An ambulance leaves the emergency department at Maine Medical Center in Portland on March 13, 2020. Credit: Troy R. Bennett / BDN

Nine in 10 Maine paramedics have been vaccinated against COVID-19 with a mandate going into effect later this month, but the requirement could further squeeze rural areas that have long faced shortages of emergency medical services workers.

The Maine Emergency Medical Services Board was skeptical of Gov. Janet Mills’ vaccine mandate, voting in August to give workers two additional weeks to get vaccinated beyond what the Democratic governor initially proposed. It also exempted dispatchers from the requirement, saying only those who worked directly with patients should be covered.

The state pushed back enforcement by a month to Oct. 29, also saying workers who had at least one shot by then could remain. Most EMS agencies are now reporting vaccination rates upwards of 90 percent and roughly a third of departments are seeing 100 percent compliance.

The departures are not evenly distributed around the state and the losses of even a few workers pose the latest challenge to already short-staffed rural departments. Workloads are likely to increase for those who remain and potentially longer wait times loom as agencies prepare to cover for one another more frequently.

Shortages of EMS workers were a problem in Maine before the pandemic, with training requirements, low pay and the state’s overall aging workforce making it difficult for agencies, particularly in rural areas, to recruit new paramedics and drivers.

Advocates, including several EMS board members, raised concerns in August that the vaccine mandate would exacerbate shortages. But out of the more than 200 departments that reported data as of Sept. 30, two-thirds saw at least 90 percent of workers fully vaccinated. Seventy-eight reported 100 percent vaccination rates. Only 15 reported less than 70 percent fully vaccinated.

The state expects to have a better picture of the situation later this week, said Maine EMS Director Sam Hurley. He said it was likely some regions would be more affected than others based on vaccination rates, and that the state would monitor the situation.

“We encourage all of the services to work collaboratively with their mutual aid partners and others in their area to assist with any challenges that they may be presented with in relation to their staffing concerns,” he said.

Out of the more than 4,800 emergency workers at departments that responded to the agency’s survey, only 216 — about 4 percent — said they had no plans of becoming vaccinated by Oct. 15, the deadline originally set by Maine EMS.

At the Bangor Fire Department, 77 of 83 workers were fully vaccinated as of the end of September, while two had medical exemptions. Across the river, 17 of 18 workers at the Brewer Fire Department have received the vaccine.

In Wells, about 90 percent of EMS employees were fully vaccinated before the mandate was announced, Wells EMS Director James Lapolla said. He said remaining employees were willing to comply once the rule was announced, making his job “easy” and putting the department among those in Maine with all workers vaccinated.

But Moosabec Ambulance Service, which covers Jonesport and Beals, is set to lose five of 12 workers when the mandate goes into effect, director Renee Gray said. With fewer workers left on staff, there will be more times when the agency has to go out of service, she said, meaning a department from a nearby town will have to respond to emergency calls there.

Gray said she worried about longer wait times for area residents as well as added stress among remaining EMS workers who would bear the increased workload. Last Friday, Moosabec Ambulance Service received six calls but was only able to respond to three of them, which neighboring departments took. On Saturday, they received three more calls.

“Burnout is big anyway in this business, and then throw this on there and you’re going to have even bigger burnout,” she said.

Gray noted the agency has long struggled to find enough workers and lost two at the start of the pandemic because they were not comfortable with the potential exposure to COVID-19. She recently reached out to a local high school to encourage signups for an upcoming EMT class, and said increasing the availability of training or upping pay could help boost recruitment too.

“I’m trying to move forward,” she said. “I’m not hung up on the people that don’t want to do it. I hate to lose them, and I’ll fight for them, but I’m not going to wallow in it. I’m going to keep seeking somebody that might say yes.”

BDN writer Caitlin Andrews contributed to this report.

Correction: An earlier version of this story misstated the name of the ambulance service serving Jonesport and Beals.