When you call 911 for a medical emergency, you expect someone to come, but dwindling recruitment numbers and funding make filling that expectation harder.

Technically, they’re also not considered “essential” workers, but there’s a push to change that in New York’s budget.

“The classification around ‘essential’ and the debate that's raging is really around surviving or sustaining emergency medical services for long enough to find a permanent solution,” explained Bryan Brauner, the CEO of Twin City Ambulance.

Brauner understands the issues. They’re getting increasing calls and responding with fewer people.

“Emergency medical services often becomes the responder of last resort,” he said. “There are a finite number of ambulances ... It is hard to obtain and that's hard to maintain."

Twin City Ambulance has a fully paid staff. They found success in paying people to go through their EMT Training Bootcamp.

Not everyone can do that. It also doesn’t help with retention, especially at current pay rates, which are around $20 an hour for EMTs.

Brauner supports officially making EMS “essential,” but questions what that would bring.

“Being essential means being compensated like you're essential," Brauner said. "Somebody has to pay.”

That burden could fall on counties, which is something Stephen Acquario, executive director of the New York State Association of Counties, says would be an issue.

“Any time the state is mandating a service, a one size fits all, it never works," he said. "What we really need to do is have flexibility.”

He supports things like income or property tax credits for volunteers and investment in recruitment.

“The state of New York has really made a lot of efforts over the past few years under Governor Hochul's leadership to address this situation,” he added.

There is more to be done.

“I don't think we have a minute to waste, to be honest,” Acquario said.

Perhaps the biggest new push is changing reimbursements for services.

“Medicaid pays approximately 60% of what Medicare pays. Medicare pays less than it costs to provide service," Brauner explained. "So Medicare pays less. Medicaid pays a lot less.”

It's a difference that means more or less money in people’s pockets.

“What should an EMT be paid? What should a paramedic be paid," asked Brauner. "Not what are they paid. Because what are they paid is a function of reimbursements.”

EMS providers estimate a $67 million gap in those reimbursements. Brauner hopes some of the multimillion-dollar investments in health care in this year’s budget could fill that. 

"Sixty-seven million dollars is tangible," he said. "'Pass this legislation that we hope can make things better' is not.

“Whatever the time frame is between now and implementing those solutions, you're going to see emergency medical services continue to erode," Brauner continued. "How much of a chance are we willing to take?”

The New York state budget must be approved by April 1. Bills working their way through the state Senate and Assembly could also address the issue of reimbursements. Those remain in committee.