EMS Subcommittee

Monday, February 10, 2025 - 9:00 am

Robin DeLoria - Chairman

Chairman DeLoria called this EMS Subcommittee to order at 9:00 am with the following in attendance: Clayton Barber, Chris Clark, Robin DeLoria, Derek Doty, Ken Hughes, Jim Monty, Favor Smith, Matt Stanley, Davina Thurston, Meg Wood, Mark Wright, Mike Mascarenas, Josh Favro, Matt Watts and Michael Watts.

ALSO PRESENT: Dina Garvey

DELORIA: Okay, no resolutions for the meeting, today?

WATTS, MATT: Nope

DELORIA: Well, one of you guys take the lead.

WATTS, MATT: Michael, can.

WATTS, MICHAEL: So, like we said, no resolutions for today.

Some staffing updates; the EMT position that was previously approved for Ticonderoga, has been posted and applications were received. We’ll be doing interviews on this coming Friday for that position and anticipate them starting, probably early March.

DELORIA: Quick question, is there anybody from this committee that sits in on those interviews?

WATTS: MICHAEL: They haven’t in the past.

DELORIA: They haven’t in the past?

WATTS, MATT: Nope, usually, it’s the three of us. Josh will be gone this week, but we’ll have Wendy, probably sit in on it.

DELORIA: Okay

WATTS, MICHAEL: So, contract renewals for 2025; Ticonderoga, we actually received back, yesterday. Moriah is done. Willsboro/Essex is done. Schroon Lake is done. Etown/Lewis is done. Keene and Keene Valley have been sent out. Wilmington’s I have with me, today. AuSable Forks I have with me.

STANLEY: I’ll take it.

WATTS, MICHAEL: And Newcomb, was provided to you, today, as well.

DELORIA: Yup, I got mine, I will take care of that.

WATTS, MICHAEL: They’ve all been sent out, except for Wilmington, who I have here with me now.

DELORIA: If I get this done, I can bring them up on Wednesday.

WATTS, MICHAEL: That would be great.

So, on the radar for the near future, Keene and Keene Valley, are in the process, internally, trying to set up some sort of consolidation of services. In the near future, they may be looking for some staffing and the paid on-call incentive for the volunteers. That’s all still pretty early on in the conversations that they have going on with them. Essex EMS, they went out and met with them, yesterday, regarding the paid on-call incentive for the volunteers. Some fact finding on our end, trying to put together some sort proposal to try and get that off the ground and running. We have another meeting with them, set in March. They’ve got some things that they’re working on, on their end and some things that we’re working on, on our end to try and make that come to fruition.

WATTS, MATT: Mike, do you want to talk about anything on that?

MASCARENAS: Yeah, when we kicked this whole thing off, and Robin, will certainly remember this and some of the Board members that have been here for some more time. The per diems are really the key to this program, in terms of its successes. Without being able to get people to do that work, at that rate, it’s quickly going to become unaffordable and some hard decisions will have to be made. So, we tried through the years to get these volunteers to work these per diem shifts and I don’t think we’ve always done a great job at explaining to people, what it is, what the ask is and getting them onboard. Because once you go to a paid service it’s even hard to attract volunteers that are pretty limited to bring with. So, in these couple of communities that are struggling, recently, we’re trying to make a focus to getting these folks onboard, over the long run. So, the way that per diems are supposed to work, if you remember, is the County will pay the per diem rates.

STANLEY: And what are those rates?

MASCARENAS: Contractual, through per diems, not per diems, on call rates are $3.00 an hour and then if you’re activated, you get your rate, which is going to depend on the level of training you possess. So, if you’re an EMT, an AEMT, if you’re a paramedic, once you’re activated, you’ll get that call. If there is no call, you’ll get your rate for that weekend, in that community, to sit home and be available, really is kind of what it is. But, the cost is substantially less, which is why the County, years ago, when we adopted this model, was willing to take on that on call rate. We want to make it attractive for communities to get onboard with this and not have to figure out, budget-wise, how they’re going to deal with it. Willsboro/Essex is there to kind of pilot this thing, for us and be able, hopefully at the conclusion of this planning process, be able to do a blueprint for the rest of the communities that follow, but it’s not if, it’s when.

