With STAR EMS beginning service in Troy, residents are being asked to trust a private company with one of the most critical public services there is: what happens when you call 911 and someone’s life is on the line.
Trust is not built on logos or promises. It’s built on standards, oversight, transparency, and verification.
This isn’t an attack on STAR EMS. This is a serious, overdue conversation about what the City of Troy chose to require, and what it chose not to.
If you’ve never thought much about EMS before, that’s understandable. Most people don’t, until they need it.
This post is meant to explain, in plain terms, what matters, what’s missing, and why it’s fair to ask questions now, not after something goes wrong.
What EMS Actually Is (and Why It’s Different Than Fire or Police)
Emergency Medical Services isn’t just “an ambulance.”
EMS involves:
- Medical decision-making under pressure
- Medication administration
- Cardiac care
- Trauma response
- Safe transport
- Dispatch coordination
- Integration with fire and police
- Continuous quality review
Unlike fire and police, EMS in Troy is now outsourced. That means the City no longer directly controls:
- Staffing levels
- Training culture
- Quality review
- Internal discipline
- Performance reporting
When a service is outsourced, oversight must increase, not decrease.
That’s where standards come in.
CAAS Accreditation: Why This Is a Huge Deal
One of the most important sections of the City’s RFP is this requirement:
“The contractor shall… also hold the CAAS accreditation (Commission on Accreditation of Ambulance Services).”.
That language matters. It shows the City understood that CAAS was the appropriate standard for EMS oversight. It was not accidental. It was not implied. It was written plainly.
CAAS is not a marketing badge. It is the gold standard for ambulance services in the United States. CAAS accreditation means:
- Independent audits
- Verified staffing models
- Verified training standards
- Verified quality improvement programs
- Verified safety policies
- Verified medical oversight
- Verified response time reporting
In other words: someone outside the company checks the work. And yet… STAR’s response states:
“While Star EMS is not currently accredited by the Commission on Accreditation of Ambulance Services (CAAS)…”.
They go on to describe an internal QA/QI program and say they would “welcome the opportunity” to pursue CAAS if the City requires it. That last part matters.
The City could have required CAAS. The City chose not to.
This isn’t about whether STAR has good intentions. It’s about why Troy accepted self-reporting instead of independent verification. Skipping CAAS accreditation was not a neutral or technical decision. It was a deliberate choice by the City of Troy to remove an independent layer of oversight from a life-critical public service.
CAAS is not a “nice to have.” It exists precisely because internal reviews fail under pressure, budget constraints, and political incentives. Cities require CAAS, or an equivalent independent accreditation, for one core reason:
You cannot effectively audit yourself when lives, contracts, and reputations are at stake.
What CAAS Actually Does (Beyond the Brochure)
Most residents hear the word “accreditation” and imagine:
- A checklist
- A certificate on the wall
- A one-time inspection
That is not what CAAS is. CAAS exists to independently verify whether an EMS system actually performs the way it claims to, over time, under stress, and during peak demand.
1. Independent Verification of Response Times
Not:
- “We tracked ourselves”
- “We met averages internally”
But:
- Audited call data
- Verified timestamps
- Standardized definitions of what “response time” actually means
Without CAAS, response time becomes a claim, not a fact.
2. System-Level Oversight, Not Just Individual Calls
Internal QA/QI programs tend to focus on:
- Individual calls
- Individual crews
CAAS evaluates the entire system, including:
- Whether enough ambulances exist for peak demand
- Whether units are staged effectively
- Whether coverage gaps are predictable or chronic
This matters because residents don’t experience “average performance.” They experience system failure, when help is late or unavailable.
3. Medical Oversight With Teeth
CAAS requires:
- Independent physician medical direction
- Review of protocols and outcomes
- Ongoing corrective action, not just recommendations
Without CAAS, medical oversight relies on:
- Internal reporting
- Contractual goodwill
- City enforcement that the public never sees
That is not transparency. That is trust without verification.
4. Workforce Safety, Fatigue, and Substance Policies
CAAS does not simply ask: “Do you have a drug policy?” It asks:
- How is it enforced?
- How is impairment detected?
- How are fatigue and long shifts managed?
- How are safety incidents tracked and corrected?
This matters because EMS errors are often system-induced, not the result of individual negligence. Skipping CAAS means skipping the independent review of those risks.
What Skipping CAAS Signals to the Public
Whether intended or not, waiving CAAS sends a clear message:
- “Trust us.”
- “We’ll review ourselves.”
- “You don’t need to see the underlying data.”
That is not how modern public safety oversight works.
Not in aviation.
Not in healthcare.
Not in fire services.
EMS should not be the exception.
The Responsibility Lies With the City
STAR EMS responded to the contract it was given. If independent oversight is missing, that is because the City allowed it to be. The City:
- Wrote the RFP
- Acknowledged CAAS as the standard
- Accepted a proposal without it
- Did not require an equivalent alternative
That is a governance decision, and residents deserve to understand its implications.
Bottom Line
Skipping CAAS was not a paperwork shortcut.
It was a choice to remove an independent safeguard from a system people rely on at their most vulnerable moments.
When oversight is optional, transparency disappears.
When transparency disappears, trust erodes.
