Rural Maine ambulance services are struggling under a staffing and cost crisis that has been unfolding for nearly a decade, and leaders in the field are looking to lawmakers and the state government for help.
The State Emergency Medical Services Board this month supported a bill to fill some of the gaping holes in the patchwork system that serves Maine emergency rooms and moves patients between hospitals and health facilities.
The bill, which is still being drafted and will be considered in the second legislative session in January, was sponsored by Rep. Rachel Talbot Ross, D-Portland, and would classify EMS agencies as essential services, potentially unlocking more federal funding for small ambulance providers in Maine.
In an interview on Tuesday, Talbot Ross said she also intends to create a statewide task force to assess Maine’s EMS needs and develop long-term plans on how to repair and maintain ambulance services in rural communities. She was alerted to the crisis by an Indian Township EMT who approached her and asked for help, describing the long hours and low wages of the workers, as well as the failing funding model being made. most felt in rural areas of the state.
“We finally need to recognize that EMS is not just an aspect of public safety, but an integral part of our health care delivery system in Maine,” said Talbot Ross. “We must recognize that we are in the midst of a crisis and that we can no longer wait to act. It was a pre-COVID emergency, and we didn’t pay attention to it. “
Maine’s EMS provider network is a combination of state-funded services, often run by fire departments in more populated areas, and private companies that make deals to answer 911 calls in towns too small to manage theirs.
Talbot Ross said declaring EMS essential is one way to open up federal resources for existing ambulance services that need help, not another unfunded mandate for small towns. She said she also plans to convene a stakeholder working group to study how best to provide EMS services in the future, and how to attract and retain new paramedics and pay for quality care. even in remote communities.
STRUGGLE FOR YEARS
The state’s EMS system has been struggling for years. In December 2019, the Portland Press Herald / Maine Sunday Telegram published a two-part series detailing the long and steady decline in EMS capacity statewide. The series traced the myriad forces responsible for the decline, including a late reimbursement rate from MaineCare and Medicaid, low wages for frontline workers, high operating costs for providers, and Byzantine layers of state regulations and federal.
Months later, the pandemic shut down businesses, schools and government, and lawmakers have never addressed the issues revealed by the series.
Maine has lost nearly 1,500 paramedics and paramedics since 2003, more than a fifth of the workforce, according to Maine EMS, the agency that tracks and licenses paramedics and paramedics statewide. Meanwhile, the average number of EMS calls each month continues to increase – with more than 22,000 so far this year, up from around 19,900 in 2020, 21,700 in 2019 and 19,500 in 2018.
Many paramedics and paramedics are aging out of the system, said Bill Jarvis, chief of the Jackman Moose River fire department on the Quebec border, which has an ambulance and volunteer team of about half a dozen, most of them. in their fifties or sixties. In the past four years, he said, two local classes of paramedics have produced only three new paramedics. During the same period, he lost five who left the service or retired. The wage is minimum wage, $ 12.15 an hour, but doubles when paramedics are on call.
“For years, we’ve seen this come slowly,” Jarvis said. “I think the pandemic has accelerated it a bit. “
Although Maine is the only state to reimburse 85% for ambulance services for MaineCare and Medicaid patients, the remaining 15% gap is often filled by taxpayers, said Rick Petrie, a service professional. Emergency Medical Officer and Director of Operations for North East Mobile for 40 years. Health Services, which serves coastal communities from Rockport to Sanford.
Petrie said an update to the federal reimbursement rate by Medicare officials is still four or five years away, which means the state must take action by then to shore up the system.
PROBLEMS EXACERBATED BY THE PANDEMIC
The pandemic made matters worse, driving out more staff who could not maintain multiple jobs – a common practice for paramedics and paramedics – or did not want to be vaccinated as part of a warrant for the workers. health in Maine, said Brent Libby, chief of the Windham fire department and chairman of the state’s EMS board.
The board gave its backing to Talbot Ross’ bill in a unanimous statement released this week.
He also urged lawmakers to consider county government as a possible avenue to strengthen local services, but there were no details on how that might work.
Petrie said things could get worse if the state doesn’t act and some cities are already feeling the pain.
When a car crash injured five people on Mount Desert Island last month, for example, the island’s three EMS providers could only muster one ambulance, and first responders had to call a helicopter. LifeFlight and two ambulances an hour from Bangor.
In another case, Petrie said a child treated at Maine Medical Center in Portland had to wait four hours before hospital staff could find an ambulance available for transport to a Boston facility. Staff eventually had to call a Massachusetts ambulance.
Petrie said she spoke to a doctor in Augusta who had recently considered taking a patient to another facility on her own when there was no ambulance.
“You have these EMS providers in the background – the paramedics, the fire fighters carrying the weight of the EMS system on their backs,” he said. “I worry about their resilience. The drain on suppliers is terrible.
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