A bold move more than 15 years ago by former Livingston County Administrator Nick Mazza would change the future of its emergency medical services and create a model other counties look to replicate.
Having the county assist with EMS services wasn’t something that had been done before. But as local agencies had trouble finding crews and volunteers in certain parts of the county — along with slow response times — Mazza said it was something that needed to be done.
“We started to work on that aspect of that but what really kind of generated the county stepping up and doing it was we did have a private ambulance company that operated in the northern part of the county that did a lot of responding and they wanted a massive subsidy, just basically pay us for being here for the county. They kind of tried to put us in a corner,” said Mazza, who served as administrator from 1989 to 2009.
“I got in front of the board and I was the one that told the ambulance company that we were not going to pay a huge subsidy, that we would do it ourselves, but there is a lot of people that stepped up and made this happen,” Mazza said.
That pressure to pay up or not have ambulance services was something that Mazza said left Livingston County with no choice but to look at other options.
“At that point we decided we were not going to pay a large subsidy,” he said. “We went and got a certificate of need from the state. The board was fully behind it. We did it rather quickly and got the thing going. We had a young guy named Bill Sheahan (former EMS coordinator), who had since moved on and he was just tremendous.”
The former EMS system, Mazza acknowledged, had problems and became an issue not just for the volunteers but also for the local residents.
“It really became a quality of life issue for the county,” he said. “Someone had a responsibility to get this done and it fell on the county. It was probably the best place to do it, without a doubt.”
Having the county handle EMS services Mazza admitted was a bit of a gamble.
“It was a bit of a risk, but we really had no choice, we had to step up and get it done,” he said. “It went a lot smoother than it could have.”
What also helped, Mazza said, was that Sheahan knew how to talk to the volunteer ambulance workers and that helped.
“He could talk their language and he really put the whole thing together, along with others like (former public health director) Joan Ellison and (former EMS director) Kevin Niedermaier.
Mazza admits it was a bold move and not everyone was on board with it.
“The idea of a county doing it, a lot of the volunteers were skeptical and weary of the county coming in but the county proved itself over time,” he said.
Providing a model
The situation Livingston County faced in the early 2000s is playing out across the GLOW region and state in 2021. Volunteer ambulance services are struggling to answer calls and be a reliable source of transports, and their capabilities are further diminished by lengthy response times.
Livingston County’s model has been talked about statewide, including among officials in Genesee and Orleans counties.
In Genesee County, EMS Coordinator Timothy Yaeger described an ongoing EMS crisis as he told a county committee in January that he needed to find a way “to ensure we have ambulances available for the citizens of this county.”
A survey of agencies and residents followed and Municipal Resources Inc. is working on a report about the future of fire and EMS services in Genesee County. The report is expected in June.
“We are well aware of the Livingston County EMS delivery system,” Yaeger said. “MRI will be looking at all options, including a county-based EMS system.”
Orleans County has begun to look at Livingston County EMS as a model for an ambulance program.
“We first heard about it through being involved in EMS,” said Justin Niederhofer, deputy director of emergency management in Orleans County and the Orleans County EMS coordinator.
An EMS Task Force in Orleans County hasn’t gotten to the point where they’ve decided what to do, though Niederhofer acknowledged that Livingston County’s model is one that the task force is exploring.
Orleans County officials are planning to meet with Karen Dewar, director of emergency medical services in Livingston County, to learn more about Livingston County’s operation and get a better understanding of how it functions.
Dewar said she gets many phone calls from other EMS departments across the state. The calls come from EMS coordinators, emergency management directors, and county administrators.
“We are there to either assist or respond, if needed,” Dewar said. “I kind of go through our process and how we build. We are not cookie cutters by any means, but there aren’t a lot of other counties that are doing this, so they are trying to figure out where to begin.”
Dewar said both small and big counties have reached out to her.
“There have been some very large counties with very large cities in them that have reached out,” she said, “I keep things, honestly, very basic. I don’t know what their needs are or what their gaps are, so they need to do those analysis on their own. But we do have this model and if they are not sure that they want to take the leap. I ask them if they do have areas that are uncovered and they have patients waiting extreme amounts of time for ambulances what is plan B, who is going to step up to provide that service.”
Even Mazza, who now lives in Albany, said he gets calls from other EMS departments.
“For these rural counties it is a challenge and I get calls over the years,” said Mazza.
“I am sort of still active with the state, city, county managers group and I know right now Otsego County, which is the Cooperstown area they are looking to Livingston County as to how to do this. They are experiencing the same things that we experienced years ago,” said Mazza.
Evolving over time
In Livingston County, EMS is provided by integrating nine transporting ambulance services, seven fire department first response agencies, four Advanced Life Support services, the SUNY Geneseo First Response Agency, and three air medical agencies.
“It was always about cooperation, it was not about taking over,” Mazza said. “It evolved into that.”
In addition to being a joint effort, Mazza said the county was also there to offer support.
“I lived in Avon and they were one that had their own and before I moved they said we cannot do this anymore,” he said. “The county has to be the one to do it. We did not force ourselves, it was ‘Here we are if you need us.’”
Avon Rotary Lions Ambulance dissolved in 2019 after more than 60 years of operation. Livingston County EMS assumed coverage on Avon.
Dewar said getting the county involved in EMS services was a unique move.
“At least in Western New York and probably the state it was one of the first that decided that county government was going to provide ambulance service to assist with EMS coverage in the county,” Dewar said.
Part of the problem with individual towns and village running their own EMS departments ranged from staffing issues to some areas and getting called into other areas that were not their own.
“The Geneseo Ambulance Corps, it really was a strong one and they had a lot of volunteers, but they felt like they were getting called out of Geneseo way too much,” Mazza said.
