Commentary from Niagara County Legislator Shawn Foti on the need for ambulance service across Niagara County


Foti. Floor shot

Niagara County residents have right to expect a certain level of service from their government.  Keep the roads plowed in winter.  Pick up the trash.  Protect our communities.  And when a medical emergency arises and they call 9-1-1, that help will arrive as quickly as possible.  That last one is becoming a bigger challenge every day and is the reason for some serious discussions taking place right now. Volunteer membership has been declining every year, while call volumes increase rapidly. NYS continues to overwhelm volunteer EMS departments with extreme regulations and requirements, making it very difficult to provide and afford providing these services. We know our volunteers need help and support in order to continue the long proud legacy of volunteerism in Niagara County.

Let me start off by saying, there is universal agreement among all the stakeholders in Niagara County that something must be done to ensure that emergency medical services are available in a timely fashion to all corners of Niagara County.  As both a county legislator and a long-time volunteer firefighter, I have a good understanding of both the problems we are trying to address and the process we must go through to reach a viable solution.

Here are a couple of facts to keep in mind.  First, the county has contracted with Mercy Flight EMS to provide two advanced life support (ALS) ambulances to support our volunteer companies in answering EMS calls.  That contract runs through this fall and thus far, it seems to be working. I have personally seen the contracted ambulances responding to calls, and many times, they are the first rig on scene. Initially, I was hesitant regarding this contract but eventually voted in favor of it. We ran in to unexpected hurdles through the process of starting the county run service and we were facing a tough situation with the unexpected early closing of Lockport ER. A decision had to be made, and we did not want to leave our volunteers stranded with longer transport distances and longer wait times. The most efficient temporary solution was to contract with Mercy to get more ambulances on the road around Niagara County. Summer is the busiest season for emergency calls so we are also getting an excellent sample size of how a third-party ambulance service can perform.

Second, the county has hired consulting firm CGR to guide us through all the different options we have for ambulance service; the necessary regulatory steps needed to implement each option; and the costs/benefits of each one, including potential for reimbursement for services through insurance companies. So, what are some of those options that CGR will be considering?

The most discussed option has been around creating a county-run ambulance service, overseen by our Department of Emergency Services.  The county has taken some steps in this direction, including the purchase of an ambulance.  This is a popular choice with many volunteer firefighters who believe this model ensures the best service and maintains control and accountability within our departments.  A full-blown county system also is the most complex option, probably the most costly and requires a lot of spade work to structure it the right way (i.e. potentially creating an ambulance district so those participating municipalities help fund it.)  We also need to address union work rules, legacy costs and other issues that involve expanding the county workforce into a new area. I believe this option provides a long term and sustainable solution to our problem. It also opens up the possibilities of providing volunteer EMS departments with financial incentive to continue providing ambulance services in their district through call revenue sharing. There are many complex factors to this option which is also the reason it has not been a smooth path forward.

The next option would be a continuation of what we are currently doing, which is to contract out for ambulance service in order to put more ambulances on the road and to lower response times.  This limits county exposure to lawsuits, which is particularly important because the county is self-insured, and also allows us to ramp up and down depending on the time of year.  During the pandemic, Niagara County was able to test this type of model when FEMA provided two on-call ambulances to our community.  The coordination between these third party ambulances and our emergency personnel was pretty seamless and all agreed it worked well.  As stated above, the current contract with Mercy will give us further data on this option.  Of course, the questions around this model include long-term costs and viability (i.e. what if the provider of services is not making money and decides to shut down.)   There are also questions of reliability of service when compared to a system that is government run.  After all, every second counts when responding to an emergency call.

The third option, not surprisingly, would be a hybrid of the two.  Hybrid models can appear to give us the best of both worlds, but the question would be if it is too costly, too cumbersome, and puts too many cooks in the kitchen.  The hybrid model could give us the most flexibility to meet our cyclical needs while ensuring proper government oversight.

I have my own opinions on which option I believe is best, but I am also making sure to follow the data being provided to us. This has been frustrating for all of us and I want to thank everyone involved for their continued efforts. There is a lot to work through, but the key is getting this done right, not fast. The short-term solution of contracting with Mercy EMS allows all stakeholders a voice in this process and proper consideration of all options.  But it is important the entire community know we are moving forward, we are making progress and we will have this figured out as we move into 2024.


Shawn Foti is a Niagara County Legislator representing the 14th District, which includes to the Towns of Newfane, Somerset and part of Lockport.