What if you were suffering a heart attack and you called 911, but no one was available to help?

That is the situation many rural areas are facing.

Officials from the Delaware County Department of Emergency Services raised the alarm to the Board of Supervisors during a meeting last week.

Stephen Hood, department director, and Margaret Wilson, deputy director and emergency medical services coordinator, warned of the grim prospects facing the county if the current system is not addressed.

Unlike police and fire departments, no legal mandate exists for municipalities to provide EMS care, Wilson said, and there is no national authority governing EMS and no dedicated funding stream.

“People in need of emergency medical assistance expect the service to be provided as needed, 24 hours a day, seven days a week,” Wilson continued. “Most people are unaware that the current system is failing, and there are already situations where the expectation has not been met.”

EMS care in Delaware County is provided primarily through fire districts and staffed by volunteers, Wilson said. These agencies provide EMS care to their local communities for a fraction of the cost of a paid system, but ambulance availability is dependent upon the volunteers available to staff the unit, she said.

The county is home to 16 transporting agencies dispatched by Delaware 911 and six basic life support first response agencies, Wilson said. Of the 16 transporting agencies, only four have paid staff, while the remaining 12 are operated by volunteers.

The volunteer agencies have an average of six people state-certified to provide emergency medical treatment, Wilson said. To provide 24/7 coverage, each volunteer would need to commit 28 hours a week on the ambulance, the equivalent of an unpaid part-time job.

Emergency calls are increasingly pushed to neighboring districts in the form of mutual aid, which results in prolonged response times and taking an ambulance away from the neighboring agency’s primary response zone, which creates a cascading need for more mutual aid, Wilson said.

Often, a paid service is called in to provide assistance.

Under New York state law, fire departments cannot bill for ambulance services, so the costs fall back on taxpayers, she said.

That is one thing that has always puzzled us. Why shouldn’t fire departments be able to bill for the services provided? Yes, taxpayer money is used to fund the volunteers, but a soft-billing approach makes sense. Bill the insurance of the person transported. Take what the insurance pays, and if the patient can pay the rest, great, if not, the agency doesn’t send it to collections.

Our rural agencies need to do something. With all the training and recertification EMTs and paramedics need, it is hard to keep a solid volunteer base. The shift to paid services is already happening.

Wilson urged the supervisors to consider organizing shared services or collaborative efforts throughout the county.

“People need to understand we’re in a dire situation in Delaware County,” Wilson said. “It comes down to what everybody is willing to spend, and how long you are willing to wait for an ambulance.”

All of our local counties need to work on changing the system. In the past we’ve advocated for countywide fly-car systems, where paid paramedics are placed at strategic locations throughout the county at all hours. From there, they can meet ambulances en route or on site to provide care. With the shortage of basic EMTs and drivers, this may need to change to 24/7 staffing of ambulances spread throughout the counties. Services could be supplemented with volunteers.

If counties are able to bill for services provided, it would lessen the impact on the tax base.

What we can’t do is nothing. Residents’ lives are at stake.