Another issue, he said, for part-time volunteers was the many state requirements that they needed to follow.
“The volunteers were wonderful and they were great, however the training requirements and all of that became sort of onerous for part-time volunteers,” he said. “The certification requirements and the training became a whole lot for a volunteers to keep up with, so it was an evolving situation you could see it coming.”
‘Baby steps ...’
Dewar said that the county-local model works. She said the success is very much a team effort.
“From the top down, it needs to be a team effort and that support needs to be there,” she said.
When explaining the Livingston County model to others, Dewar said she tells them “to focus on the gaps that they have.”
“My staff will tell you that I will say, ‘baby steps,’ a lot because it is,” she said.
From small steps to big ones, Dewar said the EMS department has also grown from having very little staff to a what is now a very well-respected department.
“We started very small with a couple of ambulances and part time staff,” she said. “My position and Sam’s position (Samuel Tinelli, supervisor of operations), were the only two positions at the time. As we have grown, we have eight ambulances and seven squad cars and between our full and part time staff we have about 55 employees.”
Livingston County EMS responded to 575 calls in 2004 and in 2005, its first full-year of operation, responded to 2,150 calls. The number of calls has steadily grown in the years since, surpassing 3,0000 for the first time in 2011 when it took 3,080 calls.
As the agency expanded its coverage, the call volume continued to increasing. Climbing to 4,177 calls in 2016. For the past three years the calls have surpassed 5,000 calls annually, peaking in 2021 with 5,887 calls, according to county data.
A clear message
But no matter what the county size or the problems they are having Dewar said there is always one clear message.
“Letting response times increase or shopping for ambulances to respond is not getting the patient care that they need, so if they have already identified gaps then they really need to be moving forward with a plan to start somewhere,” she said. “We did not get where we are right away, it was a building process. It has turned into a successful model and that is why counties are reaching out to us.”
For Mazza, having people still ask about the Livingston County EMS model is a huge compliment.
“I certainly have a sense of pride and accomplishment, but at the same time I have to give credit where credit is due,” he said. “There were a lot of people that made this happen. I am very proud, certainly it has grown a lot since I have been gone but we did get it started. It was a risk.”
Current County Administration Ian Coyle, who took over from Mazza and worked with him through the transition, said the current EMS system is very much a team effort.
“The board was an early supporter of using county funds to supply county-wide emergency medical services,” Coyle said. ”Director Karen Dewar and her team have stepped up time and time again to fill critical voids in services. But make no mistake — this is a team, group and collective effort from a variety of partners, many of which are outside county government.”
Responding to needs
“The only way LivCoEMS is even able to be a successful model is because we have local partners at the village and town level that continue to fulfill their ALS/BLS/rescue responsibilities and cover their service areas,” Coyle said.
What also helps to make the county EMS successful is the relationships that they have been able to form with other agencies.
“I think there are two things that have made Livingston County EMS as successful, one is that we take everything in stride,” said Tinnelli, the supervisor of operations.
“Everything that we do is taken as a response to the needs of the community,” Tinnelli said. “But one thing that we have been able to do and one thing that we have been able to talk to other counties about is forming partnerships with the community, so that when we say that we are fluid in what we do, we are excited to have the community, the county, the jurisdictional ambulances and first responders working with us to provide this service.”
In order to provide that high quality service both Dewar and Tinelli said it is important to hire the right people for the job.
“If I know that there is someone that has applied here, we have the conversation that I don’t want to be the cause of another agency not being able to get their agency out the door,” Dewar said. “So all of the employees that we bring on, we want them to think about that. To find the balance to maintain the obligations that they are already committed to and if they are coming aboard here, we want people who can work well with the volunteers and we have people who have come from a volunteer sector and it is important that they maintain that team mentality.”
Tinelli said from college students to older residents, the mix of people who work at the EMS department is very diverse.
“We have some older employees, some people who have worked in other areas but have found that the rural community, the county-based EMS system is the right fit for them,” he said. “What we have is people though our system who have become incredibly dedicated to the community down here and to the different areas that we cover.”
Understanding the role
Too often, Coyle said, the role of what EMS does sometimes gets misunderstood by other counties.
“I believe once boards and legislatures get past the misconceptions that EMS is somehow a different type of public safety than other 24/7 public safety responses that are presently county funded and county supported, they realize that county wide EMS, even to just fill gaps, is a no-brainer,” he said. “Each county’s individual needs will be different and their on-the-ground realities of response times, local crew availability and sustain ability and financial where withal will like wise be unique, We are here to help assist counties as others have assisted us in the past with service models for other county programs.”
As far as what the future holds, Dewar said there is always room for improvement.
“As far as where do we go from here, a lot of that is dictated by what the needs of the community are,” Dewar said. “We feel we are very progressive with our training and with our equipment. We are constantly evaluating and seeing if there are other needs that are not being met and is it something that we can meet within our agency.”
By the numbers: Livingston County EMS calls
A look at call volume for Livingston County EMS:
- 2004: 575 calls.
- 2005: 2,150 calls.
- 2006: 2,489 calls.
- 2007: 2,821 calls.
- 2008: 2,797 calls.
- 2009: 2,722 calls.
- 2010: 2,826 calls.
- 2011: 3,080 calls.
- 2012: 3,066 calls.
- 2013: 3,043 calls.
- 2014: 3,353 calls.
- 2015: 3,890 calls.
- 2016: 4,177 calls.
- 2017: 4,812 calls.
- 2018: 4,904 calls.
- 2019: 5,710 calls.
- 2020: 5,176 calls.
- 2021: 5,887 calls.
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