EMS Subcommittee

Monday, April 14, 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 (9:16), Matt Brassard, Chris Clark, Robin DeLoria, Derek Doty, Shaun Gillilland, Ken Hughes (9:10), Jim Monty, Cathy Reusser, Matt Stanley, Davina Thurston (9:08), Ike Tyler, Joe Pete Wilson (9:14), Meg Wood, Mark Wright, Mike Mascarenas, Josh Favro, Matt Watts, Michael Watts and Bill Tansey.

ALSO PRESENT: Dina Garvey

DELORIA: Okay, we’re ready to go, okay, Matthew, I will turn this over to you and you can begin.

WATTS, MATT: I would just as soon come back to number one, because that will be a big discussion.

The staffing updates; we have an open position in Moriah, with someone resigning and also one of our parameters have left. He’s staying per diem, but he’s left to be closer to home. He’s now going to be working full time, 2 minutes from house, instead of an hour from his house.

DELORIA: That’s number two on the agenda?

WATTS, MATT: Yup

Contracts, we’re pretty good on that, we’re still waiting on a couple of them, but for the most part we have all of them. No new contracts.

Number five, kind of goes with Number One, so we’ll skip that one for now.

The AEMT course is completed, I think there’s only one person that’s tested so far and everybody else will be testing in the next few weeks. The one that did test, did pass and she’s one of our employees, as well.

There’s several CPR classes, First Aids, Stop the Bleed classes that the paramedics have gone and done.

DELORIA: Is this a new mandate for lifeguards to have the First Aid, I got something in the mail from the Department of Health on that, are you familiar with that?

WATTS, MATT: I’m not, but we typically do the First Aid with them, anyways.

REUSSER: Is that all part of BLS?

WATTS, MATT: Not necessarily, it can be and for the lifeguards, when we’ve gone out and done that we have done the First Aid with it.

WATTS, MICHAEL: We work pretty closely with Dee Olcott in the Youth Bureau to schedule all of the CPR and First Aid trainings, whatever she needs for the day camps. We try and accommodate them as best we can.

DELORIA: Yeah, we have one down there in Newcomb, she’s usually right on top of things.

MASCARENAS: I think it’s Professional Rescuer, isn’t it? For the CPR and the First Aid?

WATTS, MICHAEL: I’m not sure that the lifeguards, themselves need. It varies every once and awhile. The day camps, there’s some that have to have a Wilderness First Aid course.

MASCARENAS: Right

WATTS, MICHAEL: Those might be the Camp Directors and then all the Counselors have to be CPR certified, as well. So, currently we do like 70-100 of those a year.

WATTS, MATT: Yeah, I think that’s about it, we can go back to the resolution request.

DELORIA: What about money, Mike?

MASCARENAS: They told me we’re good, but it hasn’t reached our coffers, they said it has been submitted.

WATTS, MATT: Claim #2 was submitted and approved.

DELORIA: Claim #1 was approved in 2021.

MASCARENAS: Well, that was the tiny one, we actually got payment on that one.

DELORIA: Oh, you did?

MASCARENAS: That was like $100,000.00 and some, years ago.

WATTS, MATT: Now, Claim #2 for $796,000.00 was approved and moved up the chain.

MASCARENAS: Haven’t saw it hit the coffers.

MONTY: Approved in Albany?

WATTS, MATT: Yes

MONTY: Is that the same as #3?

MASCARENAS: No

MONTY: That’s not approved by anybody? Has it left? Has it gone to Albany?

WATTS, MATT: Yes and then they kicked it back.

MASCARENAS: What happens is, until you get, with DOS, if you ever worked with DOS, until you get the claim in front of it straight, the claim behind is always going to be wrong. So, Claim #3 is going to be wrong, because Claim #2 had to make adjustments, which means Claim #3 starts wrong.

DELORIA: Right

MASCARENAS: So, with them, it’s always kind of chasing it down.

DELORIA: Ironically, your Claim #3 is what DOS owes Newcomb for our project, nearly the same amount. They’re probably holding your money to pay us and I’m good with that.

MASCARENAS: If somebody gets their money, we’re all good.

DELORIA: That one email I sent out and I put in a little do to for you guys. We actually did get a check last week for $764,000.00.

MASCARENAS: Oh good.

DELORIA: But, now they’re pushing back on this MWBE crap and I had enough and I sent them one of my notorious, Robin, I’m not being very nice today email and that seemed to have spurred something down there, we’ll see what happens. We’re in Newcomb, for god’s sake. We did everything that we could do to ensure that the contractors put forth a diligent effort to find MWBEs, but you know what? They don’t want to come up here, that’s Albany/Schenectady area, that’s not the North Country. You know how it is.

