As EMS costs continue to rise, Dutchess County looks for answers

Amid growing calls for action on emergency medical service contract costs, solutions are lagging as county officials explore options.

The county has allocated $4 million for EMS over the last two budgets, hoping to combat rising costs, a diminishing workforce, and declining numbers of volunteers. But six months into 2026, data reflecting results from the infusion has been hard to come by — and the problems persist.

At issue is the very status of emergency responders: unlike fire and police departments, there is no state mandate for a town to employ EMS responders. The cost of these services falls to the individual towns, and they’ve ballooned in recent years: North East, Amenia, and Dover split a $1.3 million contract, and Stanford pays $768,000 for its ambulance services. “This is a runaway train,” said county legislator Eric Alexander, who represents Amenia, Washington and a portion of Pleasant Valley. “So the first stop is to slow it down.”

“I was pleased when the county executive agreed that this needs to be a priority,” said Chris Drago, who represents northern Dutchess in the county legislature, “but this continues to be a Band-Aid solution.”

That’s due in part to a lack of competition. Empress EMS is the region’s primary EMS provider, and it just acquired Northern Dutchess Paramedics in late 2025. The company is the only provider of advanced life support services, commonly known as ALS, like ambulances. Basic life support, or BLS, which entails non-invasive life-saving techniques, can be administered by volunteers or first responders.

Even those BLS volunteers, however, are subject to the inherent challenges of providing timely support in rural areas such as north Dutchess. Round-the-clock coverage for an area that receives lower call volume gets expensive fast.

The high costs run parallel with Empress’ profit model. That hasn’t led to any complaints about their service, but as Rep. Drago put it, “I feel we need to take profit out of the equation of saving people’s lives.”

There are three primary ways the ambulance service makes money: billing patients and receiving reimbursements from insurance companies, taxpayer subsidies, and inter-facility transport. The latter involves moving patients to better-equipped facilities, usually in a non-emergency capacity.

In short, the more a patient uses an ambulance, the greater the profit. That’s led to northern Dutchess County to receive less attention than communities in the south — Empress ambulances tend to concentrate in the more populous southern towns, where call volume is higher. The vast majority of grants that fund fly cars, which are vehicles with basic medical equipment that allow for EMTs to provide some immediate triage care, awarded as part of the county’s EMS initiative, went to mid- and southern Dutchess towns.

But help may be on its way. Northwell Health is a healthcare provider that has been expanding north from its base in Long Island and New York City. It recently acquired Sharon Hospital in Connecticut, and has been speaking with lawmakers about providing supplemental ALS coverage to the area. At a March meeting in Milan, Northwell representatives made their pitch to town officials and emergency response leaders from northern Dutchess.

In the meantime, Northwell is implementing its own ALS program at Sharon Hospital. It involves employing hospital-based paramedics to provide a number of services. Instead of waiting for a call to come in, these paramedics will be an extra pair of hands in the emergency room and provide inter-facility transportation, in addition to their emergency response duties.

“We wanted to facilitate a dependable and effective movement of critical care patients,” said Matthew Cassavechia, Director of Emergency Services at Northwell. “We want to have a paramedic following these patients after they’ve been discharged, integrated into the larger continuum of care…it’s proven to be very effective in the general Sharon Hospital area.”

For now, Northwell hasn’t been integrated into the northern Dutchess emergency response pipeline. But that day may be fast approaching. “We’re eager for them to come online as an EMS provider in Dutchess County,” said Rep. Drago. “We could use their help.”