a single cohesive system of care, EMS in the County has several
distinct service models that are dictated by political boundaries and are reflective
of generations of choices by political and agency leaders. The ability of ambulances
to respond in a timely manner varies between the communities.
∞ The median response time during the busiest time of day (noon to 3:59 pm) for all
ambulance agencies was 6 minutes 30 seconds or faster. The 90th percentile
response time for all ambulance agencies and all call types was 16 minutes, 12
seconds or less. These represent strong performance from the current system, but
individual agencies and the dispatch center should track outliers to identify if there
are systemic factors such as a surge of requests or an unusual incident causing
delayed responses. There is no established “standard” for EMS system response
unless a community specifically adopts one.
∞ Funding models are disparate with several ambulance services (Dryden, Groton
and Trumansburg) supported by communities that choose to significantly fund their
services and Bangs serving the remaining areas without tax funding.
∞ The exchange of mutual aid between ambulances agencies is perceived by Dryden
Ambulance and Trumansburg EMS to be unsustainable. Dryden reported more than
a third of responses were out of its home district, and for Trumansburg, about 1 in
8 responses were mutual aid. However, County 911 data cannot articulate a clear
picture of the exchange of mutual aid as it is currently structured.
∞ Demand for mutual aid is growing with two tax-funded agencies (Dryden and
Trumansburg) regularly called upon to send ambulances elsewhere including to
neighboring counties.
∞ The payments from insurance companies and government programs are
insufficient for the cost of operating an ambulance service and providing for system
readiness in the current environment.
∞ The current staffing model has little ability to respond to surges in calls and at
times there are not enough ambulances to handle routine call volume.
∞ The need for interfacility transports out of Cayuga Medical Center is growing as
patients more frequently need to go for specialty services.
∞ Some stakeholders are ready for seismic changes including a shift to countywide
municipal EMS service.
Staffing
∞ Volunteers have almost completely disappeared from the ambulance service and
EMT and paramedic numbers have declined as they get hired by career fire
departments or choose to work in other fields. EMT training courses are not offered
consistently or at convenient locations and cost may be a barrier.
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∞ Career staff see their agencies as having professional staff, good response times,
quality equipment and good public perception. They see weaknesses in their
agencies centered around administrative leadership, high call volume, low-quality
stations and training.
∞ Volunteers felt that successful retention characteristics for volunteers included
feeling included, strong leadership, a robust training program and opportunities to
advance.
Recommendations
Based on our data analysis and stakeholder engagement that identified key needs, gaps and
pressure points in the systems, we offer a series of specific recommendations, ranging from
expanding educational programs to improving communications and data reporting to creating
a County-level EMS service to augment existing operations.
Key recommendations include:
∞ Increasing County support for efforts to expand EMS training programs, especially
within the City of Ithaca, which lacks traditional pipelines into the field.
∞ Tracking the exchange of aid, dropped calls and outlier response times in order to
more carefully and regularly monitor system performance. The current records
management system was designed primarily for law enforcement use and modified
to work with fire and EMS. Key system EMS performance measures are not readily
tracked in the system. This data should be reviewed on a regular basis by the
Department of Emergency Response (DoER).
∞ Ensuring that County dispatchers are aware of the status of all ambulance services,
including Bangs Ambulance, in order to maximize efficient response.
∞ Considering allowing agencies to “hold” low priority calls, a practice used in the
other communities that can improve the flow of EMS resources during high
demand periods.
∞ Establishing response time goals. for first responders, ambulances, and advanced
life support with variation based on call severity and community served.
∞ Establish “care bundle” targets for cardiac, stroke and trauma that dictate the
preferred procedures and time windows to provide the best possible care for a
patient.
The most expansive recommendation is for Tompkins County to expand its EMS/RMR (Rapid
Medical Response) Program to provide Advanced Life Support First Response on a regular
basis and ALS Ambulance Transport on an as-needed basis. The intent would not be to
supplant existing services but to fill gaps to prevent draining resources from outlying areas.
The goal is that the County EMS/RMR is a safety net ambulance provider when other
resources are depleted. Specific cost estimates, modeling and regulatory and operational
considerations are provided in the Recommendations section of the report.
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Table of Contents
Summary ............................................................................................................................................. i
Background ............................................................................................................................... i
Vision for the Future .............................................................................................................. i
Methodology ........................................................................................................................... i
Key Findings ..............................................................................................................................ii
System Functioning ...............................................................................................................ii
Staffing ...................................................................................................................................ii
Recommendations ................................................................................................................ iii
Table of Contents ............................................................................................................................ iv
Project Background ......................................................................................................................... 1
System Overview.............................................................................................................................. 2
Call Patterns ............................................................................................................................. 2
Call Distribution ..................................................................................................................... 3
Transport Patterns ................................................................................................................... 6
Funding Mechanisms .............................................................................................................. 7
Themes from Stakeholder Engagement ....................................................................................... 8
Key Findings ..................................................................................................................................... 9
Recommendations ........................................................................................................................ 10
Education and Recruitment .................................................................................................. 10
Communications .................................................................................................................... 11
System Oversight ................................................................................................................... 12
System Support ...................................................................................................................... 13
County Expansion of EMS/RMR Program ............................................................................ 14
Steps to Expand .................................................................................................................. 14
Cost of EMS Program .......................................................................................................... 15
Potential Funding Mechanisms ......................................................................................... 18
Important Caveat ................................................................................................................ 18
Other Considerations for the County .................................................................................... 18
Taking Action .......................................................................................................................... 19
Supporting Information ................................................................................................................. 20
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EMS Agency Profiles .............................................................................................................. 20
Bangs Ambulance ............................................................................................................... 21
Dryden Ambulance .............................................................................................................. 27
Groton Ambulance .............................................................................................................. 35
Tompkins County Rapid Medical Response ...................................................................... 40
Trumansburg Emergency Medical Services ...................................................................... 44
Fire Service Rescue Program ................................................................................................ 50
EMS Education ....................................................................................................................... 50
Provider Survey ...................................................................................................................... 51
“What do you see as weaknesses of your paid agency(s)?” ............................................ 52
“Regarding EMT training (original and refresher), would you prefer if the training was
offered (see options in narrative below)” .......................................................................... 53
“What is your age?” ............................................................................................................ 53
“What is your gender?” ....................................................................................................... 54
Appendices ..................................................................................................................................... 56
Appendix I -Presentation to Legislature ................................................................................ 57
Appendix II - Broome County Call Holding Policy ................................................................. 58
Appendix III- Madison County EMS System Agreements ..................................................... 59
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Project Background
The Emergency Medical Services (EMS) system in Tompkins County has been undergoing
substantial changes over the last ten years that have led to concern from elected officials and
agency leaders that the EMS system is not likely to be sustainable in its current form over the
next five to ten years. According to EMS stakeholders, key factors include a growth in calls,
increasingly scarce EMS workers, financial pressures and inadequate response resources. To
better understand the existing conditions and identify options for the future, the Tompkins
County Legislature, at the urging of the Tompkins County Council of Governments,
commissioned this analysis.
CGR was engaged in July 2025 to conduct an evaluation focused on the transporting EMS
agencies located in the County (Bangs Ambulance, Dryden Ambulance, Groton Ambulance and
Trumansburg Ambulance) and the County’s two-year-old Rapid Medical Response (RMR)
program. As part of the project, CGR met with leaders from the County, each agency, several
fire departments, the emergency communications center, and the Cayuga Medical Center.
CGR also conducted a survey of the existing EMS providers.
This report is structured with a System Overview, Key Observations and Recommendations
upfront with Supporting Information, including several appendices, following for those
interested in a greater understanding of the situation.
Vision for the Future
Throughout the engagement there was a clear message from informed
stakeholders that the current emergency medical services system in
Tompkins County needs to be redesigned to be more sustainable and
responsive to the needs of community. Transitioning from the current
model will require disrupting the status quo and the investment of
public funds.
A single EMS provider that was adequately staffed, well led and
properly funded covering the whole county would lead to better patient
outcomes for the residents and visitors to Tompkins County. There are
enough ambulances and close to enough EMS providers to staff this
system. However, this would be a dramatic paradigm shift.
The revenue from patient transport would cover a significant portion of
the operating expense, but there would still be the need for financial
support from the County to fund it.
This single provider could be either municipal or non-profit. Serving the
lower population density of the communities that surround Ithaca
would require a subsidy. This is dramatically different from today’s
system and will take difficult or unpopular decisions to get to this type
of system. However, this will likely be the EMS system in Tompkins
County by 2050.
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System Overview
Tompkins County is served by four ambulance providers that responded to 17,082 total calls
between August, 1, 2024 and July 31, 2025. The Tompkins County Rapid Medical Response
program responded to 341 incidents during that time. The providers serve 22 municipalities,
with the City and Town of Ithaca making up 53% of all calls.
Call Patterns
∞ In the year between Aug. 1, 2024 and July 31, 2025, the County averaged about
48 ambulance calls per day. Nearly 50% of calls occurred between 8 a.m. and 3:59
p.m., with fewer calls on weekends and little variation by month. The highest
monthly average of 52 calls occurred in September and the lowest average of 44
occurred in November. These calls for service did not include the several daily
requests for mutual aid outside Tompkins County that are most often handled by
Dryden Ambulance and Trumansburg EMS with responses to Cortland, Schuyler
and Seneca County.