MASCARENAS: It’s been that way since that came out, they don’t exist.

DELORIA: So, enough of my rant and I am glad that we did get some money and everything approved pending, of course the budget hasn’t passed yet, either. Two weeks behind on that, right?

MASCARENAS: Yup

DELORIA: Maybe that’s where they’re trying figure out where they’re going to pay that out of.

MASCARENAS: Well and they have shut down their financial system.

DELORIA: And the other stuff they owe us, right.

WATTS, MATT: Okay, so we’ve been working for a month or so with Willsboro/Essex, mainly and started working with Keene and Keene Valley. We’re doing the on-call for the per diems, program that we’ve talked about for a while now. We have agencies that are now onboard and wanting to do it, so we’ve been working with them. So, we have a resolution to implement the paid on-call program. I don’t know if everybody got a copy of it, but Bill drew us a resolution up for it.

DELORIA: Mike, where are you on the numbers for that? What was almost shocking when I saw that.

MASCARENAS: Yeah, for this year, we’ll see. I think we’re good budget-wise based upon, we had some money budgeted, not what we had originally budgeted, years ago, we budgeted about $350,000.00 for paid on-call, nobody took advantage of the paid on-call, so funds got shifted into other avenues, equipment and such. October/November, we need to pull something from contingent, we will. I’m not thinking we’re going to have to with some of the other vacants that we have in several other departments throughout the County. I wouldn’t ask for additional dollars now, I think that would be over budgeting in terms of the County, as a whole. It is, absolutely, the cheapest and probably the only way that this becomes solvent, long term. The one thing I will say that we’re going to have to work out, I think for the remainder of this year, I think we absolutely call this a pilot. We see how it goes. I think it will go well. we’ll treat it kind of like we treated the grant. The County will pick up the entire on-call cost. At the conclusion of this year’s cycle, we’re going to take to figure out the revenue piece. I think the County should continue, in my brain, I am happy to listen to suggestions, to pick up on the on-call costs and what I mean about that is the enactive hours. So, the person that’s enactive, I would say, long term we would continue to pick that up. The active hours, the hours we’re going to have in question. That means when a call goes out and that person is now active, who picks up that cost and I think it can go one or two ways. If the community is going to get the revenue from that call, then they should pay the hourly rate or then we would get the revenue from that call. One of those two things would have to happen, just so everybody’s clear. We can’t pay the cost while the other agency gets the revenue, that just isn’t right. So, we will have to work that out as we get into next year, but I say for now, we see how this thing goes and we’re in okay shape to be able to do that and hand over blueprints to anybody else that wants to do it. So, we know this isn’t going to be perfect. Bill, has worked hard with these guys trying to develop and resolution that makes sense and there will be growing pains and we’ll see how that goes long term.

DELORIA: Did you want to insert the word, pilot, into this resolution?

MASCARENAS: I think so or at least be very clear that is it a pilot.

TANSEY: It certainly would be easy to insert the word pilot.

STANLEY: And should we put a date that the pilot ends, so it sunsets in case we don’t?

MASCARENAS: Yeah, I would like the contract to end December 31^st and we would do new contracts going into next year, is all. We do annual renewals anyway.

GILLILLAND: It should be an annual renewal.

MASCARENAS: Yeah

GILLILLAND: This is a program that Ken and I have been, had a hard time selling and any excuse for the naysayers to say that the County is all f’ed up, because they don’t know how to run this system is going to be used against us, so I would avoid that, personally.

MASCARENAS: Avoid what, Shaun?

GILLILLAND: Putting in there that it’s a pilot and we’re going to have an end date on and all this other stuff.

MASCARENAS: Yeah, there’s not an end date for the program, but I think contractual end dates should be on an annual basis. Like we said, there’s renewals.

DELORIA: Right and this resolution will accompany regulations from your office, along with contracts to be added into a contract with these people? Because you talked about payment and collection and whatnot? So, they’ll be contracted?

MASCARENAS: For the remainder of this year it will be the status quo, people are under contract, they will be able to retain that revenue and especially for those agencies that are struggling, put it away, that’s what I am going to tell you, because don’t then come to us and say we need more equipment, we need this, we need that, when we’re trying to give you a leg up on this thing. So, I think it should be in good shape?

GILLILLAND: Can I say one thing on your last subject, which was who picks up the revenue from the run. I was thinking about it earlier, over the weekend, the County is basically, at this point, has this program to order to cover the gaps that are developing in the system. The gaps that are potentially decertifying for the agency, in so far that if you can answer, you’re done. So, it makes perfect sense that if the County’s picking up that, and the whole philosophy of the whole program which is like we are there to, you know we want to keep the volunteers as long as possible and we are there to cover, and provide the services, instead of us going and grabbing the entire enchilada, we’re only going to take a bite of it.