DELORIA: So, essentially, we’re looking at a cap on full time employment and these agencies, period and beyond that, the County’s not going to fund anything other than per diems to make this a successful program.

MASCARENAS: If there’s full time rates, the County will continue to fund the benefit. However, I don’t think we can be a committee that always says yes to requests.

DELORIA: Or we’re running out of grant money, also.

MASCARENAS: Well, we’re running out of grant money and we need to have some needs to place in terms of staffing levels and those types of things. So, when we go into a community and we say, okay, yeah, we’ll approve your per diems. Well, that doesn’t mean you can have 6 people on call at night. We need to have some control of that in how that staffing plays out.

WATTS, MATT: That’s one of the homework things that he’s going to be working on.

WOOD: Well, we have one volunteer, she’s at least 65. She’s great, she’s there all the time, and she volunteers. She doesn’t need to be on per diem rate, she’ll do it. But, we have and I have to talk to you, but we have no interest in our town for that kind of a program.

MASCARENAS: Yeah

DELORIA: Well, the program could be in place and they could just decline participation, like you would in the retirement system.

MASCARENAS: Absolutely.

DELORIA: This is what we’re offering, do you decline? And then you adjust the volunteers.

WATTS, MATT: It’s available, if they want to participate, they can.

DELORIA: But, it need to be in place, because when those volunteers go away, you have nothing. You follow up?

WOOD: Well, I understand that.

DELORIA: Yeah, yeah

MONTY: Going back, you were talking per diem rates, Mike and I remember that was one of the big things that we talked early on. So, basically for someone, that’s per diem for a weekend, if they don’t get called out, they’re guaranteed $144.00.

MASCARENAS: Yeah, basically, depending on the number of the hours they’re on call.

MONTY: Right, you decide to be on-call for 24 hours, both days, it’s $144.00 for not doing anything. If you do get called out, if you’re an EMT, you go with the EMT rate, for the time that you’re called out and stuff.

WATTS, MATT: Yes

MASCARENAS: Correct

MONTY: I get it, I think it’s great, but I think you hit the nail on the head, we need to get consistently with the staffing levels at each agency, because each agency, because each agency does stuff a little different.

FAVRO: Correct

MASCARENAS: Yes

MONTY: And I think if this is going to be a county run program, well, guess what? And you want support from the County, my opinion is, they have to get onboard with what you guys develop as a staffing level for each agency. I know you’ve got to consider the number of runs that you do. There are a lot of things that need to be considered, but not having everybody involved, consistently, is going to be a detriment.

DELORIA: Right

MONTY: It’s going to hold everything back and that needs to be figured out. It needs to be figured out sooner rather than later. I mean, I’m looking at this, here they owe us $2 million from 4 years ago. How does that affect your budget, Mike?

MASCARENAS: Horrible and I had a bit of a battle on that on Friday.

MONTY: You know, I’m saying, we’re kind of treading water, here. We need to, you know we need to move the end to figure how it’s going to be and if you want our help, guess what? You’re going to do it our way.

STANLEY: One of the things, though, I don’t think you can make too many rules to start with. Like I think you need to get buy in to start with. Yeah, maybe there needs to be some overall rules that you can’t have your entire squad on per diem for a weekend, but I think there are still a lot of, a lot of the agencies are still don’t want to give up control, yet to the County.

MONTY: But they can’t afford it.

STANLEY: Correct, but let’s get them to play first.

MONTY: We’ve been trying for 5 years to get them to play.

STANLEY: Yup, I agree.

MONTY: And it’s not to come to an end or it’s going to fail. It really is, we’re not much closer than we were. We’ve done good things, but we’re not much closer to figuring this out than we were 5 years ago.

DELORIA: So, what you’re referring to, is minimum standards per agency that the County is going to support financing to ensure that we have that coverage and then add in this defined coverage for the per diems and the maximum that the County would support. Like you say, you don’t want your whole squad on per diem, the necessary coverage, coverage is coverage.