1,713 1,555
3,935 4,077
3,691
2,452
Overnight
00:00-03:59
Early Morning
04:00-07:59
Morning 08:00-
11:59
Afternoon
12:00-15:59
Evening 16:00-
19:59
Night 20:00-
23:59
#
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Tompkins EMS Call Volume by Time of Day
(Aug. 1 2024 to July 31 2025)
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Call Distribution
∞ Most calls in the County came from the Town and City of Ithaca (53%), followed by
Lansing (11%) and Village of Dryden (5%). All other municipalities had low single
digit share of calls, ranging from 0.03% of calls (Airport) to 4% of calls (West
Danby). The table below excludes the 53% of calls that are in the City of Ithaca and
the area of the Town served by the Ithaca Fire Department. It also does not include
several hundred calls covered by Dryden and Trumansburg ambulances outside of
the County.
2,085
2,578 2,572 2,592 2,569
2,783
2,244
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
#
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Tompkins EMS Call Volume by Day of Week
(Aug. 1 2024 to Jul 31 2025)
45.3
48.8 47.5
49.1 47.3
47.1
47.5
49.3
51.8
49.4
44.2
45.7
Av
e
r
a
g
e
#
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a
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EMS Call Volume per Day by Month
(Aug. 1 2024 to Jul 31 2025)
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∞ The following map provides a high-level overview of the location of EMS calls in the
study period in Tompkins County. The darker areas indicate a greater density of
calls. A more detailed map that allows a user to zoom in to a specific area is
available online at https:/arcg.is/1451Tb
2%2%
1%1%2%
5%
3%
2%
3%
2%
11%
1%
4%
0.2%1%0.3%
2%2%2%1%
0.03%0.1%
0%
2%
4%
6%
8%
10%
12%
%
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Municipality
Share of EMS Calls, excluding 53% in Ithaca (Town and City)
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A table summarizing estimates of mutual aid 1 calls in Tompkins County by agency
between August 1, 2024 and July 31, 2025 is provided below. The County’s
dispatch system tracks if calls involve mutual aid in a free text field, so this could
not be easily analyzed. Therefore, we have estimated mutual aid by examining
which agency was first dispatched to an EMS incident and which agency was
recorded as the first agency on the scene. For example, Dryden was recorded as
being first on scene of 243 more calls than it was first dispatched to, suggesting it
was providing mutual aid on those calls. By design, the County RMR program is
often the first agency on scene for Bangs but then Bangs will arrive to handle the
transport. Therefore, we are only able to estimate the amount of mutual aid given
or received for calls in the County that are not a part of the RMR program’s primary
coverage area in Lansing and the towns south of Ithaca. Also, this analysis does not
1 Mutual aid in this report refers to the response of one ambulance agency to a call outside of its primary
jurisdiction.
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include calls outside of Tompkins County because of how the data was collected
from the dispatch center’s records management program 2.
Transport Patterns
∞ All ambulance transports in the County were handled by an ambulance service that
bills for its services, although billing practices and amounts vary. A table that
summarizes the calls transported to hospitals by agencies between August 1, 2024
and July 31, 2025, is provided below.
∞ Most transports were to Cayuga Medical Center (55% all transports by County
agencies).
∞ Interfacility transports out of Cayuga Medical Center (CMC) accounted for
about three calls per day, handled primarily by Bangs Ambulance. However,
out of County resources were regularly used to transport patients that Bangs
could not handle. CMC reported over a 75-day period from May to August
2025 that it had 380 transports, or about five per day. This illustrates the
need for out-of-county resources for two transports per day on average.
∞ Some patients transported to CMC require further transport out to a higher
level of care.
∞ Bangs transported the most patients (11,052 transports, 72% of all transports)
of all agencies, with most patients going to Cayuga Medical Center (60% of
Bangs’ transports).
∞ 26% of patient transports were to hospitals outside of the County (Guthrie
Robert Packer Hospital, 1 hour from Ithaca, SUNY Upstate Medical Center 1.25
hours from Ithaca, Guthrie Cortland Medical Center, 30 minutes from Ithaca).
2 County staff pulled the data from the records management system and inadvertently filtered out mutual aid
calls outside of the County. This oversight was not identified until the report was in the final reviewing stages
after all analysis was completed. A decision was made to acknowledge to oversight and fill the data gaps with
information directly from Dryden and Trumansburg.
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∞ 34% of calls resulted in a non-transport either because the patient declined or
the ambulance was canceled enroute or on scene. A two-thirds transport rate is
common for EMS systems.
Funding Mechanisms
∞ The Town of Dryden has made substantial financial investments to support its
ambulance service through $1.2 million raised by a special ambulance district. The
town contracts with Dryden Ambulance, Inc. to provide service to Dryden residents
and, as noted in interviews, increasingly, surrounding municipalities in the County
that are not taxed for the service.
∞ The Village of Trumansburg and the towns (Ulysses, Covert and Hector) served by
Trumansburg EMS raise $1.4 million in taxes, which is offset by about $325,000 in
billing revenue, to operate the ambulance in its communities with a growing
demand for mutual aid to neighboring communities that do not fund the
ambulance service as noted in interviews.
∞ The Village of Groton funds its ambulance through the general fund of the Village
and it accounts for a substantial portion of the Village’s budget. The Town of Groton
funds the ambulance service through its agreements with the Village for fire
protection.
3 Percentages in this column represent the portion of calls for transport to a medical center out of the total
number of calls (e.g., 55% of all calls for the period went to Cayuga Medical Center).
4 ‘Other’ consists of health care facilities that were transported to less than 100 times by Bangs, 50 or less
transports by Dryden, 20 or less transports by Groton, and 20 or less transports by Trumansburg.
5 Percentages in this row represent the portion of all calls from medical centers that were transported to by an
agency (e.g., 72% of all calls for the period were transported by Bangs)
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∞ The City and Town of Ithaca have the largest concentration of calls for service and
do not provide any financial support to Bangs ambulance nor is there a contract for
services - just long-standing practice.
∞ Bangs Ambulance has a long history of providing reliable ambulance services at no
cost to the City and Town of Ithaca and several other towns in the County. All of
Bangs’ revenue comes from patient billing and other fee for services such as
standbys at athletic events or festivals. Bangs has never approached either the City
or Town of Ithaca for subsidy.
∞ There are almost no volunteers responding to ambulance calls in the County.
∞ All agencies have reported some difficulty hiring qualified applicants for open
positions. As the largest employer, Bangs Ambulance seems to have the hardest
time maintaining a fully staffed work force.
Themes from Stakeholder Engagement
CGR interviewed more than 20 individual stakeholders representing the ambulance services
and communities they serve, participated in a Fire Advisory Board meeting, and conducted a
survey of EMS providers to develop a thorough understanding of the challenges and
successes in the EMS system. The following themes were developed and grouped in three
overarching categories.
Workforce
∞ Volunteers have almost completely disappeared from the ambulance service.
∞ EMT and paramedic numbers have declined as they get hired by career fire
departments or choose to work in other fields.
∞ Because of changes in the last few years, EMT training courses are not offered
consistently or at convenient locations. The cost of taking a class is also a potential
barrier.
∞ About 80% of the career workforce started as volunteers,
∞ Career staff see their agencies as having professional staff, good response times,
quality equipment and good public perception. They see weaknesses in their
agencies centered around administrative leadership, high call volume, low-quality
stations and training.
∞ 7 in 10 volunteers would recommend volunteering to a friend. Volunteers got
involved in giving back to their community, as a pathway to a career position, and
because it was a family tradition.
∞ Volunteers felt that successful retention characteristics for volunteers included
feeling included, strong leadership, a robust training program and opportunities to
advance.
∞ It is difficult to move from EMT to paramedic because there are no paramedic
classes in Tompkins County - the nearest one is more than an hour drive from
Ithaca.
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Funding
∞ The payments from insurance companies and government programs are
insufficient for the cost of operating an ambulance service and providing for EMS
system readiness in the current environment. EMS system readiness is the
continuous operational capability of an emergency medical services system to
effectively mobilize, deploy, and sustain coordinated, high-quality clinical care. It
relies on the real-time alignment of trained personnel, specialized equipment,
robust communication networks, and adaptive protocols to meet both daily
demands and sudden disaster surges.
∞ Costs for capital items such as ambulances and cardiac monitors have been rising.
∞ Funding models are disparate with several ambulance services (Dryden, Groton
and Trumansburg) supported by communities that choose to significantly fund their
services and Bangs serving the remaining areas without tax funding.
Operations
∞ The Tompkins RMR program has filled an important gap in the EMS system caused
by the limited availability of daytime first responders and the loss of a transport
ambulance several years ago.
∞ The current staffing model has little ability to respond to surges in calls and at
times there are not enough ambulances to handle routine call volume.
∞ The need for interfacility transports out of CMC is growing as patients more
frequently need to go for specialty services.
∞ Stakeholders perceive growth in non-essential EMS calls such as lift assists at
senior living facilities or minor medical complaints.
∞ Better use of data could improve the efficiency of EMS operations.
∞ Demand for mutual aid is growing with two tax-funded agencies (Dryden and
Trumansburg) regularly called upon to send ambulances elsewhere including to
neighboring counties.
∞ Some stakeholders are ready for seismic changes including a shift to countywide
municipal EMS service.
Key Findings
∞ Rather than a single cohesive system of care, EMS in the County has several
distinct service models that are dictated by political boundaries and are reflective
of generations of choices by political and agency leaders. The ability of ambulances
to respond in a timely manner varies significantly between the communities.
∞ The exchange of mutual aid between ambulances agencies is perceived by Dryden
Ambulance and Trumansburg EMS to be unsustainable. Dryden reported more than
a third of responses were out of its home district, and for Trumansburg, about 1 in
8 responses were mutual aid. However, County 911 data cannot articulate a clear
picture of the exchange of mutual aid as it is currently structured.
