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 Driver/ 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:

  • Be certified to administer narcotics for pain management

  • Offer a paramedic “fly-car” to enhance the availability and geographic reach of advanced-level emergency care

  • Initiate in-home follow-up visits with patients as well as in-home safety assessments and fall prevention classes

  • Establish a Community Health Education Program for First Aid/CPR/Automated External Defibrillator use.

  • Create, with Jefferson Community College, the first off-site training center for Emergency Medical Technicians (EMTs)

  • Establish a Junior EMS program for area youth and a Paramedic Student Bunk-in Program


TIERS is the first line of defense in the health care system for residents of Orleans and Clayton Townships, providing the highest level of professional emergency care available with on-duty Paramedic-level responders available 24/7. Specifically, TIERS:

  • Operates four fully-equipped ambulances stationed in Clayton. In times of adverse weather and higher call volumes, we work with the Fire Departments within Clayton and Orleans to house an Ambulance to aid in coverage at a "satellite" location.

  • Responds “out-the-door” in less than two minutes with ambulances outfitted for advanced care, serving as “emergency rooms on wheels”

  • Responds with Paramedics whose training includes over 600 hours of clinical care experience, and represent a level of care typically available only in larger urban areas

  • Works in tandem with the Clayton Volunteer Fire Department, Wellesley Island Fire Department, and their Fire/Rescue Boats to respond to emergencies occurring on the islands within the two townships and with Life Net Air Ambulance for patients needing specialty care

  • Provides mutual aid to the Towns of Cape Vincent and Alexandria as well as Wellesley Island when their volunteer rescue squads are either unable to respond or encounter more serious emergencies requiring a higher level of critical care

  • Offers inter-facility transportation services for hospital patients in the region

  • Provides medical education and training opportunities to residents throughout the region

TIERS was established as a not-for-profit charitable organization with its annual $750,000 operating budget derived from three funding sources:

  • One third from the Townships of Clayton and Orleans that supports basic readiness

  • Patient billing which accounts for about half of the annual income

  • Fund-raising, charitable giving, and grants which account for the remainder

On the expense side:

  • Fully two-thirds of TIERS’ annual expenditures are for Paramedic and EMT staff delivering patient care

  • Additional significant costs items include ambulance purchases, durable equipment, operations, pharmaceuticals, medical supplies, and building maintenance

Like most EMS providers nationwide, TIERS finances are pressured continually by added mandates and certification requirements, rising costs for medications, declining volunteerism, and flat revenues.


TIERS is your Emergency Medical Services provider in the Towns of Clayton and Orleans. We have been recognized by our statewide peers for the exceptional level of care we provide. With your generous support, the question “What if TIERS hadn’t come for me?” will continue to be answered: “They will always come, and quickly, and prepared for any level of emergency.”