EMS proposal quick comparison

Specific proposals outlined estimated costs, staffing levels and response times.

Camden First Aid Association

The current EMS service provider for Camden, Hope, Lincolnville and Rockport is Camden First Aid Association. Camden First Aid has proposed a combined cost of $407,000; with Camden contributing $174,000, Rockport contributing $129,000, Lincolnville contributing $77,000 and Hope — part of which already is covered by Union Ambulance — contributing $27,000.

Coverage is provided 24 hours per day, seven days per week by several response teams. Two teams are on duty during the day, while one team is on duty nights. A paramedic or advanced EMT is present for 90 percent of calls.

Camden First Aid also has an access team for vehicle extrication as well as a technical rescue team for calls requiring specialized rescue equipment, most often those for stranded hikers.

Estimated response times to several locations in each town were provided as well, and the average response time is slightly longer than six minutes. Camden First Aid estimates response time to Camden-Rockport Middle School at four minutes, Hope Corner Fire Station at 13 minutes, Hope Elementary School at 15 minutes, Camden Hills Regional High School at four minutes and Lincolnville Central School at 15 minutes.

Camden First Aid has an in-house billing service.

Sterling Ambulance Service

Sterling Ambulance Service responded to the towns' RFP for coverage of Hope only, at an estimated cost of $6,500.

Coverage would be provided 24 hours per day, seven days per week.

Sterling estimated response times in the range of five to 15 minutes, depending on distance from its Union base.

North East Mobile Health Services

North East Mobile Health Services proposed to serve all four towns at a cost of $28,000.

The service, with headquarters in Scarborough, proposes paramedic coverage 24 hours per day, seven days per week. There currently is a base located in Rockport, housing two ambulances with a staff of seven as well as a paramedic fly car, but the RFP response states there will be four ambulances available, a staff of 20 and the service may negotiate use or purchase of Camden First Aid Association's existing base on John Street in Camden.

North East proposes to continue the technical rescue team established by Camden First Aid in addition to its own specialized strike team, bariatric response team and several others. Extrication is proposed to be handed over to Camden Fire Department unless not feasible, in which case North East would continue with Camden First Aid's access team as well.

Response times estimated to Camden-Rockport Middle School and Mid-Coast Recreation Center are estimated at seven minutes from the Rockport base. Hope Corner Fire Station could be reached in 13 minutes, Camden Hills Regional High School has a listed response time of six minutes, Lincolnville Central School at 16 minutes, Camden Snow Bowl at seven minutes, Camden Hills State Park at eight minutes, Lincolnville Beach at 14 minutes, the intersection of Routes 17 and 90 in Rockport at nine minutes, Mirror Lake in Rockport at 11 minutes, Windward Gardens in Camden at six minutes and Quarry Hill in Camden at four minutes.

North East maintains its own billing services.

Delta Ambulance Service

Delta Ambulance Service currently has bases in Augusta and Waterville and proposed 24 hour per day, seven days per week coverage at a cost of $44 per capita. That fee would result in an annual cost to Camden of $231,396; Rockport, $155,012; Lincolnville, $103,400, and Hope, $62,832.

Staffing of eight full-time people as well as additional per diem personnel was proposed, as was a Sept. 1 service start date to allow for establishing a Delta Ambulance base in the Midcoast. Emergency calls could be staffed at a minimum of an EMT-basic, though the organization is permitted to the paramedic level.

Delta proposed to maintain the existing access and technical rescue teams established by Camden First Aid Association.

Delta did not provide an estimate of response times as they currently do not have a starting point.

The service maintains its own billing services.

In the wake of financial troubles at Camden First Aid Association, the four towns served by the emergency medical service continue to explore options via a request for proposals.

A total of four proposals were submitted, three to cover all four towns and the last to provide emergency services to Hope only.

To help members of the EMS review team decipher the proposals, town officials invited Atlantic Partners EMS Executive Director Rick Petrie to address some common questions April 30. Petrie also will be part of the EMS review team as an adviser.

Many questions posed during a meeting at Camden Opera House related to finances and the four criteria posed in the request for proposals — scope of work, experience, quality of personnel and cost. While a few members of the public were present, the majority of the audience was made up of town officials, many of whom are members of the EMS review team. Camden Town Manager Patricia Finnigan noted the select boards of the four towns would not “make a decision on our own, though, Rick [Petrie] will give us the foundation.”