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∞ Staffing challenges were a consistent theme during interviews with stakeholders
and there is significant angst about the future of the EMS workforce.
∞ The median response time during the busiest time of day (noon to 3:59 pm) for all
ambulance agencies was 6 minutes 30 seconds or faster. The 90th percentile
response time for all ambulance agencies and all call types was 16 minutes, 12
seconds or less. These represent strong performance from the current system, but
individual agencies and the dispatch center should track outliers to identify if there
are systemic factors such as a surge in calls or an unusual event. There is no
established “standard” for EMS system response unless a community specifically
adopts one which has not happened in Tompkins or any municipality.
Recommendations
This section outlines recommendations to improve the EMS system’s operation and
sustainability in several key areas. They are based on our data analysis and stakeholder
engagement that identified key needs, gaps and pressure points in the systems. The
recommendations range from expanding educational programs to improving communications
and data reporting to creating a County-level EMS service to augment existing operations.
As we have been finalizing this report, the County’s Department of Emergency Response and
the individual agencies have continued their own efforts to address high-priority needs. As a
result, action has been taken to enhance the EMT training and expand the RMR program to a
smaller degree than recommended.
Education and Recruitment
An inadequate supply of new EMTs and a paucity of opportunities for career advancement
were consistent themes during interviews. Changes in education and recruitment approaches
can help increase the supply of EMTs and ALS providers to serve the County’s needs.
∞ Emergency Medical Technician (EMT) education needs to be consistent, centrally
located and at minimal cost. The County is already working with CNYEMS and TCCC
to develop a centrally located EMT training location and program. This endeavor
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needs to be supported by the County government through staff support and
potentially dedicated training funds to augment those being provided by the state.
A location in the Town or City of Ithaca would be best to serve the whole population
because it would be more convenient for the largest number of students. The cost
of EMT education was also identified as a barrier to enrollment in multiple
interviews.
∞ EMS System through DoER or other regional organization needs to recruit residents
from Ithaca to become EMTs. Traditionally, individuals became volunteer EMTs
through their local fire departments or rescue squads. Outside of the student
organizations at Cornell University and Ithaca College, neither the Town nor City
have those organizations that serve as a tool to bring people into the field.
Therefore, the two largest municipalities in the County do not have an existing or
historical pathway to the profession creating a recruitment gap in potential future
EMTs. The County, in cooperation with the Town and City, should develop a
program that targets Town and City residents, particularly young adults to
encourage them to get involved in this career. The City of Ithaca Fire Department
requires new employees to be EMTs and would benefit from a larger pool of
certified candidates for future positions in addition to the ambulance agencies.
∞ Consider a BOCES or similar school-to-career pipeline. The Tompkins-Seneca-Tioga
BOCES does not have a dedicated EMT training program. This type of program has
been successful in several nearby areas such as Wayne Finger Lakes.
∞ Hybrid education is needed for this generation of providers. Future EMS training
programs should incorporate hybrid learning methodologies to allow for a mix of
distance learning and in person education.
∞ Consider distance learning option for paramedic education. This avenue is under
exploration and needs to be supported at the County level. Currently, anyone
seeking to become a paramedic must leave the County. This adds an additional
burden to an already challenging educational process.
∞ Expand Advanced EMT (AEMT) education. The AEMT level of care is appropriate for
many calls for service, particularly when there is a short transport time and
distance. The County should support this program and ensure that it has regular
offerings.
Communications
The following recommendations will address inefficient aspects of the dispatch system as well
as gaps in information and tracking that prevent intelligent use of resources.
∞ Allow agencies to “hold” low priority calls. The current practice is that the 911
Center works to quickly assign an ambulance to incidents including using mutual
aid when needed. This practice should continue with high priority incidents.
However, the County’s call takers use a sophisticated call triage process that has
strong reliability and accuracy in identifying low priority incidents such as simple
falls and minor medical complaints. It does not make sense to use mutual aid to
respond to low priority calls for Bangs, for example, when it is likely that an
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ambulance from Bangs will clear a hospital or other event and be able to respond
in a relatively short time frame – perhaps even more quickly than the mutual aid
unit. The practice of holding low priority calls is used successfully in several nearby
communities including Broome County..6 While there are barriers including Central
New York Regional Emergency Medical Advisory Committee policy and the opinions
of DoER staff and the County Attorney to adopting this policy, it would improve the
flow of EMS resources during high demand periods.
∞ Dispatchers need to know the status of Bangs’ Ambulances. Dispatchers can track
the status of all the ambulances in Tompkins County, except for Bangs. The
information is already available with the existing technology, but work practices of
Bangs do not allow this information to be shared. The County should mandate that
this information be shared to allow for appropriate decision-making by the
dispatchers.
∞ Track exchange of aid dropped calls and outlier response times. The current
records management system was designed primarily for law enforcement use and
modified to work with fire and EMS. Key system EMS performance measures are
not readily tracked in the system. At a minimum, the County should develop
practices to track the exchange of aid between services, when an agency is unable
to respond to an incident and when there are outlier response times such as more
than 15 minutes for a high priority call or more than 30 minutes for a low priority
call. This data should be reviewed on a regular basis by the Department of
Emergency Response (DoER).
∞ Initiate nurse triage and alternative transport models for low priority patients. This
model has been implemented in several communities in the state with strong
success in decreasing EMS transport of low priority patients. One established
vendor charges a fee per call that is referred to them. This process can reduce EMS
calls while still getting patients to appropriate care.
System Oversight
County government does not have a formal oversight role in EMS in New York in that it cannot
mandate specific types of service or practices. However, through existing avenues such as the
Central New York Regional EMS Council (REMSCO), Regional Emergency Medical Advisory
Committee (REMAC) and the County’s EMS Advisory Board, the County could establish
voluntary guidelines. The following are recommendations to improve the service to the
community.
∞ Establish response time goal. Working with the agencies and the CNY REMAC, the
County should establish response time targets for first responders, ambulances,
and advanced life support. The targets should have variation based on call severity
6 See Appendix II for the policy from Broome County.
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and community served. For example, a serious call in an urban environment would
have a stricter response target (8 minutes) than one in a rural environment (15
minutes). The performance targets should be based on either an 80th or 90th
percentile, not an average.
∞ Establish “care bundle” targets for cardiac, stroke and trauma. Like the response
times above, the County and/or CNY REMAC should establish “care bundles” for
certain key, high-impact patient conditions such as stroke, acute coronary
syndrome, and trauma. The care bundles dictate the preferred procedures and
time windows to provide the best possible care for a patient.
∞ Encourage CFR and AEMT providers through the EMS Advisory Board. The Certified
First Responder (CFR) program can provide an essential piece to the EMS system,
particularly as part of fire department and law enforcement responses ahead of an
ambulance. The CFR training program has not been emphasized in recent years,
but it is only a third of the length of the EMT courses and prepares participants to
provide essential care in emergencies. The Advanced EMT program has been
offered a few times in recent years and could serve to bridge a gap when
paramedics are not immediately available, but the patient needs more care than an
EMT could provide.
∞ Contract for EMS responses to help support system readiness. As noted above, the
County does not have an ability to regulate EMS delivery. However, it could enter
into EMS delivery contracts with ambulance services that might have a similar
impact to regulation. The agreement could:
∞ Require sharing of status information.
∞ Establish response time targets for high priority calls.
∞ Require reporting of information on regular basis.
∞ Establish and maintain minimal scratch rate.
∞ Mandate participation in local coordination activities.
In return for meeting those standards, the County could pay participants a fee per 911 call
if they meet standards for quarter/month, etc. These payments for services would go to all
ambulance providers that respond regularly to 911 calls in the County similar to the model
used by Madison County.
System Support
The following recommendations focus on actions to target EMS resources on the most
important situations.
∞ Reduce EMS responses to psychiatric emergencies. The County and City of Ithaca
have been using various initiatives to reduce the need for EMS resources to
respond to mental health issues. The Crisis Alternative Response & Engagement
(CARE) Team and Ithaca Police Department (IPD) initiatives have potential to
decrease these transports, and the County should support them as necessary with
funding and other assistance.
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∞ Evaluate the role of RMR with lift assists. A large share of dispatches (12%) are for
falls. Many falls are lift assists, which do not result in transport and therefore do
not generate revenue for the ambulance services. If the County took an active role
in using its RMR units to respond to these calls, it might be possible to reduce the
volume for the ambulances and allow them to remain available for higher priority
calls.
County Expansion of EMS/RMR Program
The RMR program was envisioned nearly five years ago to meet the needs of some
communities in the County as their fire departments and volunteer ambulances were no
longer able to provide the service adequately. RMR has met the need of providing BLS (Basic
Life Support) first response during the weekday hours in communities without their own
ambulance or first responding fire department.
However, the gaps in the EMS system in the County have grown and it now appears that there
is periodic need for additional advanced life support and ambulance transport services in the
County. This is demonstrated by the need for ambulances to regularly provide aid outside of
their community (Dryden and Trumansburg), the frailty of the EMS workforce leading to
staffing and unit shortages (Groton, Bangs, and Trumansburg), and the inability to meet the
demands of interfacility transportation from CMC, leading to the hospital getting ambulances
from outside of the County (Bangs). Additionally, the demand from neighboring counties
(Cortland, Schuyler, and Seneca) pulls resources out of Tompkins County adding further stress
on the EMS system.
∞ The intent would not be to supplant existing services but to fill gaps to prevent
draining resources from outlying areas. The goal is that the County EMS/RMR is a
safety net ambulance provider when other resources are depleted.
