Tompkins County committee authorizes grant application to add paramedic-level Rapid Medical Response

The Tompkins County Public Safety Committee on June 23 unanimously authorized county staff to apply for a capital grant to expand the county’s Rapid Medical Response (RMR) program and to add paramedic-level (ALS) capability.

The vote authorizes the county to pursue grant funding described in meeting materials as the Destiny/DASNY capital grant and signals legislative support for shifting RMR from EMT-only responses toward a model that includes paramedic "fly cars." "The grants will only be given if there’s going to be demonstrated expansion that will carry cost for operation as well," said Joe, who spoke for the Department of Emergency Response during the discussion. "So if we get the grants and we accept it, there will be local dollars that we will put towards expanding the service." The motion was moved by Rachel and seconded by Veronica.

Why it matters: County staff said the grant would pay for vehicles, paramedic-level equipment and building upgrades needed to expand service, and would require the county to show ongoing operational expansion. Officials estimated the department’s fiscal target could increase by roughly $490,000 if the county implements ALS service at scale, with most of the budget impact expected in the 2028 budget cycle. "This would allow us to run 24/7 paramedic-level service for one vehicle," Joe said, describing the intended operational change.

Committee discussion and fiscal trade-offs: Members asked how often ALS skills would be used, how staffing would be paid and what the budgetary implications are for property taxpayers. County staff said the grant does not require a local match but accepting the award would carry locally funded operating obligations. "We continue to drill down the numbers," administration staff said, adding that vehicle procurement and outfitting could take many months and that full operating costs would be phased into future budgets. Officials noted potential offsets and revenue options—including targeted fee proposals—are being explored to limit property tax impacts.

Contingencies and alternatives: Staff said if the county does not obtain a required certificate of need (CO), it could accept the grant with a narrower scope (for example, replacing vehicles and equipment) and later re-submit for ALS expansion. "If we don't get the CO, we would still be able to accept it," Joe said, but noted that scope adjustments and additional paperwork would be required.

Next steps: Administration will continue to refine estimates and present implementation details to the full legislature; staff and committee members said they will work through timelines, revenue options and the EMS working group’s scenarios to align long-term planning with grant requirements. The committee’s authorization allows staff to proceed with the application process and the planning work needed should funding be awarded.