APPLETON —  With millions in funds hoped for to help cure Maine’s sickly emergency medical services system, one Appleton official says it is time for local leaders to get involved.

“We need all elected officials to put whatever weight we can behind this,” Patrick Costigan told the Appleton Select Board at its Tuesday, Nov. 1, meeting.

“This is an important topic for all of us, and I would put that on your agenda if it’s not already on it, because otherwise we’re not doing ourselves any favors,” he said.

Costigan is one of two Appleton representatives on the Union Ambulance Advisory Board. The other is Select Board member Scott Esancy. These boards statewide are grappling with how to resuscitate an emergency medical services delivery system so riddled with problems and close to collapse that state legislators in May created the “Blue Ribbon Commission To Study Emergency Medical Services in the State.”

Experts say a large sum of state money might wait behind the commission to put the system on the road to recovery and sustainability.

One idea advanced in the final weeks of the commission’s work states: “between $65 and $69 million to bring every EMS service in the state from the red into the black,” Jesse Thompson told the Select Board Nov. 1.

Thompson, a firefighter and paramedic at the Gardiner Fire Department and EMS Director in Union, speaks for Union Ambulance Advisory Board. This board also includes representatives from Washington and Appleton, towns that contract Union EMS services.

In his presentation to the Appleton board and in an interview Thursday, Nov. 3, Thompson said several issues plague Maine’s EMS system including funding problems and a lack of personnel.

The funding issue is due to a shortfall between the costs to deliver services and government and insurance reimbursement rates.

“Medicare and MaineCare reimburses us only 80 percent of what it takes to go on a call, and that’s on a good day,” he said.

Efforts are now underway to itemize every expense associated with services in an effort to bolster the argument for higher reimbursement rates, according to Thompson — things like factoring in the cost of the town bookkeeper and human resources director.

In terms of personnel, low pay and the need for two years of training, in addition to per diem EMTs transitioning to full-time jobs with benefits, have sapped the pool of recruits.

“We don’t get reimbursed what we should so it’s harder to pay what we need to pay; we’re losing people faster than we can train them,” Thompson said.

Thompson said this whole effort could mean the counties will be given the responsibility for making sure every town is covered by an EMS service. That will depend on exactly what the Legislature puts into law as a result of the commission recommendations.

Rick Petrie sits on the Blue Ribbon Commission and has spent 41 years in the EMS system in Maine. He is a paramedic and Chief Operating Officer for North East Mobile Health Services, a private firm serving three towns in Knox County and others statewide.

He believes most people in Maine, including in the Legislature, take EMS services “for granted” because paramedics and ambulances are always there when needed.

Not in a bad way, he said, but in the sense that EMS personnel are so committed to what they do that patients do not see the issues of low pay, stress and dwindling personnel numbers that strain the system behind the scenes.

“We have fire departments that can’t find people who want to work. When I took the test in 1984 (to be an) Auburn firefighter there were 75 people who showed up. Now, departments have to combine their exams just to get enough people to run an exam,” Petrie said.

“We are in serious trouble in the State of Maine,” he said. “And I don’t think anybody really has a full grasp of what it takes to put an EMS system together and get ambulances to respond.”

Thing are so bad in some areas that in a recent case, three EMS services had to be called for a critical case before the third could actually respond. In all, it took 57 minutes to get paramedics on the scene. The man died, according to Petrie.

That said, the veteran paramedic is “very hopeful” legislators on the commission are beginning to understand what is needed not only to correct the problems but also to set a plan in motion for sustainability, including good pay and benefits, training, incentives for volunteers and recruitment. Above all, he hopes EMS services will be put on par with the fire service in terms of those needs.

If the commission’s report includes a recommendation for millions in funding, Petrie echoed Patrick Costigan’s call for elected officials to get behind it.

The commission has met four times and will meet twice more, including on Monday, Nov. 14, before drafting its report to the Legislature, expected in December.

“I am hopeful because they put together the commission,” Petrie said. “That is a good start, they are starting to recognize the gravity of what we are asking for. We are talking about $70 million a year for five years to bolster the system, to be able to build it back up and strengthen the foundation and, going forward, have a system designed for sustainability.”

Towns are often caught in a financial crunch when, like Appleton does with Union, they must contract with other towns for EMS services.

Select Board Vice Chair Peter Beckett told The Camden Herald on Friday, Nov. 4, “We are all concerned really about the rising cost of providing the sort of services and ours more than doubled this year.”

Appleton’s bill to be serviced by Union EMS has risen steadily in recent years. It went up about 55 percent from $33,400 in fiscal 2019/2020 to $51,667 in fiscal 2020/2021, according to town financial reports. This year Beckett said he believes it is around $100,000.

“The cost of the services have just rocketed,” he said. “It always used to be a volunteer type of service and has really migrated completely away from that to be a paid service.”

The problem was so pressing town leaders seriously considered contracting with with Petrie’s North East Mobile Health Services, which would have cost the same as Union’s pre-hike bill, Beckett said.

In the end, Appleton stayed with Union and its higher fee because asking residents in need of care to wait 35 minutes or so for an ambulance to come all the way for North East’s nearest facility was not an acceptable option, Beckett said.

“We made the right decision,” he said. “It would be too much of a risk. Someone could die waiting.”

Patrick Costigan did not return two calls seeking input on Appleton’s specific situation as it relates to the work of the Blue Ribbon Commission and his call for elected officials to speak up. When contacted for comment on Nov. 4, fellow advisory board member Scott Esancy said, “I really don’t have the time right now.”