∞ Neighboring counties of Livingston, Wayne, Yates, and Wyoming are nearby
counties that operate ALS and/or ambulances. Schuyler County has an
arrangement with a hospital to operate an ambulance in its territory under a
contract.
∞ The County Operating Certificate (CON) can be used as contracting vehicle for
short-term staffing issues and system management such as allowing an ambulance
from Dryden to preposition itself in Ithaca if resources are depleted.
Steps to Expand
∞ Therefore, we recommend that the County should apply for an ambulance
operating certificate, with the
and occasional ambulance service (special events, surge of calls, temporary
staffing shortages).
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∞ Expanding to operate Advanced Life Support First Response requires nearly the
same steps as starting an ambulance service. The latter allows a County to operate
at both levels of care while the former only permits non-transport. The process of
establishing a municipal certificate of need (CON) for an operating certificate is
outlined in Policy 09-01 with additional details on a dedicated NYS Department of
Health website.
∞ In addition to the regulatory stapes, the County would need to acquire an
ambulance and necessary equipment. A new ambulance with full equipment costs
between $250,000 and $325,000 with about a one-year lead time. To meet the
immediate need for a service, the County should look for a used ambulance or
lease an ambulance from an existing service.
∞ Identify and contract with a third-party billing agency specializing in EMS transport.
EMS billing is a specialty service that would best be performed by an outside
vendor with extensive experience.
∞ Apply for appropriate licenses and billing permits. An EMS service needs to have
permission from the Center for Medicare and Medicaid Services to bill for
transportation. It also needs a license to carry narcotics on the ambulance and a
DOH Clinical Laboratory Evaluation Program (CLIA) permit.
∞ As part of this effort, the County would need to
. EMS line supervisors might also be needed to provide appropriate
leadership.
Cost of EMS Program
The 2026 RMR proposed budget is $684,000. Expanding the EMS/RMR program has
significant additional costs depending on the level of service pursued. We outline two
potential service levels below for the County to consider based on the current demand for
service in the County.
Gap Bridging Ambulance Service
This model is developed on the following units being on duty:
∞ One paramedic ambulance 24/7
∞ One paramedic first response vehicle 24/7
∞ 1 BLS first response vehicle 12/7
The paramedics are projected to be placed in Grade 13 of the current contract and the EMTs
remain in Grade 9. The grid below shows the cost of staffing only for an ambulance service.
This model adds transport capability to respond to calls that are currently handled by mutual
aid and provide ALS care as part of the first response model. These resources would be
available 24/7 as there are gaps identified at all times of day.
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Calls, Vacation,
Holiday Pay,
Payroll
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Safety Net Ambulance Service
This level of service is slightly more expansive than the previous model and is intended to
handle additional interfacility transport work that has been seen as a challenge for the current
system. The addition of a BLS ambulance 24/7 would help ensure that timely interfacility
transport is always available.
duty 12 hours
Calls, Vacation,
Holiday Pay,
Payroll
Additional Costs
The above models do not include the existing EMS Manager, a position that would need to be
continued. The cost of an ambulance, fully equipped, is about $250,000 and there is a one-
year lead time for delivery. Also, the costs associated with operations such as medical
supplies, information technology, uniforms, insurances, billing contracts, facility maintenance
and reserves are not included. They could cost an additional 20% to 40% of the payroll figure.
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Potential Funding Mechanisms
The following are some suggested funding mechanisms for assisting with paying for the
expanded services discussed above:
∞ The ambulances and some Advanced Life Support First Responder services will be
able to bill patients for services.
∞ This system could become part of the general operating budget.
∞ Motor vehicle registration tax: A new tax could be applied for all vehicle
registrations in Tompkins County. Chenango County raises about $320,000 on $5-
$10 per vehicle tax based on the size of the vehicle. It is anticipated that Tompkins
County could expect about double this revenue as the County has more than twice
the population of Chenango County.
∞ A portion of sales or visitor tax revenue could be designated to EMS.
∞ The County is undertaking a similar discussion related to airport funding.
∞ Chargebacks to municipalities that rely on the service could be implemented. The
chargebacks to the municipalities are done through inter-municipal agreements
between municipalities and the County. In this model, municipalities that rely on
the services more would be charged more while those municipalities that continue
to fund their own ambulances and need less support from the County would be
charged less.
Important Caveat
∞ Expanding the civil service EMS workforce may further destabilize the EMS job
market in the County. Already some of the agencies struggle to fill their open
positions and a well-paid civil service position might be attractive to some of the
employees at other agencies. Drawing employees from those agencies might lead
to a rapid decline in their ability to answer requests for services. This could lead to
agencies ceasing operations.
Other Considerations for the County
Additional options for the County to consider to improve EMS services have been adopted by
other counties in New York to address similar concerns.
∞ Enter into a contractual arrangement with ALL ambulance services to ensure
information sharing AND provide some financial support.
∞ Madison County uses this model to serve as the backup provider across the
entire county and the primary provider for certain municipalities. It funds a
centralized training and operational support program through this method.
∞ Use a CON to contract for services on an as-needed/on-call basis to fill gaps.
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∞ Columbia County uses this model to allow agencies to respond more readily to
calls outside of its primary service areas and to pay those agencies for staging
in an area to be ready for those calls.
∞ Work with a healthcare system or other non-profit to provide ambulance service
under a County operating certificate. A non-profit service could operate less
expensively than a municipal service. An example of this is in neighboring Schuyler
County.
∞ Schuyler County had historically been served primarily by a single non-profit
organization. There were challenges in the operations and leadership of that
organization. The county and the local hospital, Schuyler Hospital, sought to
work with the organization to improve the services, particularly around
interfacility transport. However, the non-profit was not a willing partner.
∞ To meet the needs of the community, the county and hospital chose to enter
into a partnership to establish a new organization operated by the Cayuga
Hospital System (Centralus), the parent of Schuyler Hospital. This new
organization, Schuyler EMS LLC, began operation in January 2023. It has
funding from the County but is operated on a daily basis by the Cayuga Hospital
system. It operates 2 ALS ambulances 24/7 and a BLS crew from 9 am to 9 pm
on weekdays.
∞ Some of the challenges in establishing the service were pushbacks from the
existing services and the approximately six-month lead time before the revenue
stream from transports became consistent. There were also some difficulties in
purchasing the necessary vehicles to operate and significant startup costs for
the agency, but the revenue from transports is expected to defray many of the
costs going forward.
Taking Action
The Tompkins County Legislature should act with deliberate speed and appropriate financial
resources to address the key gaps related to an increase reliance on mutual aid, a scarcity of
EMS providers, inconsistent data tracking and training, and a growing demand for services.
The options outlined above provide a variety of actions the County can take to address the key
challenges facing the EMS system in Tompkins County. We hope this report is helpful in
providing the County with information to act with deliberate speed to improve the efficiency
and sustainability of this critical public service.
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Supporting Information
EMS Agency Profiles
The following subsections provide a description of the major EMS agencies in operation today
in Tompkins County (Bangs, Dryden Ambulance, Groton Ambulance, Tompkins County RMR,
and Trumansburg Ambulance). Information for these agency profiles was gathered through
stakeholder interviews (both on-site on July 22, 2025, and virtually during the month of
August 2025) as well as data requests (select EMS Charts data and general profile
information on each agency).
High level summary information on each of these agencies is provided on the table below.
The Top 25 calls by nature (in order from most to least) for all agencies in Tompkins County
are summarized in the table below. These call types account for 94.5% of calls. The nature
codes have been created by Tompkins County and do not indicate the severity of the patient’s
condition. (The Emergency Medical Dispatch (EMD) code does indicate severity and is
recorded in a text field available to responders. However, this information is not readily
analyzable.) Additional information shared by callers is passed on to the responding units over
the radio or through notes sent electronically.
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Bangs Ambulance
Bangs Ambulance is a private, for-profit EMS organization located on Green Street in Ithaca,
NY in operation since 1945 when it started as a side operation of Bangs Funeral Home. Bangs
holds a Certificate of Need (CON) that covers all of Tompkins County, the only agency in the
county that holds this certificate. The agency responds to about 12,000 calls annually, which
is roughly four times the call volume of the next busiest agency in the County. This call volume
includes interfacility work, which accounts for about 1 in 10 calls and scheduled standbys
which account for about 300 calls per year.
Bangs operates its ambulances out of a former Ithaca Fire Department fire station which it
acquired in 1980. It maintains separate administrative offices about a half mile away.
Vehicles
Bangs currently owns and operates 10 ambulances and three fly cars. Additionally, Bangs
owns one gator (off-road utility vehicle). All the ambulances are equipped with advanced life
support equipment. Bangs chose not to share additional data regarding its fleet with the
research team.
Funding/Billing
Bangs receives no municipal funding; all their revenue is driven through reimbursement from
ambulance billing and standby events. Bangs chose not to share financial data with the
research team.
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Inter-Agency Coordination and Mutual Aid
Bangs responds to most of its calls in the City and Town of Ithaca. As a County wide CON
holder, it responds to calls across the County. Bangs is the primary ambulance for three of the
four largest municipalities in the County (City and Town of Ithaca plus the Town of Lansing) as
well as all the more rural towns south of Ithaca. Additionally, it provides interfacility transfers
to and from hospitals (inside and outside of Tompkins County).
Bangs has no formal contractual agreement with the City, the County DoER, or any other
municipalities. Bangs utilizes Tompkins County’s Spillman dispatching and records
management system for tracking managing operations. It uses a separate log in for the
system and operates independently from the County’s operations. County dispatchers need to
log into a separate session to view Bangs’ activities. The County provides this service free of
charge and without a written agreement.
