ELLSWORTH — It’s an emergency and you need help. How long will it take for an ambulance to arrive?
If you’re in Hancock County, likely a little less than 16 minutes, on average, according to data provided to The American by the Maine Emergency Medical Services Department of Public Safety, the licensing agency for emergency responders in the state. The data looked at response times for all of the ambulance services active in Hancock County between roughly July 2019 and July 2020.
That figure is on par with rural response times reported in a 2017 study published by the Journal of the American Medical Association (JAMA) of more than 1.7 million EMS encounters nationwide. Researchers in the study reported that, in rural areas of fewer than 2,500 residents, EMS units averaged more than 14 minutes from the time of a 911 call to arrival on scene. But, they noted, nearly 1 in 10 rural patients waited almost half an hour for an ambulance to arrive, a delay that could have serious consequences.
When patients do have to wait, those longer response times “have been associated with worse outcomes in trauma patients,” note the authors of the study. “In some, albeit rare, emergent conditions (e.g., cardiopulmonary arrest, severe bleeding and airway occlusion), even modest delays can be life-threatening.”
Average response times were cut in half in urban (more than 50,000 residents) and suburban (between 2,500 and 50,000 residents) areas, to between seven and eight minutes. Ellsworth, with roughly 8,000 residents, would fall into the suburban category, although with a total area of nearly 94 square miles, the city is large and portions of it are very rural.
Ambulance response times have been on the mind of city staff and officials in recent months as they wrestled with whether to keep the city’s EMS agency license and have firefighters respond to medical calls. On Monday, city councilors unanimously approved continuing to have Ellsworth firefighters respond to medical calls at the basic, non-transport level.
Northern Light Medical Transport, which has housed two ambulances in the Ellsworth Fire Department since 2018, responds to calls in Ellsworth and many surrounding towns. An agreement to house ambulances at City Hall was reached after County Ambulance, which had served the area for more than 40 years, closed abruptly that summer.
While the city has a housing agreement with Northern Light, it does not have a service contract, which allows staff to have an understanding of when crews are out but does not require them to prioritize calls within the city.
That has led some officials to express concerns over response times. Ellsworth Police Chief Glenn Moshier said at a meeting last month that residents are “waiting extended periods of time for an ambulance,” and councilors have publicly discussed two incidents this year in which ambulances in the city were either tied up on other calls or took a long time to arrive on scene.
In June, City 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.”
Staff from Northern Light were not present at recent council discussions. In an email after a late July meeting, the agency provided data showing that for calls within the city, it took crews an average of 6.54 minutes to arrive on scene from the time they were notified, squarely in line with national figures in suburban areas. That figure stretches to 12.75 minutes when calls outside of the city are included in the data.
“In other words it’s a shorter ride from EFD [Ellsworth Fire Department] to Finelli’s Pizza than from EFD to the Trenton Bridge,” said Northern Light Medical Transport Director Ed Moreshead in an email.
Jason A. Oko, the state’s data and preparedness coordinator, said there are a couple of important aspects to note about the state data.
Services are not, for instance, required to report how far they travel to the scene, but that can greatly affect response times, particularly in rural areas. Ellsworth, where response times average 12.75 minutes, is around 94 square miles in area, while Bar Harbor, where response times average 7.5 minutes (the fastest in the county), is roughly 63 square miles.
Per Maine licensing rules, response times in a ground ambulance’s primary service area must average 20 minutes or less from the “call for emergency medical assistance” to “arrival-at-scene” on an annual basis.
Most ambulance services in Hancock County had an average response time between 11 and 14 minutes over the past 12 months.
The data is organized by the severity of the call, with Alpha level calls being the least severe and Echo being the most life-threatening (Omega calls are generally transfers between facilities).
The data includes a number of instances in which the acuity level was “Not available,” which Oko explained is because the acuity level is reported by the dispatcher but “not always received by the Ambulance Service.”
It’s difficult to draw many conclusions about response times “through a lens of the dispatch acuity,” said Oko, “Unless you can guarantee that the acuity level assigned by the dispatch center is being communicated to the agency, in this case Northern Light Medical Transport. Maine EMS rules do not currently require this information be communicated; it is, however, being added to our rules in our current rules change process.”