ELLSWORTH — A committee tasked with deciding whether Ellsworth firefighters should continue to respond to medical emergencies will likely recommend to the City Council that they keep doing so, in part due to concerns that Northern Light Medical Transport may not be able to handle the volume of calls in the city.
“They are taking on additional responsibility,” said Ellsworth Fire Department Chief Richard Tupper of his staff, “but it is fulfilling a need that is obviously out there.”
Firefighters have been helping on medical calls for years. But officials have been grappling in recent months with whether to keep the city’s recently acquired emergency medical services agency license, which it got to ensure that the city was covered when firefighters who were individually licensed as emergency medical providers occasionally helped ambulance crews out in the field.
Having an agency license, however, obligates trained city staff to respond to medical calls, which Tupper said in previous meetings was not fully understood at the outset. And some city officials have been wary of venturing too “deep into the puddle” of emergency response, as Councilor John Phillips put it on July 23.
The city could alter the license and respond only to the most severe calls, Tupper said. But the understanding of an emergency often changes mid-call: “An alpha level call, the lowest level seriousness nature call, may come in and you get there or you get additional information and you find out that this call that might have only needed the two [emergency medical technicians] on the ambulance to begin with now needs six to carry them out of the woods,” he said. If the city sent trained staff to help, they might not be covered if their license doesn’t permit them to respond to a certain type of call.
The city had been hopeful that its contract to house Northern Light Medical Transport ambulances in the fire department would be adequate in providing ambulance coverage for the area, but that hasn’t proven to be the case, said Ellsworth Police Department Chief Glenn Moshier.
“We’re waiting extended periods of time for an ambulance,” said Moshier, who said he supports having firefighters respond to emergency medical calls, although it could result in an added strain on the city’s dispatch system.
Moshier wondered whether “Northern Light is living up to the expectations that were set forward in that agreement,” referring to a partnership formalized with the city in 2018.
“From my perspective, it doesn’t appear that they are,” he said.
City Councilors approved a plan in November 2018 to house two ambulances owned by Northern Light Medical Transport in the fire department. The nonprofit agreed to pay the city roughly $10,000 per year as well as the cost of modifications to the space ($8,700) to house two ambulances.
The plan was put together after County Ambulance closed suddenly in August after having served the city for over 40 years. But the agreement covers housing only — it’s not a service contract, as Tupper pointed out last Thursday.
“The city doesn’t have a service contract with them; we have a housing contract with them,” he said. But, he added, “Having them here, at least we have some understanding when they’re not available.”
At the time, Northern Light did offer a service contract to the city at a rate of $9 per capita with a 3 percent annual increase, or around $72,000 for the first year.
In theory, under the housing arrangement, a third ambulance is sent from Dedham to be staged in Ellsworth when the two in Ellsworth are out on calls.
“Does that happen perfectly every time? No,” said Tupper, “but quite frequently, that pattern exists.”
In an email after the meeting, Northern Light Medical Transport Director Ed Moreshead said that the group was “very surprised and disappointed to hear the discussion that occurred at the public safety committee meeting on July 23. The information that was presented was not based on actual data. While we have offered data on response times, costs and other numbers it was never requested of us.”
Moreshead said that between July 1, 2019 and June 30, 2020, Northern Light in Ellsworth responded to all but 12 of the 1,523 requests for service it received, or 99.2 percent. The 12 remaining calls were responded to by the organization’s mutual aid partners.
Last Thursday, the committee discussed a recent incident in which three calls came in “back-to-back,” one on the Winkumpaugh Road, one on the Bayside Road and then another for a patient elsewhere having chest pain. With both ambulances committed, the city called in Peninsula Ambulance, which was 25 minutes away.
That time lag could be potentially deadly for a patient with chest pain, said Councilor Michelle Kaplan, who works as a physician assistant.
At a meeting in June, Council Chairman Dale Hamilton read a letter from Mariah Curtis, who wrote that her grandmother, Nancy Davis, “bled to death for 40 minutes from a small varicose vein while waiting for an ambulance at 16 Wood St. This was before the perfectly capable Fire Department was being dispatched to medical calls as licensed first responders.”
Moreshead said that, over the past year, it took Northern Light crews on average 6.54 minutes to arrive on scene from the time they were notified.
“We look forward to our continued partnership with the city as we ensure the Hancock County communities that we serve have safe, reliable and effective emergency transport,” said Moreshead. “If, at any time, there is a specific concern, we are glad to meet with the city of Ellsworth.”
The Northern Light personnel in the ambulances are very good, said Tupper on July 23, but the organization has struggled with staffing and resources in the same way that many public safety agencies have in recent years.
“This is not a localized problem; it’s a statewide problem for having enough resources and staffing,” he said.
That was part of the reason the city didn’t want to start its own ambulance service, Moshier pointed out. “We didn’t want to have to hire and train and retain personnel to run ambulance services. We were leaving that to the experts, to the pros, to the commercial services, and ultimately I don’t think that they’re holding up their end of the bargain when they came into this community what they were able to provide.”
Asked by Councilor Phillips how often residents are left waiting for an ambulance, Tupper replied that “It happens frequently.”
Kaplan said that ambulances are having to carry patients farther and farther for care, as “A lot of those services that 20 years ago used to be provided at your local hospitals are no longer provided at local hospitals. They’ve downgraded some of the services.”
Kaplan, who was previously employed at Northern Light Blue Hill Hospital (she and her husband, Dr. Mark Kaplan, sued the hospital in 2014 alleging retaliatory discharge and other claims), said that Northern Light prioritizes transports between its own facilities, which can be more lucrative.
Ambulance companies are often reimbursed at a fraction of what it costs to care for a patient, if they are reimbursed at all, said Tupper. Transports between facilities often make up for revenue lost due to low reimbursement rates.
“It sounds like corporate America is running the ambulance, making sure they’re taken care of, there we are sitting on the outside looking in,” said Phillips.
Having firefighters able to respond to emergency medical calls, Phillips continued, “You guys are going to be going out and service but we’re still going to be stuck with a lack of good ambulance service by the sounds of it, or prompt, maybe is a better terminology. That issue still exists.”