Strengths of Agency – What’s Going Well
∞ Dedicated, experienced staff: Many long-term employees (20–30 years) provide
continuity and deep system knowledge.
∞ Current staff: 75 active employees – roughly 50/50 split FT and PT
∞ Strong student pipeline: Relationships with Cornell and Ithaca College help recruit
pre-med students as EMTs and paramedics, although many only stay with the
agency for a few years.
∞ High call volume and operational capacity: 10 ambulances, 12,000 calls/year, and
a well-established infrastructure.
∞ Community trust and legacy: Over 80 years of service in Tompkins County, with a
reputation for reliability.
Largest Challenges for Agency
∞ No public funding or contracts: Bangs provides service without any municipal or
county subsidy, relying solely on billing.
∞ Staffing challenges: Difficult to compete with publicly funded EMS agencies offering
better benefits and lower workloads.
∞ Bangs had eight new staff going through training at the time of CGR’s interview.
Two will be BLS full-time employees (after these staff come on board, Bangs will
be fully staffed at BLS level).
∞ Bangs stated it could probably use one more full-time ALS to be at a good level.
∞ Inappropriate requests for 911 volume: Many non-emergency calls (e.g., lift assists,
minor falls) tie up resources unnecessarily.
∞ Dispatch and coding issues: Frustration with 911 center protocols that mandate
immediate ambulance responses for low-acuity calls.
∞ Issues occur at ALS and BLS level (roughly 50/50)
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∞ Burnout and retention: High call volume and low reimbursement rates (especially
from Medicare/Medicaid) contribute to burnout of career staff.
∞ Lack of EMS training availability: Fewer local EMT classes have reduced the
pipeline of trained volunteers and staff.
∞ Volunteer agency decline: Perception that the County’s creation of paid response
teams has drawn from the same limited volunteer pool, weakening local agencies.
∞ Limited benefits: While pay is competitive, benefits are lacking compared to public
agencies.
∞ Interfacility transfers: Long-distance transports (e.g., to Rochester) take crews out
of service for hours, leaving gaps in service inside the County.
Disposition of Calls (Bangs Ambulance Data)
CGR requested EMS Charts Data from Bangs (Receiving Hospitals field). Data is summarized
in the tables below for the period between August 1, 2024 and July 31, 2025. The variation in
totals is a result of filtering related to non-transport calls. A roughly 2/3rd transport ratio is
similar to other emergency medical services systems.
7 ‘Other’ consists of health care facilities that had less than 100 transports by Bangs.
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Nature of Calls by Dispatch (County 911 Data)
The Top 25 Calls by Nature (in order from most to least calls in the top 25) for calls where
Bangs was the primary agency between August 1, 2024 and July 31, 2025 are summarized in
the table below.
Calls by Municipality Location (County 911 Data)
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Calls by location that Bangs responded to between August 1, 2024, and July 31, 2025, are
shown in the chart(s) below. The data from the 911 Center used the fire district as the
designator of the location, rather than the municipality. The vast majority (almost 70%) of
Bangs’ calls are inside of Ithaca, with the next most occurring in Lansing (12%) and Newfield
(5%). All the transfers out of CMC are indicated as being in the IFD service area. Based on this
analysis, Bangs provided mutual aid 111 times to Trumansburg, 17 times to Dryden and twice
to Groton.
Calls by Time of Day (County 911 Data)
The busiest times of day for Bangs are between 8:00 am and 8:00 pm, with two-thirds of calls
occurring during those hours.
Calls by Month (County 911 Data)
297 303 137 18 259 13 392 2
1,519
2 633 32 118 45 42 32 79 22 5
8,273
20
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
#
o
f
C
a
l
l
s
Municipality
1,407 1,190
2,959 3,178
2,814
1,877
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Overnight00:00-03:59 EarlyMorning04:00-07:59
Morning08:00-11:59 Afternoon12:00-15:59 Evening16:00-19:59 Night 20:00-23:59
Calls by Time of Day
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There is very little variation in call volume by month for Bangs ambulance. There is a slight dip
in June and July when the colleges are not in session.
Calls by Month 2024 2025 Avg/ per
day
Response Times (County 911 Data)
The response times are presented based on which agency was dispatched as the primary
agency according to the dispatch system. The calls for service include both high priority events
and interfacility transfers. The response time is based on the time from when the primary
agency was notified of an event to when an ambulance was noted as on the scene. Given the
relatively large response area and using call severity information to decide on emergency
response, the response time intervals appear reasonable.
Suggestions by Bangs
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During CGR’s interview with Bangs, the following suggestions to improve EMS in the County
were made:
∞ Rebuild volunteer agencies: Invest in training and support to restore the dual-
response model (volunteer + transport).
∞ County training facility: Support the County’s efforts to centralize and expand EMS
training.
∞ Reform dispatch protocols: Allow more flexibility in response times for non-
emergency calls to avoid unnecessary mutual aid. A significant volume of Bangs
responses were reported to be low-acuity or non-emergency calls that do not
require ambulance transport (lift assists, minor falls, and wellness checks). Specific
suggestions include:
∞ Re-evaluate 911 dispatch protocols, particularly for low-priority calls.
∞ Empower EMS providers like Bangs to triage non-emergent calls internally and
delay response until an appropriate unit is available.
∞ Explore alternative response models for non-transport cases.
∞ Explore funding models: Consider contracts or per-call subsidies to help offset
costs and improve competitiveness.
∞ Improve data tracking: Better tracking of direct calls, mutual aid, and transport
rates could inform smarter resource allocation.
∞ Support workforce development: Reinstate state reimbursement for EMT training
and expand Bangs’ tuition reimbursement model. Suggest that the County support
a more regional workforce development approach.
∞ Regional coordination: Address mutual aid imbalances and ensure fair distribution
of service responsibilities.
Dryden Ambulance
Dryden Ambulance operates out of North Street in Dryden, NY and provides primary
ambulance service to the Town and Village of Dryden, the Town of Hartford, and a portion of
the Town of Virgil, for a total approximate area of 150 square miles (east side of Tompkins
County). Dryden Ambulance was formerly a volunteer fire department ambulance until 1992,
when the ambulance service was separately incorporated and two paramedics were hired. At
that time, the department averaged between 500-600 calls annually. Today, the call volume
has increased to approximately 2,500 calls annually.
Vehicles
The station was built in 1991 and had three bays and a total of approximately 1,900 square
feet.
Dryden Ambulance owns and operates three ambulances and one fly car:
∞ Ambulance 551: 2024, Modular Type, Wheel Coach, 22,000 miles
∞ Ambulance 552: 2019, Modular Type, Wheel Coach, 105,000 miles
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∞ Ambulance 553: 2022, Modular Type, Wheel Coach, 71,000 miles
∞ Fly Car: 2021, Model – Explorer, 21,000 miles
Funding/Billing
Dryden Ambulance receives approximately $1.2M in funding from the Town of Dryden through
a tax district as well as revenue from billing. All billing revenue generated by Dryden
Ambulance is retained by the agency because of its contract with the Town of Dryden.
The approximate mix of payors is:
∞ Federal = 68%
∞ Commercial = 22%
∞ Self-Pay = 10%
Additionally, Dryden Ambulance has a contract with the Town of Virgil and Town of Hartford,
receiving funding of $7k and $20k, respectively.
Inter-Agency Coordination and Mutual Aid
Dryden Ambulance responds to mutual aid calls dispatched by the County 911 Center. It was
stated during an interview that 35% of Dryden Ambulance’s call volume is outside of its
service area, which has put a strain on its resources and reduced availability of service to its
own residents who are paying a high premium for the service to be available in their
community. The table of calls below from 8/1/24 to 7/31/25 has 35% of calls outside of its
primary service area. Both Cortland and Ithaca accounted for 7.5% of the overall call volume
for Dryden’s ambulance during that time. Groton was having staffing issues for several
months and accounted for 11% of calls for service.
Location of Calls (Dryden Ambulance Data)
The data below presents a more accurate picture of the call distribution for Dryden Ambulance
from 8/1/24 to 7/31/25 because the data provided by Tompkins County 911 did not include
all calls outside of the County through inadvertent filtering during the export process. 34% of
Dryden’s calls were mutual aid during that period, including about 11% of all calls responding
to Groton.
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Strengths of Agency – What’s Going Well
∞ Strong community and municipal support: The Town of Dryden provides $1.2M in
funding and allows the agency to retain all billing revenue.
∞ Stable staffing and leadership: Long-tenured leadership and a core group of
committed staff have created a reliable and respected service.
∞ High service coverage: Dryden Ambulance covers 99.96% of its calls and maintains
two 24/7 ALS crews with a third during the day.
∞ Efficient operations: The agency has a solid reputation and minimal turnover.
∞ Flexible scheduling: 48-hour shifts are allowed, which is a draw for staff commuting
from outside the area.
∞ Good 911 center relationship: Dispatch is generally responsive and well-managed.
Largest Challenges for Agency
∞ Mutual aid overuse – largest crunch/issue: As stated above, more than a 1/3 of
Dryden Ambulance’s call volume is outside its primary service area, straining
resources and reducing availability for its own residents (who pay a high premium
for the service to be available in their community).
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∞ Dryden Ambulance does not turn down mutual aid calls because it fears that if
it does so, Dryden may not receive help when needed.
∞ Staffing pressures: Competition from state agencies offering better pay and
benefits is making recruitment and retention harder and driving up costs to
become more competitive.
∞ Training pipeline issues: Local EMT training is limited, with no in-county programs
currently available.