MONTY: Yeah, but like Meg, said. She’s only got one volunteer, each town probably has different number of volunteers that come in and do it and stuff. Some volunteers that I’ve heard, said, well, if I’m going to do a per diem thing, I might as well go full-time and do it and that’s fine.

WOOD: Yeah

MONTY: It helps us in one sense, but it takes away from the potential of per diems over here.

MASCARENAS: Right, one of the issues, I think, we’re struggling with in terms of recruitment, staffing, are people that hold other jobs. That’s what this opens us up to do. We’re noting beating down the doors, everything we’re doing is built around full time. So, if you work at International Paper, if you work at school, if you work wherever, you’re not looking at a career change. You maybe somebody that’s interested in helping your community and being willing to take a weekend shift, once a month, and work somewhere else. We need you, we want you. We don’t want to turn those folks away, so if you are a school teacher, if you work at IP, I want to be able to take advantage of some of those things and that shift a month is important to us. So, we put something there to give people a little incentive to do so. That’s our untapped resource, people that are holding other employment.

DELORIA: And you’re using Ti as an example, I’m going to use Newcomb as an example. We end up paying overtime, an significant amount of overtime, because we don’t have per diems in Newcomb. Now, that doesn’t cost the County, that costs Newcomb, you follow me? So, the agencies need to look internally, too and see what that availability might be for per diems and bring people on.

WATTS, MATT: Do you have volunteers that would be willing to?

DELORIA: No, that’s the other thing.

WATTS, MATT: So, you’re kind of in the same boat as Schroon Lake.

WOOD: How much training is involved in other to become a per diem?

DELORIA: Too much

WATTS, MATT: Depends on whether you’re talking a per diem driver or a per diem EMT.

STANLEY: How much, many hours does an EMT need?

WATTS, MICHAEL: About 200 hours for an EMT class.

DELORIA: 200 hours is a lot, give me a break.

STANLEY: But, I think if the agencies get on board with this, you could utilize the being paid per diem to be on call as an incentive. So, if you’re somebody who doesn’t go anywhere and somebody that wants to give back to the community and you’re home every weekend, get the training and get paid $144.00 a weekend, maybe a tool that may help recruit some people, but I think on the flipside, come of these agencies are hesitate, like our agency, we only have two full time staff and everybody else is a per diem, so they don’t have to pay the benefits and all that stuff, but it’s to get enough coverage. Now, if we could lower some of those per diems to get some volunteers to sit a weekend, without having to pay those per diems to sit in the station.

DELORIA: And like Mike’s saying the volunteers is gone and it’s not coming back in my opinion and I think the fire service is next on the list.

WATTS, MATT: Yes, absolutely.

DELORIA: It’s the way of the world.

MASCARENAS: And we can’t handle both at once.

DELORIA: Absolutely, no.

MASCARENAS: We need to fix this one before we move on.

STANLEY: Well, I am just looking at my community. There is a lot retire COs in my community and I mean, you’re retired, some of them before they’re 50 years old. They know how to respond to incidents, they may be looking for something to do and this maybe, but we sit and talk about it here, it doesn’t get to the agencies and it definitely doesn’t get out to the people in our communities. So, I think we need to get those agencies on board and we need to do a better job of educating people, because where I live, people want a rolling hospital. If they have a cough, they want the hospital to come to their house, so how do we fund that responsibly?

MASCARENAS: Well, that’s a training expectation, too, right? I think Matt, would be the first tell you that ambulatory service has changed greatly over the years. It was get them stable, get them to the hospital. It is a rolling hospital.

WATTS, MATT: It is

MASCARENAS: It’s exactly what it is.

WATTS, MATT: Just this weekend, our ambulance was standing by in Newcomb and went to a call for them and the patient was in tachycardia, very unstable, they cardioverted them, which is shocking him when they still have a heartbeat, three times, gave them all these meds and everything, got him stabilized to be able to transport him and got him to Glens Falls. So, in the old days, they would have just picked him up…

WATTS, MICHAEL: Put some oxygen on him.

