Ambulance service crisis hitting county
A tipping-point has been reached with the ability of ambulance services in Washington County, whether volunteer or staff-driven, to serve the public.
A tipping-point has been reached with the ability of ambulance services in Washington County, whether volunteer or staff-driven, to serve the public. The pandemic and the state vaccine mandate for healthcare workers, including ambulance personnel, is combining with stresses on the industry long in the making that have reached a crisis level, explains Eddie Moreside, the Downeast EMS director.
The news that the Sipayik Ambulance Corps is currently out of service because of the vaccine mandate, according to Colleen Dana-Cummings, the interim health director of the Pleasant Point Health Center, exemplifies the problem. Of the 10 staff, four of the full-time workers and a part-time one are not vaccinated. Unvaccinated staff include a paramedic and two EMTs.
Dana-Cummings points out that the ambulance service, also known as Pleasant Point EMS, was short-staffed before the mandate, operating with only one crew. 'It’s been sporadic and sometimes no coverage,' she says of the service that the corps has been able to provide. To offer 24/7 coverage, probably at least 15 staff would be needed. 'Ideally we’d want two crews, one for 911 calls and one for transports.' She has been in discussion with Downeast EMS about coverage for Pleasant Point, and she notes it’s possible that the Sipayik Ambulance Corps could come back into service. Along with covering Pleasant Point, the service also responds to calls in neighboring communities.
As with staffing shortages in law enforcement and healthcare, the pandemic has focused a spotlight on long-term issues in the ambulance field. The challenges identified by Moreside and other ambulance service leaders are low compensation for stressful and emotionally draining work, a declining population that is aging out of the work and volunteer arena, and a lack of engagement with the next generations with no clear curriculum supported career path starting in high school and continuing through trade schools and the state’s community college and university system.
'We’re in a crisis here. Aroostook is, too,' stresses Moreside. The Downeast EMS ambulance service, a quasi-municipal nonprofit, serves 23 communities in the eastern part of the county, including Eastport and Lubec. Out of 40 on his roster of employees, six to seven people have left over the last six months 'because of the mandate coming out and concerns about COVID.'
Downeast EMS and Calais Fire/EMS, as services that are structured to have employees with wages and benefits, are in somewhat better shape than many of the volunteer staffed ambulance services around the county.
However, 'the problem has been building for years,' says Kenneth Clark, chief of Calais Fire/EMS. 'We’ve never been able to get enough people to join the field.' The staffing issue has been 'exacerbated by the vaccine mandate.' Out of 26 employees he has lost four because of the mandate.
The vaccine mandate may be hurting the healthcare industry in the county’s EMS services, but Maine EMS reports that '96.9% of Maine’s emergency medical service (EMS) licensees have been vaccinated against COVID-19, according to a statewide survey conducted by the department’s Maine Emergency Medical Services (Maine EMS) last week.'
A short-term solution to the vaccine mandate challenge is to add a testing alternative to the mandate, suggests Senator Marianne Moore in a letter to Governor Janet Mills. 'Without one, I fear my constituents will suffer.' However, a release issued by Maine EMS points out that 'the federal government has announced that it will require all healthcare workers to be vaccinated, without a testing alternative.' The release continues, 'Under the rule, individuals who are not vaccinated are permitted to continue working for EMS but are not allowed to provide direct patient care.'
Low wages suppress career paths
Renee Gray, chief of the Moosabec Ambulance Service that serves Jonesport and Beals, worked for Downeast EMS for 15 years and understands the pressures that both types of ambulance models face. For the volunteer-run service, she explains, 'For most it’s a second job. As volunteers, they’re not going to fight it [the vaccine mandate]' but just stop working if they disagree with it. Out of 10 regular paid volunteers, five have left. Paid volunteers at Moosabec earn $3.75 an hour while on call at home. When they are out on a call they earn between $19 and $21 per hour. 'I had one new driver,' says Gray. 'They were going to take the EMT class and then the vaccine mandate came,' and Gray hasn’t heard from the new driver since.
Moreside explains that wages for ambulance personnel range but that a 'reasonable wage' for the region would be $14 to $15 for the basic level, $15 to $17 for advanced, and $19 to $22 for a medic. At a service that is not volunteer run, compensation will often include health insurance, vacation, sick and personal time. 'That’s to retain our employees,' he notes. However, those wages and compensation packages would not compete with those in the southern part of the state, and he feels that many who want to be in the field migrate to better paying areas.
EMS education is grueling and time-consuming, says Gray. Students interested in caring for others may well look at EMS and nursing programs, look at the wages they will earn as they move into careers, and choose nursing. Moreside says that a paramedic earning about $18.50 an hour can do more in an ambulance than a nurse can in an emergency room, but the nurse is making around $26 to $30 an hour. This is a part of what EMS is up against, he notes.
In her letter to the governor, Senator Moore states, 'As you are well aware, many of Washington County’s emergency medical services are run by volunteers who receive very little, if any, compensation for their work. The healthcare worker shortage in my district was already dire before the pandemic started and now, requiring vaccination, has only added to the shortage.'
Maine EMS Director Sam Hurley states, 'In my conversations with local officials, I have often heard that low wages and other local issues are significant hardships, and I am grateful that many local officials have committed to prioritizing EMS and public safety staff as an essential service. We are optimistic to see that local leaders have recognized the importance of supporting their local systems and ensuring their long-term sustainability and operations within their area and region.'