∞ Hospital capacity and transport burden: Local hospitals often lack the capacity to
treat patients, requiring long-distance transports that ties up crews.
∞ Have recently started interfacility transport (limit it to 1-hour trips) and it has
turned transports down recently because of staffing.
∞ Funding model limitations: Heavy reliance on Medicaid/Medicare (66% of patients)
leads to significant write-offs (~$2M/year).
∞ Lack of regional coordination: Some towns rely heavily on Dryden without
contributing resources or building their own capacity.
∞ High number of low acuity calls: Dryden Ambulance would like to see a nursing line
added to remove some of the lower acuity items, or use the EMD cards the way
they are designed (hold for a small amount of time, i.e., 5 minute hold until go to
next provider) as this would help if it didn’t have to respond to omegas and alphas
(tooth aches, etc.) immediately.
Disposition of Calls (Dryden Ambulance)
CGR requested EMS Charts Data from Dryden Ambulance (Receiving Hospitals field). Data is
summarized in table below for the period between August 1, 2024 and July 31, 2025. Cayuga
Medical Center and Guthrie Health in Cortland are the largest recipients of patients from
Dryden ambulance. There are occasionally transports to further destinations based on patient
need.
8 ‘Other’ consists of four health care facilities that had 50 or less transports (Crouse Hospital, Guthrie Hospital
Lourdes, Gutherie Robert Packer Hospital, SUNY Upstate Community General Hospital, Saint Joseph’s Hospital –
Syracuse, Veterans Administration Hospital Center – Syracuse, Wilson Regional Medical Center)
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The overall call outcome for Dryden’s calls is similar to most ambulance services with about 6
in 10 patients being transported to the hospital.
Nature of Calls By Dispatch (County 911 Data)
The Top 25 Calls by Nature (in order from most to least calls in the top 25) for Dryden
between August 1, 2024 and July 31, 2025 are summarized in the table below. This list
follows a similar pattern to other EMS agencies in Tompkins County.
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Calls by Municipality Location (County 911 Data)
Using the data from the 911 Center, the calls by location that Dryden responded to between
August 1, 2024, and July 31, 2025, are shown in the chart(s) below. As noted, this data
inadvertently excluded about a third of Dryden’s calls that were outside of its primary
response area. The chart above is a more accurate depiction of their total call volume. The
data from the 911 Center used the fire district as the designator of the location, rather than
the municipality. The vast majority (about 80%) of Dryden’s’ calls are inside one of its primary
fire districts (Dryden, Freeville, McLean, Varna, and Etna), followed by Groton (8%) and Out of
County (7.1%).
0.1%0.2%
11%
39%
15%
6%2%1%4%0.2%
12%
4%7.1%
0.0%5.0%10.0%15.0%20.0%25.0%30.0%
35.0%
40.0%45.0%
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Calls by Time of Day (County 911 Data)
The following table shows the distribution of responses by time of day. The busiest time of day
is the morning and late afternoon. 64% of calls occur between 8:00am and 8:00 pm.
Calls by Month (County 911 Data)
The table below shows the responses by Dryden over the course of the year. There is minimal
variation from month to month, although the summer months were slightly busier and March
was the busiest month overall.
Calls by Month 2024 2025
165 188
419 387 409
330
0
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Overnight00:00-03:59 Early Morning04:00-07:59 Morning08:00-11:59 Afternoon12:00-15:59 Evening16:00-19:59 Night 20:00-23:59
Calls by Time of Day
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Response Times
The response times are presented based on which agency was dispatched as the primary
agency according to the dispatch system. The calls for service include both high priority events
and low priority events. The response time is based on the time from when the primary
agency, even if it was not Dryden, was notified of an event to when an ambulance was noted
as on the scene. Given the relatively large response area and using call severity information to
decide on emergency response, the response time intervals appear reasonable.
Calls by Hour
Suggestions from Dryden
During CGR’s interview with Dryden, the following suggestions to improve EMS in the County
were made:
∞ Countywide EMS system: Merge Dryden, Trumansburg, Groton, and others into a
county-run EMS system with shared staffing, funding, and infrastructure.
∞ County investment in training: Establish a county training facility to rebuild the
volunteer and professional EMS pipeline.
∞ Reform mutual aid expectations: Encourage accountability and capacity-building in
towns that over-rely on mutual aid.
∞ Explore nurse triage line: Reduce low-acuity 911 calls by implementing a nurse line
or alternative response model.
∞ Improve hospital coordination: Engage hospitals in discussions about their role in
EMS system strain and explore shared solutions.
∞ Incentivize EMT-to-paramedic advancement: Provide financial support for EMTs to
pursue advanced certifications.
∞ Reevaluate dispatch protocols: Use EMD cards more flexibly to delay or redirect
non-emergency calls.
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Groton Ambulance
Groton Ambulance started in 1964 and is part of the Village fire department that operates out
of the station on Main Street in Groton, NY. Groton Ambulance provides primary ambulance
service to the Town and Village of Groton and has a total call volume of approximately 1,000
calls annually. The Town and Village were cited as strong supporters of the ambulance
service, which typically has a paramedic on duty. The Village’s recreation director is also an
EMT who will often help staff the ambulance between 8:00 am and 2:00 pm. Other EMT and
driver staff are fully volunteers.
Vehicles
The station, which includes the entire fire department, was built in 2024 and has eight bays
and a total of approximately 15,600 square feet.
Groton Ambulance owns and operates two ambulances:
∞ Ambulance 851: 2022, Type III, Model - Ford, 46,000 miles
∞ Ambulance 852: 2016, Type III, Model - Chevy, 90,000 miles
Funding/Billing
Groton Ambulance is funded by a mix of Town and Village taxes and revenue from billings (via
MultiMed). The estimated funding breakdown is 60% cost recovery (which started in 2023)
and 40% tax revenue. Groton Ambulance’s finances are healthy currently and the budget is
self-sustaining, with strong support from the Town and Village residents with cost recovery.
Inter-Agency Coordination and Mutual Aid
Groton Ambulance responds to mutual aid calls dispatched by the County 911 Center. It was
stated during an interview that approximately 20% of calls inside Groton had to be dispatched
and responded to by Dryden via mutual aid due to a shortage of paramedics in Groton;
however, it was stated that this issue has been resolved.
Strengths of Agency – What’s Going Well
∞ Strong community support: The Town and Village residents are very strong
supporters of the ambulance and consider it as a critical resource that needs to be
supported.
∞ Fiscally stable: The strong support from the Town and Village approved cost
recovery starting in 2023, which accounts for 60% of the ambulance’s funding.
Because of this, the ambulance service is self-sustaining, and its budget is
currently stable.
∞ Efficient operations: The agency has a solid reputation and minimal turnover.
Largest Challenges for Agency
∞ Mutual aid: As stated above, 20% of Groton’s call volume was from the Dryden
Ambulance, which strained resources and reduced availability for its own residents;
however, this call volume is lower and doing better in 2025.
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∞ Staffing shortages and recruitment challenges: Groton Ambulance is experiencing a
shortage of drivers and paramedics, while experiencing growth in call volumes.
∞ Maintaining assets: With growing costs and demands on the EMS system, Groton
Ambulance has some concerns/challenges with planning and resourcing to
maintain its rigs.
∞ Hospital capacity and transport burden: Local hospitals often lack the capacity to
treat patients, requiring long-distance transports that tie up crews.
Transport Disposition (EMS Charts Data)
CGR requested EMS Charts Data from Groton Ambulance (Receiving Hospitals field). Data is
summarized in the table below for the period between August 1, 2024 and July 31, 2025.
Groton’s nearly 70% transport rate is higher than its peers in the County.
Call Outcome Data (EMS Charts Data)
About 7 in 10 of Groton’s responses resulted in a patient transport to a hospital. Several
different variants of patient refusals accounted for the next largest share of response
dispositions.
0%
3%
8%
0%
4%
1%
9 ‘Other’ consists of health care facilities that had 20 or less transports by Groton Ambulance.
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2%
0%
4%
0%
0%
2%
5%
0%
69%
Nature of Calls (County 911 Data)
The Top 20 Calls by Nature (in order from most to least calls in the top 25) for Groton between
August 1, 2024 and July 31, 2025 are summarized in the table below.
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Calls by Municipality Location (County 911 Data)
Calls by location that Groton responded to between August 1, 2024 and July 31, 2025 are
shown in the chart(s) below. The majority (49%) of Groton’s calls are inside of the Village of
Groton, with the next most occurring in Groton town-outside-village (36%) and Mclean (11%).
Not all of Groton’s out-of-county calls were captured in this data, but it reported few during our
interview.
Calls by Time of Day (County 911 Data)
About 70% of Groton's calls occurred during the 8:00 am to 8:00 pm time window and the
overnight hours were noticeably slower than other times of the day.
1 14
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Calls by Time of Day
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Calls by Month (County 911 Data)
In the year we analyzed, the call volume by month varied from a high of around 100 (or three
calls per day) in September and June to about 60 (or two calls per day) in May and November.
Calls by Month 2024 2025
Response Times (County 911 Data)
The response times are presented based on which agency was dispatched as the primary
agency according to the dispatch system. The calls for service include both high priority events
and interfacility transfers. The response time is based on the time from when the primary
agency was notified of an event to when an ambulance was noted as on the scene. Given the
relatively large response area and using call severity information to decide on emergency
response, the response time intervals appear reasonable. It is notable that the response
times during the overnight tend to be longer than during the daytime hours.