WATTS, MATT: Yeah, he probably wouldn’t have made it to Glens Falls.

DELORIA: I think another thing that I got educated to, over the past month, month and a half, too, is we currently have two ambulances that are ready to go, ALS, ready to go, all the time, looking to get another ambulance, but talking about keeping that third ambulance as a BLS ambulance, because of the fly car, we could do that and start to lower that cost and if we could lower that cost enough across the County, to get another fly car or two, like I think there’s, not every call needs to be ALS, yet, every call in treated in my neighborhood, like an ALS call and it doesn’t need to be.

DOTY: You know, my impression, because I’m like the odd man out, but to hear about the vision and everything is all great, but I would like to better understand the reliance on the State and their vision, because regardless of your plans that you’re putting on, if the State doesn’t recognize this grant program and moving it forward, what are we looking at in a year’s budget? An extra $4-$6 million or more?

MASCARENAS: If you went to a full time staffing, countywide, 24/7, you’d probably be looking at $7-$9 million total.

DOTY: Yeah

MASCARENAS: But, that’s why this is so critical in terms of on call and getting people in communities interested. One thing that we do, that I would love to see happen in some of your towns, it takes a little work, in incentivize some of your staff to get trained, contractually, offer stipends. We do with our police department. Most of your police officers are now EMTs and they get a bonus every year for those that carry that coverage. Guess what they also do? They volunteer in the communities when they can. So, they’re using that licensure, dually. Now, some of them are going to be interested on doing the on call when they’re not working the police job. But, can your highway guys? Do you have anybody interested there? You know, water/sewer departments, things like that? That would be helpful.

FAVRO: That’s what you’re doing in Wilmington; right?

SMITH: We have, so what we have is, we now have a new EMT who, when not on call during the day, it’s the daytime on call person, works in the Town Hall as a clerk and the moment the beeper goes off, drives across the street, gets into the ambulance and responds to calls. So, to me, I’m thinking into the per diem and Wilmington, manages to somehow keep coalesce and I mean we have more people joining our volunteer fire department, right now and it’s shocking and gratifying to girls and guys that have been there for 40 years, looking in the future, saying, who’s going to replace us, I’m getting old.

So, that’s nice, but to me, I’m looking at, if the County rolls stuff out and say, the County, we decide as a Board that we’re going to roll out and offer it, I would be happy to talk to the department on the behalf and look at their needs and if we could sell it like that, if that’s the direction we would go. You know, the Board votes, yes, I think as the Supervisor, it’s your job to go visit these people and talk to them about the changes at the County, because, you know, tomorrow’s another day, we’ve been lucky so far. We have a very enthusiastic, brand new person who likes it and hasn’t helped me in the office, at all, and it’s because they’re answering calls to Whiteface.

DELORIA: So, I know you guys are working on these potential contractual services and you’re going to carry that through?

MONTY: I was just going to say, that’s my goal, Favor? We trained 5 of our firemen, as first responders, because our fire department, goes out, I would say 75%-80% of the time with our emergency squad, so there’s someone there. They took the first responder course, primarily, if something happened on the scene, before the ambulance got there, you’ve got guys capable of taking care of each other. I think you’ve got another program coming up, right? Another first responders?

WATTS, MATT: Nope, nothing scheduled for first responders. We have an EMT

MONTY: I know I have a half a dozen more firemen, new ones, ready to go to do it again. So, that’s going to give us 11 more in town, capable of responding to ambulance calls, as well and I think that’s something that maybe we need to get out to the fire departments and get them, get more of them. I know in some cases, there’s firemen that are already trained, but there’s another labor pool, that we could use, because the firemen respond, in most cases, to most of the calls that go out.

DELORIA: But, the first responders, even though they would assist on scene and on the ground, they don’t have that level of training to join the per diems lists; correct?

WATTS, MICHAEL: As drivers.

DELORIA: As drivers, they can. Okay, because we have drivers, but they need the EVOC course, I presume.

MONTY: Well, firemen have already had it.