Lack of service adds stress
Compounding the stresses on existing services is the Sipayik Ambulance Corps’ current lack of service. Clark, Gray and Moreside have all been in discussions with the Pleasant Point service. Moreside says, 'They are gravely concerned. They don’t have the licensed people [on staff].' For the moment, Downeast EMS and Calais Fire/EMS are backing up the Sipayik service, but it’s not sustainable for long, nor is it fair to the communities who are paying to have both ambulance services work for them, notes Moreside. Clark says, 'We’ll do all we can to help others,' but caring for the communities 'that are signed on to us' is the priority.
As town administrator for Lubec, Gray is well aware of the tax consequences of having a fully staffed and paid ambulance service. Lubec is part of Downeast EMS and like all member communities pays a stipend to be a member. 'We’re trying to keep taxes down,' she says, but having 24/7 ambulance coverage comes with a cost to taxpayers. 'If there’s no crew, there’s no service.' If a call comes through to an ambulance corps that doesn’t have an EMT available, then the ambulance can’t go anywhere. That situation is happening as a result of the crisis in staff and volunteer shortages, she says. 'If a call comes through then the service has to try to find another service,' and in Washington County that means a huge geographic area and the possibility that an available and staffed ambulance may take 30 minutes or more to arrive at the scene.
Gray raised the potential problems associated with the mandate a while back with policy makers in the county and says she was told that ambulance services should just ignore the mandate. The advice seemed untenable to her. For the suggestion to work everyone would have to ignore it, she points out, and, even so, she wasn’t sure that she had the authority to determine such an action. Taking such a route could risk losing MaineCare reimbursement among other issues. 'I had hoped this would get resolved before now.' She adds, 'A lot of organizations much bigger than us have been fighting this and not getting anywhere.'
In her letter to Mills, Senator Moore says, 'I fear that without available EMS personnel and critical hospital services, my constituents will not receive the care they desperately need and deserve.'
Moreside says that the problems facing the field will not be resolved 'until people in Washington County step up and say, 'Enough is enough; we need to take care of the people who take care of us.''
County commission meets on issue
The Washington County commissioners held an emergency meeting in Machias on October 20 to hear the concerns of the EMS providers. Representatives from a dozen services from all corners of the county filled the meeting room with a standing-room crowd. Chairman Chris Gardner opened the session by stating that the meeting was called for 'information gathering only' and that 'this is not the day we will decide whether vaccines are good.' He cited what he termed the 'law of the first,' which he defined as stating that the first obligation of government is 'the welfare of the people.' Renee Gray, the first of the EMS providers to speak, echoed Gardner, stating, 'This is not a debate about vaccination.'
As speaker after speaker added their thoughts, a pattern emerged. They described a system that was near the breaking point long before the pandemic but now was being pushed across the line. An aging staff with few new volunteers, long hours with low pay and demanding challenges all have taken their toll. 'I can see,' said Gardner, 'this was a problem long before now.'
Miles Villalobos, paramedic chief at Pleasant Point EMS, described his operation, saying that he had a '50-50 split' between drivers and licensed medical staff and that he was concerned that he’d lose all of his medical staff because of vaccination concerns.
Several speakers pointed out that they are often tasked with taking patients to far-off hospitals, adding much time to the current case while delaying the response to emerging situations, while searching for a hospital with capacity to accept the incoming patient. The issue, they explained, is that hospitals have so many patients awaiting transfer to larger hospitals—a service routinely provided by the now-swamped EMS providers—that they couldn’t clear the beds, meaning there was no place to put the incoming patient. Moreside termed this a 'ripple down effect,' diminishing hospital and EMS service capacity to provide critical services.
To make things worse, all this contributes to a funding issue. If an ambulance service loses its licensed staffers, they jeopardize Medicare/Medicaid payments, meaning they have less ability to both fund day-to-day operations and also to help recruit new members.
The vaccine mandate did not create this problem, several admitted, but it exacerbated it to the point where they may be forced to shut down, which several have done already on a periodic basis. The representative from Pleasant River Ambulance Service in Addison pointed out that they are forced, due to staffing limitations, 'to shut down every other Sunday. We may soon have to shut down every other Saturday, too.' Most agreed that they had been forced to close their doors for brief periods, which means that services from neighboring towns must step in, resulting in response delays that extend response time making bad situations even worse.
After hearing from each service that was present, Gardner asked, 'What can we do to help you?'
One representative mentioned that they were planning on contacting Maine EMS, at which point Gardner held his hand up and said, 'That’s it. Let us write that letter.' Maine EMS, according to its website, 'seeks to promote safer, less vulnerable communities with the capacity to cope with hazards and disasters.' If the present confluence of issues makes it impossible for ambulance services to provide regular service to the county’s communities, the state agency will need to address the gaps, according to Gardner. Senator Moore, one of the legislators present during the meeting, observed that the letter writing would be a good approach.
Also suggested was a renewed emphasis on educational opportunities, with one recommending that all high school students be certified as CPR providers, and also on EMT training at community colleges. The meeting concluded after nearly two and a half hours.
October 22, 2021(Home)
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