Calls by Hour 50th Percentile 90th Percentile
Overnight 00:00-03:59 5.4 mins 14.1 mins 15.8 mins
Early Morning 04:00-
07:59
4.3 mins 11.7 mins 12.6 mins
Morning 08:00-11:59 3.5 mins 12.4 mins 14.4 mins
Afternoon 12:00-15:59 3.1 mins 8.1 mins 13.7 mins
Evening 16:00-19:59 4.3 mins 8.7 mins 13.7 mins
Night 20:00-23:59 3.1 mins 8.7 mins 13.9 mins
Suggestions from Groton
During CGR’s interview with Groton, the following suggestions to improve the county EMS
system were made:
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∞ County should opportunities.
∞ An alternative destination beyond the emergency departments would be helpful
such as the ability to transport to an urgent care facility.
Tompkins County Rapid Medical Response
The Tompkins County Rapid Medical Response (RMR) program is a pilot program funded by a
state grant and administered/operated out of the Tompkins County Department of Emergency
Response. It was in the design phase in 2023, rolled out in 2024, and grant funding ended in
2025. A decision was made to continue and potentially expand the program in 2026 with
local funds. The program allows fully trained EMS providers to respond to a scene and initiate
life-saving care while waiting for a transport agency to arrive or cancel the transport agency if
it is not needed (freeing up resources to respond to other emergencies).
As of the end of 2025, the RMR program has three units on duty from Monday to Friday
covering the period of 7:00 am to 7:00 pm with staggered numbers of units on duty. The
hours expanded in 2026, and it is pursuing the ability to provide paramedic services on a first
response basis.
Vehicles
The County Department of Emergency Response station was built in the early 2000s and has
one extra-large bay.
The program operates with three BLS rapid response vehicles at a time and has four vehicles:
∞ Fly Car 2341: 2024, SUV, Model – Jeep, 6,000 miles
∞ Fly Car 2342: 2024, SUV, Model – Jeep, 6,000 miles
∞ Fly Car 2343: 2024, SUV, Model – Jeep, 6,000 miles
∞ Fly Car 2344: 2020, SUV, Model – Jeep, 65,000 miles
Funding/Billing
Funding for the program currently comes from the county’s general fund. The 2025 budget
was $546,828; 90% goes to EMT salaries and benefits. The County has been promised a
grant from New York State to support this program but has not yet received the grant funds for
either 2024 or 2025. The RMR program does not bill for its services.
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Strengths of Program – What’s Going Well
∞ Strong community support: Residents appreciate faster response times and the
fact that RMR services are tax-funded and not billed directly.
∞ Positive field relationships: RMR has built strong working relationships with Bangs
Ambulance, fire departments, and the public.
∞ Effective coverage: RMR units often arrive before Bangs—estimated 90% of the
time in their coverage areas (Caroline and Danby).
∞ Operational impact: RMR has significantly reduced response times and provides
critical lift assists, refusals, and basic interventions (e.g., Narcan, aspirin,
albuterol).
∞ Growing trust: Initial skepticism from Bangs has shifted to collaboration and
appreciation from field crews.
∞ Bangs even has asked RMR to come into the City of Ithaca
∞ Public interest in expansion: Community members frequently ask when RMR will
expand to 24/7 coverage.
Largest Challenges for Agency/EMS System
∞ Limited ALS capability: RMR is currently BLS-only due to political and operational
constraints, despite having ALS-trained staff.
∞ Understaffed system: Bangs and volunteer agencies are stretched thin, leading to
long waits for transport and overreliance on RMR.
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∞ Training pipeline issues: EMT and paramedic training is limited in the County;
tuition costs and lack of reimbursement are barriers.
∞ Healthcare system strain: Local hospitals often lack capacity, requiring long-
distance transports that tie up EMS resources.
∞ Uneven benefits and pay: RMR staff face higher insurance costs and less
comprehensive benefits compared to other agencies like Dryden Ambulance.
Suggestions from RMR
During CGR’s interview with the members of the County RMR program, the following
suggestions were made to improve EMS:
∞ Expand RMR to include ALS: Adding ALS capability would allow more effective care
in remote areas and reduce delays in critical interventions.
∞ Increase RMR coverage: Add a fourth unit and consider 24/7 staffing to meet
demand and backfill gaps in the system.
∞ Invest in EMS education: Offer more EMT and paramedic classes locally and
reinstate state tuition reimbursement.
∞ Improve system coordination: Clarify roles between RMR, Bangs, and fire
departments; enhance dispatch protocols and data sharing.
∞ Standardize pay and benefits: Level the playing field across agencies to improve
recruitment and retention.
RMR Call Data Explanation
The County 911 records management system often listed the primary responding ambulance
first and therefore this information represents only about 25 percent of the calls that RMR
responded to during our one-year sample. Most frequently, RMR responded to calls with
Bangs Ambulance as it responded to requests in Lansing and communities south of Ithaca
without their own ambulance service. However, by comparing it with RMR’s own data, we
believe that they are a representative sample.
Nature of Call Data (County 911 Data)
The Top 20 Calls by Nature (in order from most to least calls in the top 20) for RMR when they
were listed as the primary agency between August 1, 2024 and July 31, 2025 are
summarized in the table below. They account for 25% of their true responses.
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Calls by Location (County 911 Data)
Calls by location that RMR responded to between August 1, 2024 and July 31, 2025 are
shown in the chart(s) below. The vast majority (70%) of RMR’s calls are in Lansing, with the
next most occurring in Enfield (9%) and Danby (5%).
Calls by Time of Day (County 911 Data)
The RMR program was only in service between 07:00 am and 7:00 pm during the study
period as it was designed to help fill the gap when volunteer first responders were least likely
to be available. The largest share of calls occurred before noon.
13 2 14 2
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Calls by Month and Response Time
Because of the incomplete picture of RMR responses noted above, these two aspects of the
RMR program cannot be adequately analyzed. RMR regularly reports data to the Public Safety
Committee of the Legislature.
Trumansburg Emergency Medical Services
Located in the Village of Trumansburg, Trumansburg EMS operates under municipal CONs for
the towns it serves. It staffs one ALS crew 24/7 with supplemental shifts as needed. There is
also a paramedic fly car on duty 16 hours a day.
Trumansburg EMS provides primary EMS services for Village of Trumansburg, the Town of
Ulysses, the Town of Covert and Village of Interlaken in Seneca County and parts of the Town
of Hector in Schuyler County. Additionally, it provides mutual aid to other agencies in
Tompkins, Seneca, and Schuyler Counties as well as public assistance services to members of
the community.
Trumansburg EMS also has the following special capabilities: Rapid Sequence Intubation,
Dive Team, Technical Rescue (in conjunction with the fire department) and Ropes Rescue
certifications.
Vehicles
Information on when the station was built and the square footage was not provided, but it has
a total of three bays.
Trumansburg Ambulance owns and operates three ambulances and one fly car:
∞ Ambulance 1851: 2013, Type III, 110,000 miles
∞ Ambulance 1852: 2019, Type III, 110,000 miles
∞ Ambulance 1853: 2020, Type III, 42,000 miles
∞ Fly Car 1: 2019, SUV, 47,000 miles
0
17
157
89 78
0020406080100120140160180
Overnight00:00-03:59 EarlyMorning
04:00-07:59
Morning08:00-11:59 Afternoon12:00-15:59 Evening16:00-19:59 Night 20:00-23:59
Calls by Time of Day
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Funding/Billing
Trumansburg EMS is funded by a mix of municipal taxes and revenue from billings (via Priority
One). The 2025 budget was $1.4 million. Property taxes fund the entire budget, split between
the Village and the three Towns with which it contracts (Covert, Ulysses, and Hector). Billing
revenue is reimbursed to each municipality based on the call location. The total billing
revenue is about $350,000 annually.
The approximate mix of payors for transport is:
∞ Medicare = 60%
∞ Uninsured = 16%
∞ Commercial = 11%
∞ Medicaid = 4%
∞ Motor Vehicle = 4%
∞ Other/Private Pay = 4%
Inter-Agency Coordination and Mutual Aid
Trumansburg EMS responds to mutual aid calls dispatched by the County 911 Center in
Tompkins County, but it also responds to mutual aid calls in Seneca (mainly Romulus) and
Schuyler counties (mainly Hector). It was stated in an interview that mutual aid volume is a
challenge for Trumansburg EMS in Seneca and Schuyler counties because of the length of
time it takes. There has also been an increase in mutual aid calls within Tompkins County,
mostly in areas covered by Bangs.
Strengths of Agency – What’s Going Well
∞ Strong community support: The mayor is a very strong supporter of EMS, and the
agency gets support from the municipalities.
∞ Fiscally stable: The strong support from the mayor and municipalities allows for the
agency to be financially stable and for operations to be solid with a fully paid
department.
∞ Solid paramedic retention and mix of EMT experience levels: The agency’s
paramedic turnover is very low and the EMT tenure/experience level ranges from
long-term staff to new recruits.
∞ Limited Need for mutual aid – In 2025, Trumansburg only received 24 mutual aid
responses, all when the primary ambulance was on a call.
Largest Challenges for Agency
∞ Mutual aid: As stated above, mutual aid outside of Tompkins County can put a
burden on the Trumansburg Ambulance staff because of the lengthy amounts of
time the agency is out of their community and the County.
∞ Increased mutual aid in Tompkins County – In 2025, Trumansburg provided mutual
aid 139 times, 68% of which was to areas covered by Bangs – Ithaca (City and
Town), Enfield, or Newfield.
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∞ Lack of State support and bureaucratic red tape: Trumansburg Ambulance feels
there is a lack of state support/subsidy for the rural agency, and that to get support
is a length and complicated, bureaucratic process.
