08/05/2026
This may be unpopular, but it's a conversation worth having.
Emergency Medical Services are changing across the country. More counties are moving toward county-operated ambulance systems because the traditional model is becoming harder to sustain. Whether you agree or disagree, it's worth asking why.
Take St. Lawrence County as an example. In my view, many EMS agencies are struggling with the same issues seen across rural America: declining volunteer numbers, difficulty staffing ambulances, increasing call volumes, financial pressures, and leadership challenges. In some organizations, volunteers feel undervalued or replaced as agencies become more dependent on paid providers. In others, internal politics and personal agendas seem to overshadow the mission.
Leadership matters. Problems at the top don't stay at the top—they trickle down through the entire organization. Poor communication, resistance to change, lack of accountability, and unhealthy workplace culture eventually affect morale, recruitment, retention, and ultimately the level of service provided to the public.
A question every community should ask is this: Can your local ambulance service reliably handle multiple emergencies at the same time? If the answer is no, then the system deserves an honest evaluation.
Another issue is the increasing focus on interfacility transports. Transports are necessary and they generate revenue, but they should never become the primary mission of a 911 ambulance service. If your emergency ambulance is routinely unavailable because it's transporting patients between facilities, the community is left with fewer resources when someone calls 911. When revenue begins driving decisions more than emergency readiness, it's time to ask whether priorities have shifted.
This isn't about criticizing the EMTs, paramedics, or volunteers who show up every day. They're doing the best they can within the system they're given. The bigger question is whether the system itself is being led in a way that sets them up for success.
Patients don't care what patch is on the uniform or what logo is on the ambulance. They care that when they call 911, someone answers the call quickly with the people, equipment, and training needed to help.
Maybe it's time to stop defending the way we've always done things and start asking what model will best serve our communities over the next 20 years.
Lewis County Search and Rescue will remain independent and out of the county's control.
