SULLIVAN COUNTY, NY — A minivan crashed into a Sullivan West school bus on Monday. Who was at the scene less than five minutes after the accident? The Jeffersonville Volunteer First Aid Corps.

But Ryan Terracciano, an eight-year volunteer among those responding to the accident, says the corps is struggling to survive. Without local volunteer emergency services, he said, emergency medical technicians (EMTs) will not be able to get to the scene in those critical early minutes. Minutes that save lives.

“That accident was the perfect example of why your volunteer ambulance corps is so damned important,” Terracciano said.

He talked about the “golden hour,” the critical period after the onset of a heart attack when prompt action can significantly improve a patient’s outcome. He said the corps is proud of its 15-minute response time, which is the industry standard and especially impressive for a corps serving a large, spread-out, rural area. Without the corps, responders will have to come from farther away, cutting deeply into or even erasing those precious 60 minutes. The nearest ambulance will take 35 to 45 minutes to get to Jeffersonville, and another 35 minutes to get the patient to the hospital, Terracciano said. He noted the area’s high density of elderly and obese residents.

“We’re going to start losing people,” he said.

In just the past month or two, he said, scant funds forced the corps to take on extra work that may decrease Jeffersonville’s response times. Previously, the corps refused hospital-to-hospital transport work so that their ambulances and EMTs would always be on hand for emergencies. The corps is now doing these runs, which pay $2,500, on average.

The crisis was precipitated by the closure of the Jeffersonville Adult Home, which Terracciano said provided a guaranteed income of about $100,000 per year. The building is not expected to reopen as a nursing home.

“We lost half of our income,” said Terracciano, who has organized a day-and-nightlong fundraiser on June 1 to help make up the shortfall (see related story).

“We absolutely cannot afford to lose our ambulance corps,” he said.

First on the scene

EMTS are usually the first on the scene when people call 911 to report a heart attack, accident, drowning, shooting, or other crisis. They also transport patients from one hospital to another. The lack of medical services in Sullivan County puts extra stress on an already resource-scarce and personnel-short EMS system.

Michael Bruce, captain of the Town of Cochecton Volunteer Ambulance Corps, said their transports are getting longer. 

“A lot of the things we used to be able to go to locally we have to travel for,” he said. “Some of our transports that were a simple ride to Callicoon or Harris now mean going to Westchester, sometimes Wayne or Scranton.”

He said taking a patient to the closest facility, in Callicoon, can take an hour and 15 minutes, and two and half-hours to Harris Hospitalthe next-closest.

Transport to Orange County is necessary for many critical services, which can keep volunteers on a call for up to four hours. “Keeping volunteers on the call is unfortunately the way the system works,” Bruce said.

The closest trauma centers are in Scranton and Middletown, about 50 miles away. If it’s bypass surgery or any other type of open heart surgery, the closest facility is in Westchester County or Albany, Bruce said. If it’s a stroke, there is no hospital close enough.  

“Basic life support agencies are overwhelmed,” Bruce said. “There is one advanced life support agency. We can’t get paramedics for all of our calls when they’re needed. There are so many patients.” 

He said the acquisition of healthcare systems in the area have made things worse.

“When they formed Garnet Health, and Garnet and Catskill Regional absorbed Callicoon Hospital, they all became a health system,” he said. “Then it seemed, and I don’t know why, a lot of the services that were offered at Catskill Regional and Callicoon were stopped. They tried to close the ICU [and] a skilled nursing home. They cut back on mental health. They’re taking away Sullivan County’s health care centers and funneling everything to Orange County. What they are mandating of us is taxing our system.”

Tools to streamline their work, like EKG diagnostic software, would help by “cutting out the middleman,” he said. The diagnostic tool can confirm a heart attack, allowing EMTS to more quickly transport patients to the correct location. But the tool is too far out of their budget, he said.

“Just the equipment alone is going to cost between $9.000 to $15,000,” he said. “Brand-new is anywhere between $35,000 and $40,000. And we just don’t have that in our budget.”

Patricia Skiba, a registered nurse and Cochecton volunteer, said, “It’s a tool every EMS service should have. It’s the difference between night and day with saving someone’s life. In my opinion, the state should provide that equipment to every EMS service, especially when you’re in a rural area like this, so far away from hospitals.”

Volunteers in short supply

It’s not just Cochecton and Jeffersonville that are strapped. The high number of mutual aid requests and calls from different jurisdictions indicate the system is burdened countywide. Mutual aid requests and service calls to out-of-area providers are common and increasing, Bruce said. Out of 223 calls, he said, around 100 were for mutual aid outside of Cochecton’s emergency service, with many coming from Bethel, Monticello, and Jeffersonville. 

“The problem with mutual aid is there are already manpower shortages or not enough volunteers,” Bruce said. 

In 2022, the turnover rate for ambulance corps nationwide was 36 percent for full-time EMTs and 27 percent for full-time paramedics, according to an American Ambulance Association survey, with more than half leaving voluntarily. More than one-third of new hires don’t last through their first year, the survey found.

“Low wages, a lack of work-life balance and burnout are among factors driving emergency medical services personnel around the country to quit ambulance duty,” the PEW Trusts reported last year. Cochecton corps president Mike Attianese said it’s not a recruitment problem but a retention problem. “Getting volunteers isn’t a problem,” he said. “It’s getting them to get on a call.”

Bruce believes people just don’t have the time. Back in the ‘70s or ‘80s, you could survive on one income, he said. Large employers, like the former IBM plant in Dutchess County, allowed their first-responder employees go out on calls. “You just don’t have employers like that anymore,” he said.

“We don’t like to harp about it but it’s true, we’re the backbone. Him and I”—referring to Attianese —”are responsible for over 50 to 60 percent of us getting out on calls,” said Bruce. 

Terracciano, of the Jeffersonville corps, said a steady stream of volunteers used to come from the local high school—but no longer. “It’s a different generation now,” he said.

Despite the existential threats, volunteers somehow still show up, are still the first at an emergency, and still save lives.

“I put them against the inner city EMS systems because we are with patients a lot longer,” said Bruce. “And we start bringing out our little bags of tricks and trying to do our job a lot more. I do believe we’re making a difference. And I’m pretty much speaking for all the different districts and ambulance squads, even with all of our problems. I think, with what we have to deal with, we’re performing very well.”

Editor's note: This article has been updated to correct an error regarding the Sullivan West school bus accident. The full-sized bus was a Sullivan West bus, but the minivan carrying the two pre-schoolers was a Sullivan County van transporting for county services, not a bus serving the Sullivan West district. The River Reporter regrets the error.