MASCARENAS: Exactly, you bring up a good point and I think the other point about this, that people need to understand is these things become convoluted and complicated. The issue of districts and how that works out is still a problem we haven’t been able to solve. There’s been movement at the State level for a long time to try to get the counties to be able to have districts. Well, as long as, you can have districts at the town level, it solves an immediate problem, when it doesn’t solve is how do you pay from those costs and how does a different taxing entity pick up costs for a district when districts are supposed to solvent and whole in terms of lost. So, it does become a little convoluted, if we could pick up our own district, it would be way easier, to handle that, but current we can’t. So, our other option is to figure that out next year.

DELORIA: So, historically we’ve found that this whole volunteer system is crumbling and it’s really having an effect on all of the agencies that we work with. So, essentially what everybody needs to understand and we’re trying to build a new foundation for them to build off of, that’s solid and I think a lot of this is just trying to continue to reach out to these people and causing them to understand that this is the way that we need to go if we’re going to sustain this program.

TANSEY: We drafted the contract language so that the agency has to maintain all the equipment, has to provide the ambulance, so this is just personnel. We did talk about the annual contract piece. There are ways to draft the annual review, as in don’t count on it versus being automatic. I don’t know which direction to steer that language. One is County takes it over and it’s infinite and the other is the agency better start putting something in place to take it back.

MASCARENAS: And I think what Bill’s getting at and if I’m wrong, correct me. Some of the issues are multiple agencies providing the same service. Where we’re coming in and we’re filling a void with an employee or two, not a big deal, you’re largely solvent. When we are your primary provider…

DELORIA: It’s dangerous

MASCARENAS: It comes very different, which is fine. We don’t mind becoming the primary provider at some point in time, if that’s what it takes, that’s what we’re here for. However, when you’re answering two masters and you have all these other issues, you become largely inefficient and you become more costly and at some point in time I think where’s that line that is probably what you’re getting at.

TANSEY: Yeah

MASCARENAS: Where we’re just filling maybe a shift or two, until where we’re providing almost your entire service, but still trying to play well with everybody involved.

DELORIA: Okay, so we need to adjust that in the contracts in the future, I would presume.

MASCARENAS: Yeah, it’s going to be an evolution.

DELORIA: Oh, yeah, absolutely.

STANLEY: So, what is the on-call rate? Is it different than the rate of when you’re called out to go to a call?

MASCARENAS: Our on-call rate, understand that everybody that works for us is an union employee. So, once you’re on our payroll, those union rates are $3.00 an hour and that’s an negotiated rate. That contract does not come back up for discussion until next year. I know we have talked about it, every agency feels differently about that on-call rate and what they can go with that. If that’s a huge issue, I’m an non-player, because I can’t make exceptions to the contract, I just can’t.

DELORIA: Right

MASCARENAS: So, that’s an non-negotiable. The agencies could have some wiggle room within there confines to do things. One thing that we were brainstorming the other day as an incentive that agencies may want to come up with for number of calls answered. If you make 10 calls a year, maybe get $1,000.00, if you make 20 calls a year you get $2,000.00. So, even if you’re a volunteer and you’re not on call, it’s a good carrot to get people to make the call, those kinds of things. Bill, was going to look into whether, was looking at the volunteer rules, versus the Department of Labor Law and it’s a 20% rule or something like that.

TANSEY: The Fair Labor Standards Act says that we can do nominal fees and nominal fees are defined as 20% of full-time pay. Fair Labor Standards Act, also gets into multiple agency employment. Essex County will be the employer, working for the other agency. So, we have two public agencies, you can still volunteer for the other agency. I think in fire stations or EMS agencies that we have identified, two of them are private. Keene Valley is the only one that’s still an agency, so I think we’ve got to out of under it there as well.

MONTY: Yeah, just clarify this for me, per diem is different than the on-call?

MASCARENAS: Let’s call it on-call. We’ve been confusing language and I am the blame for that. I interchange them.

MONTY: I get questions about that.

WATTS, MATT: Yes

MONTY: What’s the difference and some agencies also pay a different rate for on-call. So, I think we need to get consistent. So, we need to know what each agency is doing. The County is only paying $3.00, but I have heard, I don’t know, haven’t seen the finances, we have some agencies that may give you $6.00, of which $3.00 is the County and they’re giving $3.00.

MASCARENAS: Yeah and we can’t get into that. I can’t do it.

MONTY: I know that.

