ELLSWORTH — As the city of Ellsworth wrestles with how to provide emergency medical services to its citizens, there are several options to consider.
The city’s model for the last few decades — a private ambulance company serving a region — is actually one of the rarest in the state, according to data from the Maine Department of Public Safety.
The majority of communities in Maine — over 60 percent — employ some type of fire department-based ambulance service. Some are public-private partnerships, as is done in Brewer, or fire-based services that are entirely government-run, like the system in Bucksport.
There is no one-size-fits-all approach, says Bucksport Fire Department Chief Craig Bowden. The town has had ambulances based in its Fire Department for as long as Bowden has been working there, nearly 40 years.
Although budgeted separately, the service is under the umbrella of the Fire Department. The town pays for firefighters to be cross-trained as emergency responders.
The service is supported by the tax base.
“In the end it’s a very small amount out of the entire town budget,” says Bowden.
Bucksport budgeted $193,953 to run its ambulance service for fiscal year 2018, around 2 percent of the town’s nearly $10 million budget. The Fire Department budget, which includes the payroll of emergency responders, was $397,338.
The service also collects revenue, which Bowden says is funneled into the general fund at the end of the year.
“We pay back through revenues the entire amount that’s set aside,” he said.
Town officials have looked at other options in the past, says Bowden. But Bucksport is around 20 miles in any direction from the nearest hospital.
“There probably wouldn’t be enough money in it to support a private service,” Bowden says.
And after 50 years, people have come to expect it.
“There might be a question or comment once in awhile,” says Bowden, but “It’s received public support for as long as I’ve been here.”
“There’s not really any reason to look outside,” says Bowden. “The local citizens here want to keep it local.”
Plus, he added, “It’s not very often you get a municipal tax-based service that’s able to pay for itself.”
Bar Harbor also has had a similar system in place, says Bar Harbor Fire Department Chief Matt Bartlett, for about as long. It consolidates fire and emergency department budgets, also depositing revenue into the general fund at the end of the year, but does not pay for emergency responder training for its new hires.
“Eight out of 10 calls are emergency medical services,” Bartlett says. “I think there’s an expectation. It’s a service that we take great pride in and want to provide to the citizens. We work very hard to provide quality care. It’s very much part of our everyday work here.”
The revenue doesn’t entirely offset the cost of operations, says Bartlett, but it does make a big dent.
Brewer also has a fire-based emergency medical service, but has operated it as a public-private partnership since 1999.
“There have been some learning curves over the years,” says Lt. Erik Tourtillotte, “but it’s something that’s sustained and I don’t see it going away anytime soon. It’s been about 18 years and something’s working for sure.”
In Brewer’s case, its partner, Bangor-based Capital Ambulance, owns the trucks and provides a paramedic.
Ambulances are required by law to have at least two staff — a driver and an emergency responder. The city provides a firefighter (who is also trained as an emergency responder, part of a prerequisite to join the department) to drive the truck.
The company assumes the responsibility for the cost of the truck, billing and maintaining the equipment, while the city provides housing for staff and the truck itself, as well as a driver.
In return, says Tourtillotte, the city gets an ambulance that is “for the most part dedicated right here to this area.”
If the ambulance is tied up, Capital may send another down to cover, if one is available.
The arrangement in Brewer is similar to that floated by the Emergency Medical Services Committee in a request for proposals at a Ellsworth City Council meeting in August.
The proposal was broad, but included a public-private partnership with ambulances housed at the Fire Department. A motion to send the proposal to the city’s legal team for review was tabled, with some councilors arguing that the proposal needed refining before it moved on.
Councilor Bob Crosthwaite wondered whether ambulance services should be under the umbrella of city government at all.
“Is it our responsibility to provide this service?” Crosthwaite asked during the meeting. “If it isn’t, we don’t need to talk anymore. If it is, then it’s a new day in Ellsworth. What happened to private enterprise?”
Fire Department Chief Richard Tupper said he understood the concerns about the city incurring additional costs, but felt that it was a service expected by citizens.
“I don’t think it’s subsidizing private business,” Tupper said. “In my personal opinion, private business is the person selling wares on the street. This is emergency services.”
Right now, Ellsworth firefighters could be held liable for helping in emergency situations because they are not licensed to do so, Tupper told councilors at the meeting.
There are 273 licensed emergency medical service providers in the state. After fire-based models, nonprofits are the most common way a community provides emergency medical services to its citizens. A government-run, non-fire-based ambulance (such as one in a dedicated public safety department building) is third, at around 15 percent of services.
The least common? Private and hospital-based ambulance services. There are 11 private and 11 hospital-based services licensed in the state, a combined total of eight percent of licensed providers. With the closure of County Ambulance on Aug. 31, that number will drop to 10, three of which are headquartered in Massachusetts and New Hampshire.