WINSLOW — In January, five members of Winslow’s Fire and Rescue department will begin a one-year program to learn how to administer paramedic-level care to patients in need.
That means that, upon certification, they will be able to administer the highest level of emergency care — inserting breathing tubes, pumping stomach contents, interpreting EKGs and blood tests, issuing certain medications and more, according to the National Registry of Emergency Medical Technicians.
The training, supported by a $36,571 federal Assistance to Firefighters Grant, is part of an initiative in the municipal fire department to address the shortage of emergency care providers statewide.
In the last year, Winslow’s department has grown from six full-time firefighters to nine full-time firefighters, plus a new chief, Ronnie Rodriguez, who arrived in September 2018. The original six possessed basic EMT certification. Of the expanded crew of nine, five of those paid firefighters and the new chief have been trained as Advanced EMTs as part of a regional award shared with Waterville. One member of Winslow’s call force was also trained as an Advanced EMT. Two more staff firefighters in Winslow will be trained as Advanced EMTs in 2020.
The second of three certification levels, Advanced EMTs can start intravenous lines, operate advanced equipment and administer medications such as epinephrine.
Winslow firefighters who will begin training as paramedics in January. From left, Capt. Waylon Capp, Chief Ronnie Rodriguez, Cameron Aucoin, Lt. Jeff Reny and Connor Osborne. They are pictured with two cardiac monitors and a mechanical CPR device the department received through a regional grant.
With the majority of the department’s calls being medical ones, Rodriguez said the move will help the department stay prepared for the worst and deliver faster higher-level care to patients in need at a minimal expense to the town.
“(Medical calls) are 75% of what we do, at a minimum,” Rodriguez said. “Why wouldn’t I want to be prepared for 75% of what we do?”
Winslow has a population of about 7,600. The town’s municipal fire and rescue department responds to approximately 900 to 950 medical calls a year, Rodriguez said, and is typically the first to arrive. The town also contracts with Waterville-based Delta Ambulance for emergency response services and hospital transfers. In 2018, Delta responded to 890 emergency 911 calls and transported 706 patients in Winslow, according to Tim Beals, the executive director of Delta Ambulance, the area’s main private provider.
“If we can begin interventions that we couldn’t have before, it’s to the benefit of the patient,” Rodriguez said. “Before, we could only do so much and it didn’t matter how critical you are. Now we have improved our licensing to match the need.”
The department was also awarded two cardiac monitors and a Lucas device, which mechanically performs chest compressions for CPR, as part of a regional grant. That brought close to $160,000 of equipment to the town, which paid a matching requirement of roughly $8,300.
The added equipment and training come as Winslow begins to consider creating a municipal ambulance service, which Rodriguez said was a separate issue. While the Town Council has formed an ambulance committee to look into the details, it has met only once and has not put forth any recommendations.
Across the Kennebec River, Waterville has recently been embroiled in debates over whether to purchase ambulances as backup to Delta. Proponents argue that doing so would increase Delta’s availability to respond to smaller communities and potentially generate revenue for the city, an idea that has been contested by both Mayor Nick Isgro and private ambulance officials.
EMS IN CRISIS; NO ONE SOLUTION
As a Portland Press Herald report recently shed light on, Maine’s emergency medical services are in crisis. In the state with the oldest population, demand for emergency care is rising while the industry is struggling to attract employees and failing to get reimbursed for the costs of life-saving treatment and hospital transports.
Rodriguez said that beefing up the emergency medical qualifications of his crew in Winslow is a direct response, at the local level, to those problems. Winslow offers mutual aid to Waterville, Vassalboro, Fairfield, Benton, Clinton, Albion, China and others — even Unity, in Waldo County — as needed.
Rick Peatrie, executive director of Atlantic Partners EMS, agreed that the move will help alleviate some — but not all — of the pressure on the system. Atlantic Partners EMS helps educate, train and coordinate public and private emergency medical service providers across the state and has an office in Winslow.
“I think having more people trained is always helpful,” Peatrie told the Morning Sentinel.
