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In Maine, COVID Makes Bad Personnel Shortages Worse

Fifty years ago, Oxford Rescue was all-volunteer. If you needed an ambulance, you called the police chief, fire chief or a couple of other people who could help in town, and they called an Oxford Rescue volunteer for you. With only 50 or so calls a year and enough volunteers, it worked well enough for the time.

Thirty years ago, as more calls started coming in, volunteers used a call schedule. Sign up for a 12-hour shift, respond to calls from your house, and you’d get a small stipend at the end of the year.

Today, with just over 630 calls a year, Oxford keeps two people on staff at the fire station during the day but still struggles to find skilled professionals willing to stay on call overnight — and make $5 an hour doing it.

“We rely heavily on folks that live in near towns, meaning the ambulance would not respond for 10 to 15 minutes in good weather to a medical emergency, which is just not acceptable by any standard,” Shawn Cordwell, deputy chief of EMS for the Oxford Fire Department, said.

Oxford isn’t alone. Maine’s emergency medical services, or EMS, have struggled for years to find enough personnel, both volunteer and paid part- or full-time. People to drive an ambulance. People to help with heart attacks and car crashes. People to work overnight.

Part of the problem is that EMS workers have to undergo significant training but don’t make a lot of money. Fewer people are willing or able to volunteer these days. The job can range from stressful to traumatic, and working conditions can be miserable.

And now with a global pandemic, experts say the shortage of EMS workers may only get worse.

“We’re approaching really bad,” said Rick Petrie, executive director of Atlantic Partners EMS, a Winslow-based nonprofit that helps with education, quality improvements and administrative resources for EMS agencies in 12 of Maine’s 16 counties. “We absolutely have trucks that don’t have people in them; we can’t fill shifts. Or we have people working unbelievable amounts of overtime. Coming in, I talked to a service who had one of their paramedics, one of their firefighter-paramedics, who worked three 24-hour shifts in a row. That’s terrible… At some point we’re looking at a disaster.”

Maine has about 5,600 licensed EMS workers in the state — emergency medical dispatchers, emergency medical responders, paramedics and emergency medical technicians, or EMTs. That’s not a terrible number for a state Maine’s size, but licensed doesn’t necessarily mean working.

“A fair amount of those don’t work for a service currently,” Petrie said.

They got licensed but found another job that pays more or has better hours. Or they volunteer but rarely. Or they have retired. Or they worked only for a short time for experience before going on to medical school or another job in medicine.

“I’ve seen an ongoing shortage that’s gotten much worse probably in the last five years, where it’s becoming increasingly difficult to find folks who want to make this a career,” Ed Moreshead, director of Northern Light Medical Transport in Bangor, said. “We find a lot of people who are EMTs and want to be nurses or PAs (physician assistants) or physicians and they use this as a stepping stone. We actually lost about a year ago three people to medical school at UNE (University of New England.) They’re all in the same class. Which is nice, it’s kind of neat that they’re all here and they’re getting their experience. But we lost three employees.”

Experts say the average EMS professional works fewer than 10 years.

EMTs generally start out making minimum wage or a little more, and that’s after paying $1,000 or more for their roughly 200 hours of basic training. Paramedics make a few dollars more an hour but have to undergo another 700 to 1,000 hours of training, both in the classroom and on site. That can cost thousands.

“Those financial numbers are just for the class,” Cordwell, of Oxford, said. “Very rarely does anyone get paid an hourly wage to take the course.”

Mainers can make two or three times that wage as a nurse, or leave the medical field entirely and work without the stress of life-and-death emergencies.

“If McDonald’s ever starts paying $15 an hour, we’re in trouble,” Petrie said. “You can go to McDonald’s and work your eight hours or whatever, and not go home and obsess about the calls that you were on today or the cardiac arrest you weren’t successful on or some of the horrible things that we see.”

It’s unclear exactly how many EMS workers Maine needs. Before COVID-19, the state was planning to begin a comprehensive plan to look at the future of EMS and what will be required moving forward. It’s still working on a request for proposals to get an outside organization to help.

But Petrie estimates the state needs 15% to 20% more EMS providers — not just licensed but working.

“When I started at EMS a long time ago, you’d usually get hired part time for an EMS service and work your way up through. Prove yourself. And then if everything came together, you’d be in line for a full-time job,” Petrie said. “Now, you come out of paramedic school and you can pretty much pick where you work. We’re just that short-handed.”

Maine has 272 EMS services. Those that are small or serve rural areas tend to struggle the most. When a paramedic can choose where to go, they aren’t likely to go to the town that gets few calls and can’t afford to pay them much. Small towns also have fewer people, which means a smaller pool of potential volunteers.

“We are also hearing about our small, rural first-response services surviving on two to three people on their rosters,” Petrie said.

To deal with the shortage, many EMS services rely on mutual aid — rescue units in nearby towns that will take calls when needed. But it can take longer for another town’s ambulance to get on site, and every minute counts in an emergency.

“I call it the grandmother test,” Moreshead said. “Your grandmother has chest pains, she calls 911, the expectation is that someone is going to show up timely to get you care and get you to the hospital or your grandmother to the hospital, where she can be treated further and have a good outcome. I think everybody thinks that’s what will happen. There’s an expectation that’s going to happen.”

But that’s not guaranteed these days. “You don’t realize it until you call 911 and…it takes a half an hour for EMTs to get there or 40 minutes,” he said.

When they’re short staffed, EMS services might also be unable to respond immediately — or at all — to nonemergency situations.

“I can tell you that arranging ambulances for inter-facility transfers, hospital to hospital, is getting more difficult with increased wait times and hospitals having to call multiple EMS services,” Petrie said.