MASCARENAS: And if the agency is doing that for the same hour, that’s going to be a problem. So, if I’ve got an employee that’s getting $3.00 an hour for the County and l learn they’re getting $3.00 an hour, there’s going to disciplinary issues.

MONTY: Absolutely and there should be.

MASCARENAS: So, that is why I am saying that if there was an incentive type thing that the agency wanted to do in lieu of making up for that and it may get more people to the actual call. So, if you have a cardiac call and we only have two people on-call you would love to have more people there, right? So, is those people are showing up that are not on-call, but are volunteering and on the road, they would still get kind of a carrot so to speak. They get a $100.00 or whatever for that call.

DELORIA: For showing up, yeah.

MONTY: Which brings me to the next part of my question, I’ve got BLS people that are certified in the fire department, but that aren’t with the ambulance department and their responding to 90% of all calls. Are they entitled?

MASCARENAS: Not under me.

MONTY: Not under us, but.

MASCARENAS: They would follow the rules of the agency or the department in terms of that. So, this is just a suggestion that departments may want to look at in terms of the ones that are looking at a higher rate or saying we can’t get people to work for $3.00 an hour.

MONTY: Yeah, but once they go, they get the additional?

MASCARENAS: Not from me.

MONTY: But, the on-call guys that are there for us.

MASCARENAS: Yes, they do.

MONTY: They do

MASCARENAS: They get their rate.

GILLILLAND: So, this program, this particular program is for Keene/Keene Valley, and Willsboro/Essex and the reason they’re doing it is because, for the Willsboro side, is because we can’t get people out at night. We have well over 300 calls a year, and so the reason that we are bringing this on, is because we have to have the people to go out and respond. We wouldn’t be having this if we were just going to be paying people $3.00 an hour to do nothing. I guarantee that 4 out of 5 nights that they’re on-call that they’re going and they’re going to get the higher rate.

TYLER: Is that because of the assisted living place that you got out there?

GILLILLAND: We have a huge percentage on that, but at the same time, in the summertime you get all the other people in, it kind of evens its self out.

MASCARENAS: You have a huge summer population.

DELORIA: Okay, any other discussion?

DOTY: Is it realistic to think that your funds, which says to come from budgeted Emergency Services, is that still realistic or should we be concerning fund balance avenues so we can be successful?

MASCARENAS: Not at this time and I can tell you why. We have, we’ll learn, I’m going to give you a round number, but it’s close, around 70 positions that remain unfilled in the County.

DOTY: Okay

MASCARENAS: I’m not going to ask for more dollars out of fund balance or contingent, unless we need it. So, if we have to run transfers between departments to make those costs hold, we can do that. So, when I look at the budget, I look at 24 departments, I don’t look at Emergency Services in a thimble, so to speak. I look at it all.

DOTY: So, to follow up, as well, I am going to assume that even though, 3 towns now are looking for help, this could affect every one of us in a very short amount of time. So. I guess my question, my comment is, I won’t be one of those ones that ask is this going to be a general line item where all of us cover this, because, yes, I really feel all of us should cover it. So, I want to cover that before it comes an issue. I don’t know if successors to me will change their opinion, but I am telling you what, I know how volatile it is, even for us.

MASCARENAS: We budgeted $1.2 million, last year as a grant replacement item.

DOTY: Yeah

MASCARENAS: Yeah, we’ll be looking at that as going up as we go into 2026. That was basically was part of what ate up the over.

GILLILLAND: We’re looking at this as we would rather get hit with a softball than a hardball.

DOTY: Yeah

GILLILLAND: If we don’t do this, we’ll get with a hardball.

DOTY: Yeah, I agree.

WATTS, MATT: And another thing with this number that we put in here, we feel that it might be on the higher end of things, because that’s for the agencies doing 24/7, 7 days a week, we know some of them won’t do it, some of them will have just people filling in as volunteers and stuff.

DOTY: Right, okay

MASCARENAS: And that’s a real number based on call volume.

WATTS, MATT: Correct

DELORIA: And the .62¢, I think that, that kind of locks it in.

STANLEY: I am slightly concerned that this just says the Town of Essex, Willsboro and Keene. Only for the fact that it sounds like to excludes other people, but I like the fact that those are the three agencies, those are the two agencies in those three towns that actually have gotten on board with this per diem and responded to it. I sort of like the fact that it only says those three towns, because now the other towns and their agencies will inquire how to be part of it, but I think we need to make sure we get that language out there with the pilot to know that this is how we’re starting it out. If you want to be involved, you have to be proactive to come to the County to actually talk about it.

