Constant dollars

Paramedics caught in the heart of local ambulance services in crisis

CARIBOU, Maine – It is getting more and more difficult to manage rural ambulance services and everyone knows it.

In the county, ambulance services have been the subject of countless city and town council meetings over the past few years as revenues decline and the cost of emergency services increases in Aroostook.

While much of large-scale book balancing falls on department administrators and local governments, the precarious ambulance economy also affects individual paramedics. From uncompetitive wages to long, unpredictable hours, to the looming threat of staff shortages, paramedics say the job – which has always been tough – is harder than ever.

Caribou is one of the lucky departments – it still has enough versatile firefighters to have a full crew on each of its three shifts. But where Caribou had a long roster of volunteer paramedics and a roster of young hopefuls – starting in the department in the summers and working up to full-time positions – the department now has the minimum staff possible.

Caribou Firefighter / Paramedic Ryan Hall takes notes as he listens to a 911 call on the phone in the Caribou Fire Department garage. Credit: Hannah Catlin / Aroostook Republican

“My main concern is sustainability,” said Scott Dow, president of IAFF Local 5191 of Caribou Professional Firefighters. “We have three guys who are retiring [age] at present. If they retire… we have no one to replace them.

It is becoming more and more difficult to convince people to join and stay in the emergency services. On the one hand, wages are low. The median salary of a working paramedic or paramedic nationally is $ 36,650, while RNs earn $ 75,330 on the same metric, with only a year or two more of training .

Counting in benefits and countless overtime, most Paramedics in Caribou earn more than the national paramedic average, but only the three most senior employees in the department earn more than $ 17 an hour. The last time the union renewed contracts with the city, representatives negotiated using a job offer for a nighttime storekeeper position at Walmart in Presque Isle, offering $ 17.50.

“It’s disappointing to work here knowing that I can be paid more at Walmart,” said Paramedic Ryan Hall.

The majority of staff keep a second or even a third job to deal with the low wages and job insecurity associated with EMS and firefighting, Dow said. From carpentry to seasonal farm work, people need a back-up plan.

The work of a paramedic can be traumatic, dangerous and economically unpredictable. You never know when your last day on the job might be, and the threat of post-traumatic stress disorder resulting from particularly horrific calls is always at the back of your mind, Dow said.

“Sometimes doing something totally different makes the difference between dealing with demons or succumbing to them,” he said.

Caribou firefighter / paramedic Chad McCarthy (left) and Ryan Hall climb the ladder of one of the department’s fire trucks during a routine training exercise. Credit: Hannah Catlin / Aroostook Republican

Other fire department staff are in graduate school – one of Caribou’s full-time employees, Angela Fuller, is still attending paramedic school. Eric Dickinson, who has worked in the department for years, returns from a 24-hour shift and begins his homework for his public administration degree, for which he goes to school online.

“I take it day to day and there is no weekend or vacation,” Dickinson said.

Even with a second job, in 2020 first responders from the Caribou Fire Department worked on the department twice. Its 15 full-time employees worked the equivalent of hours of 26.5 full-time employees, 40 hours per week during the year. It’s not unusual to work a 70-hour week, Dickinson said.

Long hours are another thing that makes it difficult to recruit and retain employees.

Firefighters are among the only workers in the United States not being paid for overtime at 40 hours – the pay rise only comes in at 53 hours. Caribou’s schedule assumes that each employee will work an average of 57.5 per week over the course of a year, and then Caribou firefighters and paramedics compete for overtime.

Caribou Firefighter / Paramedics Ryan Hall (back) and Captain Danny Raymond clean one of the service ambulances during routine morning duties at the Caribou Fire Department. Credit: Hannah Catlin / Aroostook Republican

According to paramedics, what keeps the Caribou Fire Department running is the brotherhood among emergency service workers and the desire to help people no matter the cost. You have to have a spark for it, Hall said.

Even so, as the financial woes of ambulance services make paramedics themselves the subject of public scrutiny, some of the pride has lost its luster.

When Caribou City Council increased ambulance fares in outlying towns in 2020, fire department staff, including Chief Scott Susi, stopped wearing service equipment in public. The department still enjoys the support of most of the majority of the community, Susi said, but suddenly finding itself in the public eye was shocking.

“Every time I go out now, I’ve stopped wearing anything to do with the department because people stop you and ask what’s going on,” Susi said. “The pride is there, but when you’re gone [duty], Let’s go.

Dickinson said an acquaintance of his from Stockholm, one of the towns that signs a contract with the Caribou fire department, actually came to his house to ask him about the rate changes – that, of course, , the individual employees of the service did not play.

Paramedics in the department are well aware that rate changes and tax hikes are painful for the community, Dow said. This is why most employees agree that the state and the federal government need to step up support to departments.

Caribou firefighter / paramedic Chad McCarthy (left) and Ryan Hall talk to each other atop the ladder of one of the service’s fire trucks during a routine training exercise. Credit: Hannah Catlin / Aroostook Republican

Many of the problems plaguing rural ambulance services – poor reimbursements from Medicare and MaineCare insurance and rising costs for emergency equipment – could be appeased by lawmakers. For example, regulators are constantly updating the equipment required in modern ambulances, but the government rarely gives grants to acquire the new technology, which can add tens of thousands of dollars to the budget, Dow said.

But in Maine, ambulance services aren’t even considered an essential service. The fear among paramedics is that if the problem is left alone, it may never be resolved.

“We’re already in crisis, but it seems like no one wants to hear it, no one is listening,” Dickinson said.

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