That can cause problems down the hospital line.

“In those cases, the delays impact the availability of beds for patients perhaps in the ED (emergency department) and needing to be admitted, which in turn backs up the wait time for patients in the ED,” said J. Sam Hurley, director of Maine Emergency Medical Services, the state bureau that oversees EMS in Maine.

Overtime pay can help keep ambulances staffed and on the road, but not every service can afford it. And there’s only so much extra work one person can do, especially in small towns.

“Those are the services that have two or three people. If one of them gets sick, one of them gets hurt, now all of the sudden they’re down maybe a third of their roster,” said Jay Bradshaw, former director of Maine Emergency Medical Services and current executive director of the Maine Ambulance Association.

COVID-19 isn’t helping.

“Just think if they’re on a call and get exposed,” Bradshaw said. “If three people from Belgrade (EMS) get exposed, that pretty much shuts down the service right there.”

The pandemic has led to a high unemployment rate, which would normally be a good thing for fields that need workers. But experts don’t expect to see out-of-work Mainers flocking to EMS.

COVID-19 has made EMS work harder — more protective equipment to wear, more procedures to remember, more protocols to deal with.

“In an incredibly short amount of time we had to learn new treatments for breathing problems, as some of our older tried-and-true treatments put others at risk,” Cordwell said. “It also caused us to have to wear protective clothing that we generally didn’t have to wear all the time and now do, and that has made the job more difficult.

“But probably the overwhelming change that has impacted EMS providers is the unknown,” he said. “We are well-trained on a number of communicable diseases and generally know very well how to protect ourselves and others, but for the first time that I am aware of we have this invisible enemy that we don’t know if it is on our shirt or shoes.”

Some experts are concerned not only about new recruits being put off by the virus, but also about current EMS workers potentially leaving the field. People don’t want to risk exposure.

“They’re scared to death,” Petrie said. “They don’t want to infect their grandmother, their wife, their husband, their kids.”

Then there’s the other wrinkle: Training and hands-on exams have been paused for months in the wake of COVID-19. So even those who still want to start working or volunteer can’t yet.

“There are some parts of the EMS course that can be done by Zoom and virtually,” Bradshaw said. “Other parts can’t. You cannot practice taking somebody out of a car virtually. You cannot practice splinting a limb virtually. Now, there are paramedics who can’t get in to finish up their clinical rotation. There are EMTs whose classes, they’re usually summer classes, those are not happening now. And there’s some question about what’s going to happen in the fall.”

The state hopes its coming comprehensive plan will help chart the future of EMS in Maine — not only addressing the need for EMTs and paramedics, but also the need for EMS educators and evaluators.

“I would argue that this final shortfall isn’t because of lack of talent in the state of Maine, but instead lack of stable funding within the education system,” said Hurley with Maine EMS.

In the meantime, solutions to the shortage are fragmented.

For United Ambulance in Lewiston, the answer has been its own training center. Created in 2006, the accredited center last year educated dozens of paramedics and more than 200 EMTs, creating a feeder system for United and helping other EMS services. The program also pays for United Ambulance employees who want to become EMTs or paramedics and who will agree to work for the organization after they get their license.

“The training center is a pretty cool thing,” Executive Director Paul Gosselin said. “It’s worked out excellent for us. We’re very happy with it.”

Without it, he said, United’s staffing “definitely would be more difficult.”

The Maine Ambulance Association hopes more money will help improve the future for EMS workers. It has asked the state to give EMS services $7.5 million from the federal money sent for COVID-19.

“We are the frontlines of the frontline,” Bradshaw said. “We have approached both the Legislature and the Governor’s Office . . . to say, ‘Look, we need money for EMS. We need money for some very specific things — to help make sure ambulances are clean, to make sure crews are protected, to make sure they have PPE (personal protective equipment) and to support ongoing training.'”

Bradshaw said the Governor’s Office and members of the Appropriations Committee thanked the association for its request but nothing else has happened.

Petrie’s Atlantic Partners EMS has money to grant free EMT training and hopes that will help some people who might want to jump into the field but can’t afford the $1,000 cost. He and others have also been fighting to get EMS services reimbursed at a higher rate so EMS organizations can afford to pay their workers more, making the jobs more attractive.

He also hopes a public relations campaign might encourage interest in EMS careers.

“What we need to do is spotlight people doing EMS and have them talk about why they do this job,” he said. “I think what we need to do is try to appeal to people on a regular basis — what it means to be in EMS, what they can do for their community. What we’re trying to do is get people involved again.”

The problem is public service announcements cost money.

“There just isn’t a lot of that money floating around,” Petrie said. “I called the Maine Association of Broadcasters because they talk about how they’ll help in situations like this. And they will help. They can generate a fair amount of return. But you have to have $75,000 to $100,000 to start. That will generate $350,000 to $500,000 worth of ads, but still, $75,000 to $100,000 is a boatload of money.”

Back in Oxford, voters will decide July 11 whether to keep the $5 per hour stipend that overnight on-call EMS providers get. If they do, it’ll cost the town $121,000. If they don’t, it may send some providers packing.

“What I would like to emphasize is that Oxford is in a good position — we have a community that supports us year after year and for that we are eternally grateful,” Cordwell said. “We also have some amazingly dedicated EMS professionals who care deeply for the citizens and visitors of this town and are committed to providing the best care possible day in and day out.

“For those looking to enter the EMS field I would challenge them to do it!” he said. “This is the best job in the whole world, the pay is not awesome, and we often see things I wish we didn’t, but we also have the distinct privilege to help someone in the worst moment and hopefully make that moment just a little bit better.”

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