Washington County emergency responders work to avoid financial crisis

Representatives of Washington County ambulance companies, area hospitals, emergency dispatch operations and state and city officials gathered Thursday in Columbia Falls to take stock of the county’s financially troubled emergency response system.

Proposed solutions ranged from increasing the amount cities pay for ambulance services to pushing the Legislature to pass a spending bill that would support emergency services across the state.

“I’ve had to tell people who are screaming that they’re seeing people dying in front of them, ‘I’m trying to get an ambulance to send you right away,'” said Dennis Perry, operations supervisor for Washington County 9-1. -1 Regional Communication Center. “I’ve instructed more people on the phone in CPR more times than I care to care about — and sometimes we’re doing it for a long time.”

Dispatchers and the county’s 10 understaffed and underfunded ambulance services have warned of a growing emergency system in recent years. Last month, concern grew when Ambulance Corps chief Petit Manan announced it would close without an immediate infusion of additional funding. Other companies say they too are barely surviving.

RELATED: Washington County’s emergency medical system approaches a crisis

The meeting was called by Rick Petrie, special projects counsel for Atlantic Partners EMS, a nonprofit statewide EMS agency that provides support and lobbies on behalf of EMS professionals. Speaking to the group at the Wreaths Across America gym in Columbia Falls, Petrie said every rural ambulance company is guaranteed to lose money because of what he called a flawed reimbursement system.

Petrie said the problem can no longer be ignored.

“We have to make phone calls. We need to show people both in the state and in Washington how bad this is,” Petrie said. “And we desperately need your help because we have ambulance services that are closing their doors.”

The data shows that most ambulance calls are for patients who receive Medicare or Medicaid (MaineCare), with those insurers covering only about 80 percent of the costs. Petrie explained that rural ambulance services are more vulnerable because they do a much lower volume of calls than places like Portland, so they have little ability to make up for the shortage. That means the losses — about $2,000 on each call — have to come from somewhere else.

Washington municipalities do little to stop the bleeding.

At the high end, Lubec pays Downeast EMS about $90,000 a year. On the lower end, Steuben gives Petit Manan $5,500 to cover its roughly 1,126 residents. Milbridge, the other town served by Petit Manan, costs $2,500 for its 1,265 residents.

Nancy Parritt, chief of the Petit Manan Ambulance Corps, wants both towns’ select boards to pay more, asking for $25 per capita. The answer was a resounding no.

The neighboring Pleasant River Ambulance Service charges each of the four towns it serves $81 per capita and, as a result, is more sustainable.

“Every (resident) I’ve talked to in Milbridge and Steuben was very upset because they said they were going to pay $25 per person per year. They would do it to keep our ambulance,” Parritt said at Thursday’s meeting.

The pay rate for EMTs varies by city, with most only paying EMTs and paramedics for time spent treating and transferring patients, despite often being on call for consecutive eight-hour shifts due to a severe shortage of personnel. Although county EMTs can earn about $16 an hour and paramedics just over $20,000 a year, many do not.

“We know that EMTs are volunteering their time or making $3.25 an hour,” said Melissa Adams with Maine EMS, an office within the Maine Department of Public Safety. “But our elected officials think that’s OK … because that’s the way we’ve always done it.”

One Steuben resident at the meeting said she was shocked to learn how poorly many EMTs are paid. “This is terrible. I am ashamed. We have to keep them.”

Responding to the criticism, Milbridge Town Manager and Police Chief Lewis Pinkham said EMS is not their only concern. “Law enforcement is also on the other side of the problem,” Pinkham said. “You have cities offering $30,000 in bonuses and you still can’t find anyone.”

Dr. David Saquet, an emergency physician with North Light and Northeast Regional Medical Director for AP EMS, said they are also struggling with staffing. “We can’t find people to come work for us,” Saquet said. “We have to take people to the airport, put them on a plane and fly them across two states because we don’t have beds all over the country because of the same problems you guys have.”

Petrie strongly reminded the group that the focus of the meeting was to find solutions.

“The only way to move forward, the only way to survive, is together. That’s it,” Petrie said. “There’s no other way, unless each of you wants to pay $784,000 a year just to staff your ambulance, and I don’t think we want to get to that.”

The good news, according to Petrie, is that bills have been introduced in the state legislature taking the recommendations of a blue-ribbon commission that called for $70 million in funding annually over five years to support EMS services statewide.

The commission’s report, released Thursday, said the state’s EMS systems are “in crisis.”

“Maine EMS services are at or above a cliff, and changes must occur to ensure that when someone calls with a medical emergency, EMS services are able and ready to help,” the report states.

If the additional funding called for in the report is approved, Petrie said funding allocations should favor rural EMS since they are most at risk. But he and Adams said an infusion of money alone won’t solve the problem.

“If we get any of this, it’s not long term. It’s not meant to support systems that don’t work,” Adams said. “So there’s still work to be done at the local level to make sure we have a sustainable system.”

She and Petrie said a comprehensive, if not regional, “local” approach is needed. Others agreed, calling in suggestions that included everything from better benefits and paid time off to prevent burnout; to recruit in high schools and pay the state for training.

“If the state is going to set protocols and standards, I’d like to see the state be responsible for providing statewide training on those standards that could alleviate some of the financial burden,” said Charlene Hammond, chief of Pleasant River Ambulance Service.

EMS and city officials said hospitals also need to do their part to help pay for transports that often take ambulances out of service for an entire day, leaving their communities vulnerable.

“Some days, three of my four western ambulances are out of commission… I’m saying to one of them, ‘hey, Moosabec, can you come back and burn? I need you to be here,” Perry said. “At what point in the protocol do I ask (9-1-1 callers), do you have the ability to transport the person yourself to the hospital?”

Petrie asked those at the meeting to volunteer for the task force he is creating, which he said should include representatives from various stakeholders. Emphasizing the urgency, Petrie hopes to announce details and hold the first meeting soon.

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