CAMDEN, Maine ― Sitting in his fire station on a late summer weekday, Camden Fire Chief Chris Farley was worried.
As first responders, he and his firefighters work closely with emergency medical service providers and police to provide the help residents rely on for some of their worst days.
But from what he’s experienced, Farley said the private ambulance company that much of the area relies on lacks in coverage and quality of care.
“We’ve had concerns with the level of service provided by North East [Mobile Health Services] since pretty much the beginning [of working with them],” Farley said. “It’s worried me for a number of years.”
Since 2013, North East has provided ambulance coverage for Camden, Rockport, Lincolnville and Hope — an area with about 12,000 residents.
In addition to contracts North East has with the towns, the company also provides ambulance transfers for patients between hospitals.
But local officials worry these transfers are limiting the availability of ambulances to respond to 911 calls. When North East is unable to respond, patients must rely on mutual aid from nearby communities.
“People are starting to see Rockland [ambulances] here more. More and more people are asking why they’re seeing Union [ambulances] more. People are hearing from their neighbors that the ambulance took 20 minutes to get there, or that they were having chest pains but [North East] didn’t have a paramedic [available],” Rockport Fire Chief Jason Peasley said.
However, North East Mobile Health Services CEO Butch Russell disputes these concerns, stating that they are exceeding the terms of the contracts they have with the towns.
“I think what they’re trying to do is compare apples to sports cars. It’s not even apples to oranges. They’re so different the two things that we’re trying to compare. They want a system that’s dedicated [to 911 coverage], and we get that. We told them what that would cost two years ago,” Russell said. “We’re trying to make the best system possible.”
As these concerns are coming to the forefront, officials in Camden and Rockport are trying to figure out the demands for emergency medical services in their area.
“We need more people talking about this,” Peasley said. “We need to know, are they fine with the bare minimum coverage? Or do they want full time ambulances with paramedics on each dedicated to 911 calls?”
Camden and Rockport’s contracts with North East expire in June 2020, while the contracts with Hope and Lincolnville do not expire until 2021.
The split between 911 coverage and interfacility transfers seems to be causing the biggest frustration for local emergency officials like Farley and Peasley. They feel these interfacility transfers take the ambulances out of the region for extended periods, increasing the response time for 911 calls and at times leaving little to no coverage.
When North East ambulances are not available, Rockland or Union will dispatch one of their ambulance crews to cover a 911 call. Further exacerbating this lack of coverage is the lack of communication from North East, the fire chiefs said. On a given day, the Knox Regional Communications Center, which dispatches 911 calls, does not know the staffing levels or availability of North East crews.
“We can’t confidently say [North East Mobile Health Services] will show up when called because they do not provide us with their staffing levels,” Farley said in a report on the ambulance service he gave to local officials this summer.
The report includes multiple instances in which North East was called to respond to a 911 call, but could not because their crews were conducting transfers. On June 14, Farley reports that several towns were responding to a fire in Hope. A North East crew twice told the Knox Regional Communications Center that they would be “en route shortly,” according to the report. However, after 27 minutes, when asked for an update by the communications center, North East said that they would not be able to respond because they were busy with interfacility transfers and mutual aid from Union would be needed.
Farley pointed out that in emergency situations, mere minutes can make a difference, let alone nearly a half hour of uncertainty.
According to Knox Regional Communications data, from June 1, 2018, to May 31, 2019, North East relied on mutual aid from Rockland 41 times. Both Farley and Peasley feel North East relies on Rockland ambulance crews as a “crutch.”
But in some cases, residents have expressed that they would rather have Rockland respond to their 911 calls over North East.
In his report, Farley stated that in June a Camden resident expressed concerns over the quality of care his wife received from North East after falling in their home. The woman had fallen in April as well, but Rockland responded to that call because North East was unavailable.
“He told me that if compared to Rockland Fire, he had to have [North East] respond the next time, his preference would be to have Schooner Bay Taxi take his wife to the hospital,” Farley wrote.
Another Camden resident said that after two experiences with North East when her husband was having heart attack symptoms, she would just rather drive him to the hospital herself than depend on the service.
The Bangor Daily News is not naming the woman to protect the couple’s medical privacy.
The woman said that two years ago when her husband was having a heart attack, it took 30 minutes for the North East ambulance to arrive and when it did, the crew asked the man if he could walk to the ambulance. Considering that walking could put further stress on his heart, the woman insisted he should not walk.
The crew then transported him to the ambulance on a stretcher.
On a later instance, her husband was again having symptoms of a heart attack. North East responded and again asked if he could walk from the bedroom to the ambulance because they did not think they could get a stretcher into the house without backup.
“I said, ‘Well that is ridiculous, I’ll bring it in myself. You’re not waiting for backup he needs to be in the emergency room,” the woman recalled telling the ambulance crew.
They told her that was not possible and walked him to the ambulance.
“Those experiences gave me very little confidence in the service. At this point, if he were to have similar symptoms, I’d take him to the hospital by car because he’d probably be there before the ambulance even arrived,” she said.
According to North East, their crews meet the 9-minute response time requirement in their contracts with the towns more than 95 percent of the time. Per the contracts, that response time is measured from when North East recognizes a call from the dispatch center to when they arrive on scene.
However, the national standard for measuring response time starts when a call is dispatched and ends when an ambulance arrives. Based on Knox Regional Communications Center data and using the national standard, North East failed to meet the average 9-minute response time for two quarters of the most recent fiscal year.
Russell maintains that North East is exceeding the terms of the agreement in terms of coverage and response times.
What are the expectations?
The service model used by North East is supposed to make ambulance coverage more cost effective for municipalities, since the company is also receiving revenue from hospitals for the transfers, according to Camden Town Manager Audra Caler-Bell. Yet, due to low call volume, the annual cost of the service for the four towns jumped from $79,000 to $299,000 during the last fiscal year.
Russell points out that this cost is still much lower than the $1 million or more the towns would have to pay for dedicated 911 coverage.
But as concerns regarding the service the towns receive from North East come to the surface, Caler-Bell and Rockport Town Manager William Post said they need to better understand what their residents want in terms of ambulance coverage.
“[Emergency medical service is] one of our biggest responsibilities to our community. It’s something that we want to ensure that we’re providing a good quality service. I think that we really need to figure out what is the expectation [from our residents],” Caler-Bell said.
However, understanding expectations for emergency services is difficult because most people don’t give it a thought until they need the service.
“If we hadn’t had those two experiences, I probably wouldn’t have given [the ambulance service issue] much thought at all. I would assume they are there and available,” said the Camden woman whose husband had a heart attack.
Rockport and Camden need to determine if they want to extend their contract with North East, before it expires in June. Both town managers said they expect more conversations surrounding ambulance coverage to take place in the coming months.
“We have to try to figure out from residents what they want and what they are willing to pay for it,” Post said.