The effectiveness of having municipal paramedics in the area, though, will hinge on the town’s ability to coordinate with other providers in the area.
“Adding more paramedics like Winslow is starting to do is a good thing, but that needs to be a part of a bigger picture,” Peatrie said. “How do those people interact with the system? In this case, that requires a relationship between private and municipal services. There are plenty of good examples of that happening — Brewer Fire Department and Northern Light (Medical Transport) have had a relationship in place for about 20 years — but there is no one magic formula.”
Beals said that the impact on Delta “depends on (Winslow’s) intentions going forward.” Increasing the certifications of municipal staff members, he said, does not address one of the larger problems at play: a lack of people choosing to enter the field.
“It really doesn’t solve the crisis that we have with the shortage of EMS workers when people simply advance in licensure because you’re not adding new bodies, new personnel to the system,” Beals said. “Yes, they’ll be able to provide a higher level of care, but it doesn’t address the shortage. The same can be said of (Delta’s) people. We have advanced EMTs and paramedics going to school, but it doesn’t address the need, just the level of care. It’s a national struggle to get people into the pipeline.”
Still, Rodriguez pointed out, having more individuals trained at a higher level “does make a difference.”
“Really, we are emergency services (providers), and we are trying to get the highest level of care in the fastest possible time to the people in need,” he said. “We need to be prepared.”
Jay Bradshaw, executive director of the Maine Ambulance Association in Waterville, noted that the issue is “not just adding people, it’s where they’re going.” Adding paramedic-level personnel to fire and rescue crews in rural areas like Greenville or Jackman would have a large impact, for instance, especially because they are far away from major hospitals.
“There’s always two parts to the question. Do more people help? Absolutely,” Bradshaw said. “But are they in the right places? Is Winslow one of those places?”
Being a proficient paramedic takes a lot of training, continuing education and clinical hours, Bradshaw warned. An underlying thread through those requirements is money. Rodriguez acknowledged the expenses but said that if the department continues to plan properly, costs would not be an issue.
“The training budget that I have can absorb the additional required training if it continues to be approved at the current level,” Rodriguez said.
Bradshaw, who formerly worked as a paramedic, said that getting additional people certified at the basic EMT level could have a more widespread effect than pursuing paramedic training — unless fire departments can get to a patient substantially faster than the ambulance service.
“It’s not always how big is my tool chest, how big is my skillset,” Bradshaw said. “What are the things people die of? Strokes, heart attacks, bleeding. Those require someone being there doing CPR, providing oxygen, assessing a patient, stopping a bleed. Those are the things that really make a difference and those are things basic EMTs can do.”
“Statistics over and over show that 85% of calls EMS respond to need basic life support,” Bradshaw said. About 15% “are calls where advanced life support is necessary. Of those, how many are going to make a difference if (Delta is) five minutes (slower)? If somebody is bleeding, a basic EMT can stop that. If someone needs to be extricated from a car crash, a basic EMT can do that.”
Rodriguez said that Bradshaw’s critique misses the point. Rodriguez said he has not experienced problems with Delta taking too long to arrive at a scene. It’s not so much about the wait as it is being prepared for the worst, he said.
“Without knowing what each call can bring, having the ability to provide interventions without having to wait is the benefit,” Rodriguez said of having advanced EMTs and paramedics on staff. “We are trying to have the capabilities, no matter what circumstance of the call may bring, to provide immediate, life-saving interventions. It’s about being prepared.
“It just takes one active shooter and you’ve got 20 people with gunshot injuries; one bus rollover with 30 people and we are overwhelmed,” he said.
Rodriguez will be one of the five Winslow fire personnel to complete the year-long paramedic course in 2020, which will take place at Kennebec Valley Community College. Classes take place from 9 a.m. to 5 p.m. Tuesday and the first Wednesday of the month. The class also requires the completion of 550 hours of clinical training in hospitals and aboard ambulances. Winslow firefighters attended the Advanced EMT classes, offered by United Ambulance, on their own time and will attend the paramedic classes and clinical training on their own, unpaid time as well. The grants cover tuition.
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