And when trust erodes, public safety suffers.
That responsibility rests squarely with City Hall.
Response Times: Who Measures Them, and Who Sees Them?
Response time is one of the most important EMS metrics:
- How fast help arrives
- How often ambulances are unavailable
- Whether coverage is consistent across the city
STAR states that response times are monitored internally as part of their QA program RFP-COT 25-14.
But here’s the key question: Where does the public see this data?
There is:
- No public EMS dashboard
- No city-hosted reporting site
- No independent publication of response metrics
That means residents must rely on vendor-reported performance, not city-verified data. Many cities that outsource EMS publish real-time or monthly dashboards showing:
- Average response times
- 90th-percentile response times
- Unit availability
- Mutual aid usage
Troy does not.
If EMS is critical infrastructure, why isn’t Troy treating performance data like public safety data?
Mutual Aid: Help That’s 15–30 Minutes Away
Mutual aid matters when:
- All local ambulances are busy
- There are back-to-back emergencies
- There’s a mass-casualty incident
STAR’s own mutual aid matrix shows:
- Aid from MedStar: 15–20 minutes
- Ameri-Pro: 20–30 minutes
- Other providers: 15–25 minutes
And importantly:
“Mutual aid is deployed only after Star EMS resources are fully committed.”
That means:
- No automatic backup
- No nearby city units guaranteed
- No immediate cross-border coverage
This is not necessarily STAR’s fault.
But it raises a policy question:
Why didn’t the City require mutual aid agreements with surrounding municipal departments that already operate nearby?
Drug Policy: Legal Cannabis, Critical Jobs, Clear Questions
The RFP requires random and probable-cause drug testing. STAR’s response states:
“Star EMS requires that employees not use illegal drugs… or use alcohol or Cannabis when at the workplace.”
Read that carefully.
This does not say:
- No cannabis use while employed
- No THC in system during duty hours
- No impairment-risk standards
It says “when at the workplace.” Again, this isn’t about accusing anyone of wrongdoing. It’s about clarity.
In a job where:
- Seconds matter
- Judgment matters
- Driving matters
- Medication dosing matters
Is Troy satisfied with this policy language? Should the City have required clearer, higher standards?
Communications: 911 Transfers and Missing Location Data
The contract requires recorded communications and E-911 integration.
STAR confirms that:
- Calls are transferred from Troy’s PSAP
- Their dispatch does not currently have direct ANI/ALI capability (automatic number and location identification).
That means location data is passed along, not natively received. This may work. But it introduces another handoff in a time-critical system. The question isn’t whether this is allowed. The question is:
Why didn’t the City require full integration from day one?
Oversight Is a City Responsibility
Every issue above shares one theme:
These are not STAR-only decisions. They are City contract decisions.
The City:
- Did not require CAAS
- Did not require public performance dashboards
- Did not require tighter mutual aid coverage
- Did not require clearer drug standards
- Did not require full dispatch integration upfront
When services are outsourced, oversight must be explicit, visible, and enforceable.
Transparency isn’t hostility.
Standards aren’t insults.
Questions aren’t attacks.
They’re how trust is built.
What Transparency Could Look Like
This isn’t complicated. Troy could:
- Publish monthly EMS response dashboards
- Require CAAS accreditation on a defined timeline
- Disclose mutual aid usage publicly
- Clarify impairment standards
- Report complaints and resolutions (redacted)
- Host EMS performance on a city-owned site
If we can see fire response data, we can see EMS data.
Final Thought
No one should have to learn how EMS works after a bad outcome.
The time to ask these questions is now, while contracts are fresh, expectations are being set, and improvements are still easy to make.
Public safety deserves public accountability.
Endnotes
[1] CAAS Accreditation Requirement (RFP Language)
City of Troy RFP COT 25-14, Section 1.08:
“The contractor shall… also hold the CAAS accreditation (Commission on Accreditation of Ambulance Services).”
[2] STAR EMS Accreditation Status
STAR EMS Proposal Response to RFP COT 25-14:
“While Star EMS is not currently accredited by the Commission on Accreditation of Ambulance Services (CAAS)…”
[3] STAR EMS QA/QI Program Description
STAR EMS Proposal, Quality Assurance Section:
“Star EMS maintains an internal Quality Assurance/Quality Improvement (QA/QI) program…”
[4] Response Time Reporting
STAR EMS Proposal indicates response times are monitored internally as part of QA/QI, with no requirement for city-published dashboards.
[5] Mutual Aid Response Times
STAR EMS Mutual Aid Matrix, RFP Attachment:
- MedStar: 15–20 minutes
- Ameri-Pro: 20–30 minutes
- Other providers: 15–25 minutes
[6] Mutual Aid Trigger Condition
STAR EMS Proposal:
“Mutual aid is deployed only after Star EMS resources are fully committed.”
[7] Drug and Alcohol Policy Language
STAR EMS Proposal Response:
“Star EMS requires that employees not use illegal drugs… or use alcohol or Cannabis when at the workplace.”
[8] Dispatch & Communications Capability
STAR EMS Proposal, Communications Section:
“Star EMS dispatch does not currently have direct ANI/ALI capability and relies on PSAP call transfer.”