DELORIA: Okay, so I think we’ve beat this issue enough. So, you guys are still working on these proposals and stuff?

WATTS, MATT: Yup and we have another meeting scheduled with Mike. I am kind of going to give him an outline of what we propose.

MASCARENAS: Yeah, we’ve been meeting in the background, task driven type process with these couple of communities that want to be part of the pilot.

DELORIA: Is that going to come back here?

MASCARENAS: Absolutely.

DELORIA: Okay, so bring the proposals back and then we can kick them around. Maybe if you emailed them out ahead of time, then we can, at least digest, you know the course of action that you guys are recommending.

WATTS, MATT: Yeah, so it won’t be at the next March meeting, because it’s after that.

DELORIA: No, no, time, gotcha.

WATTS, MATT: But, we will be meeting with Mike.

MASCARENAS: I can send you the initial minutes of what we’ve discussed and where they’re going.

DELORIA: Alright, so #6.

WATTS, MICHAEL: So, AEMT Course, going on at the Public Safety Building, that was scheduled to test out this past weekend, but due to mass illness through the class, it has been pushed back until the 22^nd. I believe there are 12 or 13 students currently enrolled in that. So, it’s not necessarily adding to the workforce of EMS, because these people are already EMTs in their communities, but it’s increasing their training to the Advanced EMT level.

There is an EMT Course scheduled to begin in March at the Public Safety Building. that’s currently, I believe, 3 students short of being able to run. They’ve set their minimum to 8 students and I believe there’s 5 that are registered right now, so they still need 3 additional students.

WATTS, MATT: Anybody interested?

WATTS, MICHAEL: In the next couple of weeks to be able to make that happen.

DELORIA: I am going to raise this again, because I have raised it a dozen times, why not thirteen; right? Baker’s dozen. The Public Health Law governing this training requirement for people, it states in there, specifically, and I can’t read it off verbatim, because I don’t have it in front of me, that these courses would be offered remotely, digitally, as much as practical and we’ve still not seen that implemented into this training. I can tell you right now, nobody from Newcomb is going to drive up to Elizabethtown for a course at the Public Safety Building, even though it may seem practice on your guys side of the table, because it’s in your backyard and it’s where you report to work every day. These people are not going to do it. This travel is what’s killing EMTs in a county the size of Essex. You know, there’s people that are, oh my God, I would love to do that, but I am not going to spend 200 hours on the road. They’re still not going to do it.

STANLEY: So, that was going to be my question, is it possible to have EMT classes, at least partially remote?

DELORIA: To the greatest extent possible, is what the law says.

WATTS, MATT: I think they’re doing that now.

DELORIA: Let’s review that and I will send that out to everybody, so that we can all digest that.

WATTS, MATT: So, I know that some of the classes for the AEMT class is done remotely. The problem is when they’re doing labs.

DELORIA: Exactly, practical hands on stuff, that’s impossible.

WATTS, MATT: Which some nights they do both. They do a lecture for an hour and then they do a lab.

STANLEY: I guess looking at it, holistically, if it’s 200 hours and you can get a 100 hours of it done remotely, that way, at least ½ of the course they’re not traveling to and like, I’m thinking in Jay, we have the community center, where we could setup a training room.

DELORIA: A controlled environment, absolutely.

STANLEY: That people could come to.

WATTS, MATT: We can talk to North Country about it. They’re the ones that are doing the class and see what they say.

DELORIA: North Country, they’re the head of this now?

WATTS, MATT: Yeah

DELORIA: Okay, I like that.

WATTS, MICHAEL: They’re the course sponsor for all the EMT and AEMT training.

STANLEY: Because the thing that sort of handicaps the class is the practical, hands on; right? So, if you could double the size of the class and have two locations doing it and then the practical side of things, North Country were to go to the southern part of the County and then the northern part of the County, or just thinking outside of the box, to see if there would be an easier way to get people.

DELORIA: Schroon Lake, if Schroon Lake was central for the lower, I mean this is just a suggestion, I’m not telling you guys how to do your job.