∞ Staffing issues: Although Trumansburg Ambulance overall is in a good position for
service, the agency cited that it is in a bit of a staffing rut because of lost staff and
the recurring challenges in the County to recruit new EMTS into the field.
EMS Transport Destination (EMS Charts Data)
CGR requested EMS Charts Data from Trumansburg EMS (Receiving Hospitals field). Data is
summarized in tables below for the period between August 1, 2024, and July 31, 2025.
Call Disposition (EMS Charts Data)
Trumansburg had the lowest percentage of transport calls among the four ambulance
services in the County at 55% and a higher percentage of cancelled calls. Although not
definitive, this data supports its assertion that it is regularly cancelled enroute while
responding mutual aid to another district.
10 ‘Other’ consists of health care facilities that had less than 20 transports by Trumansburg Ambulance.
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Call Nature (County 911 Data)
The Top 20 Calls by Nature (in order from most to least calls in the top 20) for Trumansburg
between August 1, 2024 and July 31, 2025 are summarized in the table below. They account
for 94% of the calls Trumansburg was dispatched to during the period.
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Calls by Municipality Location (County 911 Data)
Calls by location that Trumansburg responded to between August 1, 2024 and July 31, 2025
are shown in the chart(s) below. The majority were for its primary service area- the whole Town
of Ulysses (including the Village of Trumansburg), Covert and Hector. However, this data does
not include other mutual aid requests to Schuyler and Seneca County nor a portion of their
mutual aid requests into the Town and City of Ithaca. There is a gap of 374 responses
between Trumansburg’s response data and the County’s 911 Center data. This gap is made
up of calls that occurred split between three mutual aid areas – Seneca County, Schuyler
County, and Ithaca.
Calls by Time of Day
About 67% of Trumansburg’s calls occurred between 8:00 am to 8:00 pm; overnight hours
were noticeably slower.
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Calls by Month (County 911 Data)
The table below shows the responses by Trumansburg over the course of the year. The agency
averaged 71 responses per month varying from a low in the mid-50s during January and July
with August and October in the high 80s. One confounding factor is that the agency operates
differently during the busiest week in July during the Grassroots Folk Festival; much of the
activity is recorded under stand-by events and it does not respond to as many requests for
outside assistance.
Calls by Month 2024 2025
Response Times (County 911 Data)
The response times are presented based on which agency was dispatched as the primary
agency according to the dispatch system. The calls for service include both high priority events
and interfacility transfers. The response time is based on the time from when the primary
agency was notified of an event to when an ambulance was noted as on the scene. The
79 94
181
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Calls by Time of Day
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response times are consistent with across time of day, although the median is a little slower
during daytime hours, reflecting the impact of traffic and the higher volume.
Fire Service Rescue Program
CGR conducted an interview with the Ithaca Fire Department as well as attended a monthly
Fire Chiefs meeting will onsite on July 22, 2025. Key takeaways from these conversations are
presented below:
∞ Volunteer fire departments in the County vary in response to EMS calls based on
nature and time of day.
∞ There are 13 BLS FR Departments in the County, and the response matrix of calls
they respond to varies by area.
∞ The Ithaca Fire Department typically responds to life-threatening calls (EMD calls)
and responds as specifically requested. Close to half of its 5,600 annual calls are
EMS in nature.
EMS Education
Through interviews with a variety of stakeholders and through the provider survey (discussed
below) CGR gathered that EMS education in Tompkins County is challenging for several
reasons. Key findings from our investigation into education in the County are summarized
below:
∞ The region lacks sufficient local EMT and paramedic training options.
∞ Currently, only one EMT original class is offered per semester in the area, and there
is a high level of competition between college students and other residents for
these slots. College students, although motivated to sign up for these classes (and
often more proactive than residents), do not tend to pursue these classes to
become a practicing provider in the County, but rather to gain a certificate and
resume build for other endeavors.
∞ There is not a robust local course sponsor since Tompkins Cortland Community
College stopped providing EMT classes during the pandemic. However, SUNY
Upstate is currently working to try to fill this gap in coordination with the CNY
REMSCO.
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∞ Students must pay for classes in advance (up to $1,800) and get reimbursed
later/after the class.
∞ There is currently no paramedic program in the County.
Provider Survey
CGR developed a survey sent to employees (volunteer and paid staff) at EMS agencies in
Tompkins County on July 31, 2025, to identify strengths and issues facing the EMS System in
Tompkins County. The survey was open for responses until Friday August 22, 2025.
A summary of takeaways from selected questions is provided below.
Eighty-three survey respondents indicated they were volunteers, but only approximately sixty
chose to respond to all questions.
CGR does not believe this is representative of the total number of volunteers in the County
based on data provided by the agencies (i.e., not all volunteers responded to the request to fill
out the survey, and some agencies had higher number of respondents).
The median weekly commitment is 10 hours per week, but 1 in 10 respondents exceeds 30
hours per week.
The median experience tenure is 10 years, but a quarter of respondents have been in the
EMS service for more than 35 years.
Half of the respondents to the question were EMTs while a quarter were paramedics.
7 in 10 respondents to the question said that they would be ‘very likely’ (40%) or ‘somewhat
likely’ (30% of respondents) to recommend joining a Tompkins County agency as a volunteer.
The top four reasons that were cited by respondents to this question (based on weighting by
ranking and numbers of votes) are:
1. ‘Desire to give back to my community.’
2. ‘Seeking a career and wanted volunteer experience.’
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3. ‘Recruited by a friend or neighbor.’
4. ‘Informal tradition/the way I grew up/recruited by family.’
The top four reasons that were cited by respondents to this question (based on weighting by
ranking and numbers of votes) were:
1. ‘A feeling of belonging/inclusion/being part of a ‘team.’
2. ‘Strong leadership in organization’
3. ‘Robust training program’
4. ‘Opportunities to advance/gain experience.’
80% of respondents to this question started as volunteers before being hired as a career EMS
provider with 31% saying that they were volunteers but had stopped and 48% saying that they
are still volunteering.
The top five reasons that were cited by respondents to this question (based on weighting by
ranking and numbers of votes) are:
1. ‘Professionalism of staff’
2. ‘Response times’
3. ‘Staying current/progressive with new practices and technology’
4. ‘Quality of ambulance/equipment’
5. ‘Public perception’
It is also notable that a few of the options for answers were zero or near zero responses:
‘volunteers’ (3 responses total), ‘department atmosphere’ (5 responses), and ‘internal
communication’ (0 responses).
“What do you see as weaknesses of your paid agency(s)?”
The top five reasons that were cited by respondents to this question (based on weighting by
ranking and numbers of votes) are:
1. ‘Administrative leadership’
2. ‘High call volume’
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3. ‘Quality of stations’
4. ‘Operational leadership’
5. ‘Training’
It is also notable that a few of the options for answers were zero or near zero responses:
‘equipment’ (3 responses total), volunteers’ (1 response),‘public perception’ (4 responses),
and ‘connection with community’ (0 responses).
This question asked respondents to rank a potential issue (‘time required’, ‘complexity of
training’, ‘cost of training’, ‘frequency of training, and ‘traveling to training’) as ‘not a
challenge’, ‘minor challenge’, and ‘major challenge’. For all potential issues, over 60% of
respondents said it was a challenge, with ‘time required’ receiving almost 90% of respondents
saying it was a challenge (49% of respondents said minor, 40% said major).
It is also notable that 40% or greater of respondents said that ‘time required’, ‘frequency of
training’, and ‘traveling to training’ were major challenges.
“Regarding EMT training (original and refresher), would you prefer if
the training was offered (see options in narrative below)”
The options offered in this question were ‘At TCCC campus in Dryden’, ‘at a central location in
or near Ithaca’, or ‘at several locations on a rotating basis’. The TCCC campus is an unpopular
option (13% of respondents said they would prefer this location) while ‘at a central location in
or near Ithaca’ is the most popular (52% of respondents said they would prefer this location).
“What is your age?”
For respondents who are volunteers in Tompkins County:
5%
24%
14%14%
10%
24%
10%
0%
5%
10%
15%
20%
25%
Under 20 20-29 30-39 40-49 50-59 60-69 70+
Percentage of Respondents who are Just Volunteers by Age Group
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For respondents who are career/employed EMS workers in Tompkins County:
For respondents who are paid and volunteer EMS workers in Tompkins County:
“What is your gender?”
For respondents who are volunteers in Tompkins County:
∞ Male: 71%
∞ Female: 29%
For respondents who are career/employed EMS workers in Tompkins County:
∞ Male: 79%
0%
10%
31%
24%
21%
7%7%
0%
5%
10%
15%
20%
25%
30%
35%
Under 20 20-29 30-39 40-49 50-59 60-69 70+
Percentage of Respondents who are only
Career by Age Group
0%
24%
12%12%
29%
18%
6%
0%
5%
10%
15%
20%
25%
30%
35%
Under 20 20-29 30-39 40-49 50-59 60-69 70+
Percentage of Respondents who are both Volunteer and Career by Age Group
Version. 06.08.26
55
www.cgr.org
∞ Female: 21%
For respondents who are paid and volunteer EMS workers in Tompkins County:
∞ Male: 76%
∞ Female: 24%
Version. 06.08.26
56
www.cgr.org
Appendices
Version. 06.08.26
57
www.cgr.org
Appendix I -Presentation to Legislature
Version. 06.08.26
To
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26
Version. 06.08.26
Qu
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27
Version. 06.08.26
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Appendix II - Broome County Call Holding Policy
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Appendix III- Madison County EMS System
Agreements
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