“I think it's very important to think about service so far and what we want to see,” she said. “There's no cookie cutter approach to this.”

Petrie addressed differences in license levels of emergency providers as well as how the state manages provider agencies.

Camden Select Board member John French, who also is a member of the EMS review team, asked how necessary it is to have a paramedic as a first responder. Petrie explained first responders generally are residents of the town that volunteer to respond to calls for help, though they are limited as far as what types of care they can provide. There are several levels of emergency medical technician as well, including basic, intermediate — more recently known as an advanced EMT — and paramedic, he said. The individual license level dictates the type of care.

“That's one of the things to think about,” Petrie said. “The majority of things that are truly life-saving can be done by an EMT (basic level).”

An EMT at the basic level can put on a splint, control bleeding, assist with childbirth, administer oxygen, administer medications already prescribed to patients, administer an Epi-Pen for allergic reactions and use a defibrillator. At the next license level, advanced EMTs can also insert an intravenous line and manage airways as well as some cardiac work. Paramedics, Petrie said, are allowed all of the previous actions as well as a number of field surgical procedures. While there is increased cost with increased skill, Petrie noted after more than 30 years as a paramedic himself, he has hit the top of the pay scale at $23 per hour and his son, an advanced EMT with two years' experience is paid $11.50 per hour.

“Nobody is getting rich,” he said.

Petrie explained even paramedics must have permission from doctors for certain procedures and medications, but most situations are covered by written protocols.

Currently, Camden First Aid Association is permitted to the paramedic level and most often provides that level of care, Petrie said. If a paramedic is not available, EMTs respond.

“Most places strive to find some way to get the highest level [possible],” Petrie said. “…precious few of our calls are time sensitive, life-threatening emergencies. But the ones that are, you want to make sure people are there quickly.”

Rockport Selectman Ken McKinley asked about billing nursing homes for calls that do not result in a patient being taken to the hospital, such as assisting someone who has fallen, but is not injured. Petrie said communication with facilities such as nursing homes is key, as some may have a “no lift” policy in place that requires nursing staff to call the ambulance.

Several town officials speculated about establishing a multi-town municipal ambulance service, which Petrie said is an option to consider due to factors such as protection from torte and lessened costs for fuel and maintenance.

“I want to be careful not to get button-holed into a particular place,” he said. “There's a lot of different factors that come into this…what are you getting now and how do you match it going forward?”

Petrie cited Anson, Madison and Starks as an example of several towns collaborating to manage a municipal EMS service. Interim Rockport Town Manager Roger Moody likened the idea to creating an interlocal corporation such as Midcoast Solid Waste.

Lincolnville Selectman Jason Trundy asked if it is common for non-municipal EMS services to seek a subsidy, to which Petrie responded, “It's common to ask for a subsidy. Yes, absolutely.” Petrie noted services that are not subsidized are commonly run by hospitals, a situation Pen Bay Medical Center has declined to enter into, according to town officials.

Petrie described a fairly new program called community paramedicine, which allows EMS crews to interact more with members of the community as well as perform well-being checks, though freelance paramedicine would not be allowed.

“I can't be a paramedic for hire,” he said, adding, “we don't want freelance paramedics screaming around out there in private vehicles.”

Officials also learned about standard response times for emergency calls. Petrie said American Heart Association standards seek to have between 8- and 15-minute response times.

“How fast an ambulance should get there is directly proportional to if you're the patient,” he said.

Regarding specific questions about the four proposals for EMS service received, Petrie said he had not reviewed them. He suggested town officials stick close to requests made in the RFP to determine the best provider.

“I warned you guys this would be tough,” Petrie said, adding a contract “with an out for both sides” is critical, as is financial transparency.

Members chosen for the EMS review team include three representatives from each of the four towns. From Camden, Town Manager Patricia Finnigan and Select Board members Martin Cates and Donald White will add input. Rockport representatives include Interim Town Manager Roger Moody and selectmen Geoff Parker and Ken McKinley. In Lincolnville, Town Administrator David Kinney, Selectman Jason Trundy and citizen Jim Sinclair were chosen. Hope is sending Town Administrator Jon Duke as well as Selectman Eric Campbell and budget committee member Bill Pearse Jr. Petrie will serve in an advisory capacity. Meetings of the EMS review team are not open to the public, Finnigan said.

Camden Herald Associate Editor Stephanie Grinnell can be reached at 236-8511 or sgrinnell@courierpublicationsllc.com.