WATTS, MATT: It’s not even up to us, I mean we can make recommendations for it, North Country is the one that puts it on.

STANLEY: This would be a thing to talk to Joe, about.

DELORIA: So, he can understand the dilemma, because to me that’s the hurdle. If we don’t get past that hurdle, we’re going to be having this same meeting two years from now.

STANLEY: Which is also part of the reason why we help fund them. Is for programs like this.

DELORIA: And we got behind them on their designation and the ability to be recognized as a training provider.

WOOD: So, North Country services Franklin County, too?

WATTS, MATT: Yes

WOOD: What’s the experience in Franklin County, as far as what we’re talking about now? Maybe is there a _________ that is the same thing that we’re talking about here?

WATTS, MICHAEL: I know that they teach courses at both their Saranac Lake and Malone campuses and I’m not entire sure as far as what they have for numbers.

WOOD: So, if they do it at their Malone campus, too, can they do it at the Ti campus?

WATTS, MICHAEL: They do, they do. They try and split it between the Ti campus and the Public Safety Building in Lewis.

WOOD: Okay

WATTS, MICHAEL: There will be one in the fall, down in Ti.

WOOD: I am still struggling with the turf issue, you know, I can’t get pass that.

WATTS, MICHAEL: Community events, we had our ambulance down in Newcomb, this past weekend for the snowmobile racing, they’ll be back there in two weeks, as well.

Then, of course, the paid per diem that we’ve already talked about. No real other changes there, so.

DELORIA: We had a race in Newcomb, last weekend, snowmobile race, your people covered it.

WATTS, MICHAEL: Yeah, we send our ambulance down.

DELORIA: You did, wonderful.

WATTS, MATT: That’s when they got that other call that they went to.

DELORIA: Yeah, I don’t know how that turned out, but it didn’t sound like it was a very good thing going on there.

WATTS, MATT: No, that’s what I was talking about, was the guy that was in tachycardia.

DELORIA: That’s what it was?

WATTS, MATT: Yeah

DELORIA: Wow

WATTS, MATT: Like I said, we had a paramedic there that transported him. He wouldn’t have made it, if it was basic.

DELORIA: Did not?

WATTS, MATT: He made it, but if it was just an EMT out there, then he probably wouldn’t have made it. Again, the rolling hospital, he did everything that the hospital would have done. He shocked him, three times, he gave him two different medications.

DELORIA: It’s between North Hudson and Newcomb, I think it’s 12 miles from us, it’s got to about a 15 minute drive for you guys.

CLARK: I bet it’s more than that.

DELORIA: Good, I am glad that turned out.

CLARK: Was it somebody that was staying back in there?

WATTS, MICHAEL: It was a hiking group.

DELORIA: Are we going to have a come to Jesus meeting for the money that we haven’t gotten from the State? I mean I think we should set something up.

MASCARENAS: I did, I did.

DELORIA: Did you, good.

MASCARENAS: So, hopefully, this week, we’ll get some clarity, so Friday afternoon, in the morning I sent something out to Alison Webbinaro, upon receipt, I got an email back from the Program Rep, almost immediately asking me to meet with them on WebEx. I denied the meeting, I told them with all due respect, we’ve had this meet several times, please get me somebody that can make a decision, this isn’t working out. Alison, when called me, almost instantly, following that, I was like, what’s going on here. So, she’s working at it. Again, and I felt bad for the Program Rep, in a way, it’s kind, I told them straight up, I feel like, you’re the waitress that’s bringing me bad food and I’m yelling at you for it, when I should be yelling at the cook. It’s not you, I’m not being disrespectful, but we’ve had this meeting time and time and time again and it’s not going anywhere.

DELORIA: We should FOIL their bank account records and see where the money is or where it went.

MASCARENAS: So, we’re in the process.

DELORIA: Alright

MASCARENAS: I think we’re in a good spot.

DELORIA: Meeting adjourned, thank you.

AS THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS SUBCOMMITTEE, IT WAS ADJOURNED AT 9:30 AM.

Respectively Submitted,

Dina Garvey, Deputy Clerk

Board of Supervisors