Middletown mayor weighs bringing ambulance service in-house to cut costs

Middletown’s next ambulance may come down to a basic taxpayer question: is the city getting the fastest, most reliable emergency care for the money it spends now, or would bringing the service in-house give officials more control and lower costs?

Mayor Joseph DeStefano said the city should explore taking ambulance service in-house instead of continuing to rely on Empress EMS, which costs Middletown about $800,000 a year. He asked the Middletown Common Council to work with him and with the city’s police and fire unions to study the idea, including whether EMS should be folded into the Middletown Fire Department or Middletown Police Department.

The proposal matters because ambulance service is one of the most visible public functions a city buys. If Middletown runs it itself, officials would have to decide how to staff it, train responders, buy equipment and build a local structure for dispatch and oversight. If the city keeps outsourcing, it keeps paying a private provider and depends on contract terms set outside City Hall.

Middletown is not alone in facing that choice. Other cities, including Poughkeepsie and Newburgh, also pay for ambulance service. Empress EMS says it serves multiple Hudson Valley counties, including Orange County, while Orange County government’s EMS division works as a coordinating agency between providers, other emergency services, county agencies and medical facilities. That regional web shows why the issue goes beyond one city hall budget.

The comparison most likely to shape Middletown’s debate is Kingston, which moved its advanced life support ambulance service in-house on Jan. 1, 2024. Kingston officials said their fire department had already responded to more than 100 emergency medical calls with its own ambulance in the previous six months because private ambulance availability was lacking. They also said they balked at Empress demands that city taxpayers contribute more than $500,000 to $1 million a year for service.

Newburgh chose a different path, approving a three-year Empress EMS contract effective April 1, 2024 through Dec. 31, 2026, at a total cost of $2.8 million. Dutchess County also stepped in, launching countywide supplemental ambulance coverage on Jan. 1, 2025 under a contract with Empress as part of a $2 million EMS investment in its 2025 budget.

A 2024 report from the New York State Comptroller found that EMS in New York is delivered by a mix of public and private providers and financed through local revenue, billing, insurance or combinations of those sources. The report also said counties are increasingly providing ambulance service, a shift that helps explain why Middletown’s review is part of a broader regional rethinking of who should answer the call.