History and Mission

“What if I hadn’t woken up?  And my heart remained still?  And that was the end of me?  What if …?  What if Thousand Islands Emergency Rescue hadn’t come for me… ?   Fred Schmitt, Clayton

At TIERS, your life is our mission.


TIERS was formed as a non-profit 501 (c)(3) agency in 2001 by a group of forward-looking community members who recognized that fewer and fewer volunteers were available to respond to medical emergencies and even fewer possessed the advanced professional certifications needed for more critical emergencies. We are governed by a Board of Directors with management staff available 24/7.

Created to deliver Paramedic-level emergency care, the highest level of emergency care available, and to ensure that medical emergencies are addressed promptly and at all times, TIERS is staffed around the clock, 365 days per year using both paid staff and volunteers.  (Employee roster: 5 Full-Time Employees; 14 Part-Time Paramedics; 18 Part-Time EMT’s; 23 Volunteer Drivers/ EMT’s and 2 Part-Time Admin. Asst.)

TIERS is unique in the tri-county region, being the only not-for-profit emergency medical services provider that ensures 24/7 Paramedic-level care.  Since its inception, TIERS has averaged over 1,000 calls annually - over 20,000 in total, saved scores of lives, and prevented countless long-term injuries and infirmities. The quality of care delivered and the innovations it has implemented earned TIERS an Emergency Medical Services (EMS) Agency of the Year Award from the NYS Department of Health.

TIERS was the first non-profit in the region to:

Mission Statement

Thousand Islands Emergency Rescue Service (TIERS) provides the residents of Clayton and Orleans Townships with the highest level of professional emergency medical care available, with on-duty paramedic-level responders available 24/7.


Vision Statement

TIERS will be recognized regionally and statewide for excellence and as a model agency for the delivery of the highest possible levels of emergency medical service in a rural setting.

Core Values

TIERS’s mission and vision are reflected in five core values that we hold as very important and that guide our everyday actions and decision-making.

Quality of Emergency Care

Above all else, we are a provider of emergency medical care and the quality of that care is what we value most.  When we say the patient’s life is our mission, we mean that we will always provide the highest quality emergency care possible.  In short, quality care is job one.  We strive always for excellence, to be thoroughly professional, and to be the best when dealing with medical emergencies.  On-going training and continuous quality improvement of our emergency care processes and procedures help ensure the delivery of state-of-the-art quality emergency care.

Patient Centeredness

We value each and every patient as a unique individual.   In addition to addressing a patient’s physical needs during a medical emergency, we focus on their mental and emotional well-being as well.  This means treating them with respect and compassion and preserving their dignity.  Every member of every crew practices a variant of the golden rule: treating each patient as they themselves would want to be treated and how they would want their own family members treated.

Safety First

Naturally, patient safety is of paramount importance, but equally so is the safety of our crews and colleagues.  No injured or ill person is ever saved if the rescue personnel themselves become injured or incapacitated.  Following proper safety procedures and taking precautions keeps an emergency situation from becoming worse.  As a consequence, considerable organization effort and training are focused on safety issues.


The delivery of high-quality and timely emergency medical care requires a coordinated team effort, with team members knowing their defined roles in terms of preparedness, safety, and patient care.  Being part of a team requires everyone to be responsible for making the organization welcoming and supportive.  It means having high expectations of one another and being confident that those expectations will be met with professionalism. Exhibiting respect, integrity, cooperation, collaboration, and good communication are central to excellent teamwork.  Good teamwork also means taking collective pride in how we present ourselves to the public.

Cost Effectiveness

As a community-based, government-supported, non-profit, and charitable organization, TIERS has a value proposition with the people it serves:  providing the best emergency medical care possible at the lowest possible cost. It is everyone’s job to control costs while assuring that patient care is not compromised.  Cost containment means that the organization must focus on its core mission and avoid being all things to all people.