Many ambulance departments in Waldo County are finding it harder to recruit volunteers or even paid EMTs. Unity Volunteer Ambulance Corps is discussing changing its name because the department cannot find volunteers.

Chief Bruce Cook said the department is no longer volunteer-based, but has been paying volunteers for over a year because of the shortage. The department pays people from $18 to $23 per hour while out on calls, which usually last about two hours. Since the pandemic began, he has seen a decrease in recruitment.

He used to get up to five students from Unity College on the department during the school year, but those students are no longer available because the college closed its main campus. Still, he has 12 active people on the department with a variety of availabilities.

Maine Ambulance Association Executive Director Jay Bradshaw said EMT recruitment and retention is not a new issue. He thinks it might be coming to a tipping point where services are going to rely more on mutual aid than responding to all calls themselves.

Towns have been able to maintain service with the people they have, but the list of available EMTs is shrinking for most departments compared to previous years, he said.

The number of EMT licenses held across the state gradually decreased from 3,172 in 2015 to 3,067 in 2019, according to state EMS data, but the total number of clinician licenses rose from 5,849 to 6,207 over the same period. The same report shows that Waldo County has nine ground ambulance services and one non-transporting service. Nearly half of the emergency service departments in Maine are rural or super-rural.

Many EMTs also work full-time jobs that they cannot leave if an emergency call comes in, Cook said. Most people’s jobs take them out of town, so it is a struggle to find crew members who are going to be in the area in case there is a call.

Brooks Ambulance Inc. Director Keith Nealley said many rural departments are not full-time departments, which is also an obstacle for EMTs who want to find full-time work in the field. His department usually responds to 250 calls per year — though that number increased to 350 this year — and cannot afford to pay EMTs full-time.

Another setback to recruitment is the cost of becoming an EMT and how time-consuming it can be to complete the training. Nealley said it is not uncommon for a part-time department to pay to train an individual who then will leave the department for a full-time position elsewhere.

The number of training hours is based on the level of training. EMT training requires 170 course hours, while paramedic training requires from 1,200 to 1,800 course hours, according to University of California Los Angeles Center for Prehospital Care.

Nealley does not think younger people want to spend the time involved in training and said people are not as community-minded as they used to be, on top of the difficulties that working away from home presents.

Difficult to fund

Rural ambulance departments are also increasingly difficult to fund because they are now faced with paying EMTs, while also maintaining existing equipment and buying new equipment. Some departments get funding from their towns, but others rely on insurance and billing.

Cook said the Unity department does not ask for any funds from the towns it serves. It bills patients’ insurance, which has kept it out of a funding deficit up to this year.

Nealley’s department gets funding from towns and billing insurance, he said. The department is lucky to receive 60% to 65% of the bill issued to patients. Government insurance like MaineCare and Medicare only pays a portion of ambulance bills.

He thinks many people do not see an ambulance bill as a priority bill to pay. It is not considered an essential service in the state. Bradshaw of MAA thinks that even if the state did recognize it as an essential service, it would not ease much of the struggle services are currently facing. People he talks to still recognize ambulance services as essential.

If departments cannot generate revenue through billing patients and insurance, it could put more financial strain on towns to come up with money for the service, or face shutting services down, Nealley said.

If small rural services are forced to shut down or reduce availability, it could result in longer wait times for people in emergency situations, in some cases up to a half-hour or 45 minutes, Cook said. For someone experiencing a serious medical issue, that could mean life or death.

EMTs serve more than one department

Stockton Springs Ambulance Chief Amy Drinkwater works for multiple ambulance departments along the Midcoast. Her department faces many of the same staffing issues, despite being fully funded by the town and also billing insurance.

Many of her EMTs work limited hours because they are working other jobs during the day or working for other departments also, she said. EMTs tend to volunteer for other emergency services, such as volunteer fire departments, as well.

Drinkwater also works full-time for St. George Fire and Ambulance Association and part-time for departments in Thomaston and South Thomaston, she said. She does not think there are many emergency service providers who are not working for multiple departments.

Bradshaw said all communities in Maine are able to call 911 for emergency services and reach a dispatcher. What might change is the amount of time it takes an ambulance service to respond to a call. The issues plaguing the industry, like being in an aging state and people having fewer hours available to volunteer, are complex and require a complex solution.

“There’s no magic wand, there is not one thing that is going to solve this issue,” he said. “The shortage in EMS didn’t happen because of the vaccine, it didn’t happen because of COVID. The reasons that it happens are complex.”