MASCARENAS: We had probably a ½ hour conversation about that the other day and because also, I don’t want to be having to do a resolution here every time I need to react. This is program that was always meant to be done this way.

STANLEY: Right

MASCARENAS: And so by labeling towns it almost, like you said, inhibits others, but I want them to know it doesn’t, it doesn’t. If you’re in need we’re going to do our very best to help you out and what’s going to hurt us is capacity. Do we have the people at a given time? That’s where the rubber meets the road.

MCNALLY: We’ve been operating on an on-call system for about 5-years now and what we’ve, of course you have union restraints, but we’re up to $100.00 a shifts to fill our shifts, which sure beats paying somebody to sit in the station for $20/hr. It seems to be working, but you brought up earlier today about rewarding people for numerous calls. Well, I was an EMT for 12-years and we had a bunch of EMTs and a bunch of responders in town, but what you find out is, you’re going to end up, you’re going to have the same people doing the same thing for the majority of the calls, but when you get trauma calls, car accident calls, you’re going to have 6-8 EMTs on the scene. The reason I got out of EMS, I did 12 years and I did CPR on a bunch of uncles and friends and aunts and when I knew it was time to get out is when I heard my pager go off and I used to run out the door with my bag, but it got to the point where I would hear a call go out and I would wait to hear if someone else was responding with me, because once you get stuck at a location by yourself, during CPR for 30-minutes on somebody you know and no one shows up. So, there’s a burnout phase on this EMS that I’m not sure that people realize at this table unless they’ve already done it and it’s a hard job in a small town, because you’re going to find things that make you upset and you’re going to find out that you’re working on relatives and you’re going to find out that you’re working on children and you’re going to go to fatalities with children, it’s not good. So, you know we pay $100.00 a shift, if I had to, I would pay more, because it’s a rotten job to do and you think of them, you see them at a softball game or you see them at something like that, that’s great, it’s what you don’t see is that 2:00 AM when you’re pulling somebody from underneath a car or something and it can be one of your friends.

DELORIA: So, if there is nothing further on the resolution.

BRASSARD: I don’t know if you talked about before I got here, but Moriah EMS is desperate trouble, I guess. Mike, knows, going back to last fall, we tried to get into this on-call procedure and just the pushback on that was, you know, nobody’s going to do it for $3/hr.

GILLILLAND: How many calls do you guys get a year?

BRASSARD: Over 600.

WATTS, MATT: About 600

GILLILLAND: I mean that’s almost a guarantee that somebody, if they’re on night, a full night, they’re going to make money.

BRASSARD: I would say 5 out of 7 nights there’s a call.

GILLILLAND: Now if you have Minerva, where you have 60 calls a year maybe?

MCNALLY: No, 110. I can see the call volume going down for the next years as our elderly people are passing away, because a lot of our calls are elderly.

GILLILLAND: I guess I don’t understand that particular, I’m not doing it for $3/hr., because you’re going to make money, because you’re going to make money almost every single time.

MASCARENAS: If you saw how it’s happening you would know why.

STANLEY: The problem is, you can lead a horse to water, but you can’t make them drink. They’ve got to at least help themselves.

BRASSARD: So, I am in a predicament now where I might need, I might be contacting you at the County.

GILLLILLAND: That’s why we built this program.

MCNALLY: Just one more thing, I’m not on this committee and I applaud all the efforts going into it, but I think in the back of our mind, you should never make a plan that involves volunteers, because it’s not going to be an existent thing in the years to come. The more money that is introduced, the less volunteers you’re going to have and I think that to build a plan or rely on any kind of volunteer is a mistake.

DELORIA: Alright, so let’s move this resolution.

Matt, I’ll second that, anybody opposed to that? Okay, let’s get that out there.

RECOMMENDATION TO THE PUBLIC SAFETY COMMITTEE FOR A RESOLUTION AUTHORIZING THE IMPLEMENTATION OF A PAID ON CALL PROGRAM TO SUPPORT EMS AGENCIES AND TO AUTHORIZE THE HIRING OF PER DIEM EMPLOYEES TO SUPPORT THIS PROGRAM

Stanley, DeLoria

REUSSER: Do you find that the skill set of a volunteer is much lower than the skill set of our paid, can you say, generally speaking, volunteers are of a lower level of function?

WATTS, MICHAEL: I wouldn’t want to say that the skill set is lower. The confidence…

WATTS, MATT: That is what I was going to say.

MONTY: But, if there are a BLS they got the experience to respond.

MCNALLY: But it’s the confidence that you get the more times.

WATTS, MATT: It depends on how active they are, is what it comes down to.

DELORIA: So, we have a 9:30 meeting, thank you for coming.

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