A committee responsible for distributing $31 million in funding to struggling emergency medical service agencies statewide convened in Alfred earlier this month to strategize the allocation of the remaining $19.3 million of that budget. The financial support was earmarked by the Maine Legislature last year as part of an urgent initiative to stabilize the state’s emergency medical system, which experts have labeled a critical crisis. So far, over $10 million has been successfully disbursed to 184 emergency transportation services across the state, reflecting the severity of the situation.
However, internal discord is evident among members of Maine EMS, a state agency comprising paramedics, doctors, and advanced EMTs, regarding the optimal use of the remaining funds. While some advocate for channeling funds directly to the EMS agencies facing financial hardships, others emphasize the essential need to bolster training initiatives that would enhance the overall system. The committee, charged with establishing grant guidelines, has recently suggested a significant shift, proposing that approximately half of the unallocated funds be directed toward training centers, which are crucial for educating new and ongoing EMS personnel.
The primary objective, according to Rep. Sue Salisbury (D-Westbrook), who was one of the proponents of this legislation, was to stabilize the finances of the state’s 260 eligible EMS providers. A considerable number of these agencies are teetering on the brink of collapse. “We were able to get an unprecedented amount of $31 million added to the governor’s budget,” Salisbury remarked. “Then just recently, we see rulemaking come out… which changes the trajectory of this money without a public hearing being proposed.” This change in direction has sparked significant conversations among stakeholders about prioritizing immediate service needs versus long-term training solutions.
The Maine EMS Board’s Rules Committee, overseeing fund distribution, has proposed that $9.3 million be allocated directly to EMS agencies, with $9 million set aside for training centers, and $1 million designated for regional offices that facilitate coordination between local and state EMS agencies. Notably, EMS agencies can apply for grants of up to $200,000, training centers for up to $900,000, and regional offices for up to $250,000, indicating a robust framework for financial support.
Lawmakers tasked the EMS Board with drafting guidelines and application requirements aimed at assisting agencies facing imminent risks of failure while enhancing the efficiency and sustainability of emergency services throughout Maine. The ongoing crisis has been further complicated by the closure or consolidation of several EMS services, such as the recent decision by Northern Light Health to consolidate its ambulance services in Corinth. Contributing factors to the crisis include insufficient Medicare reimbursement rates, low service call volumes, uncompetitive pay, and alarming workforce shortages, which have left many rural areas vulnerable.
In light of these challenges, a blue ribbon commission had initially provided a recommendation for the Legislature to adopt a staggered funding approach totaling $71 million over five years to bring the emergency medical system back to health. This recommendation highlights the urgent and comprehensive nature of the issues that need to be addressed to ensure a viable future for Maine’s EMS.
At the Alfred meeting, consensus emerged around the necessity of distributing funds to keep EMS agencies operating statewide. However, divergent views arose concerning the allocation process and the most pressing priorities. Some Maine EMS members voiced concerns about the board’s complicated application procedure during the initial funding cycle, as well as the decision to allocate funds for training centers in this subsequent round.
The first distribution of emergency funding reached 184 agencies on the verge of financial failure, including those in Saco, Portland, Bangor, and Caribou. Yet, a striking 76 eligible agencies chose not to apply, many of which were volunteer fire and rescue services in more remote communities. This discrepancy highlighted the shortcomings of the application process. “I spent a tremendous amount of time with services helping them walk through the process,” shared Rick Petrie, a special projects advisor for Atlantic Partners EMS, which is under contract to serve several counties in southern Maine. “(EMS agencies) were frustrated by the guidelines for what they could spend it on, and they felt really boxed into a corner.”
Kevin McAdams, fire chief in East Millinocket, noted that the application process for the initial round of funding met with relative success, particularly due to support from the town office. He acknowledged that smaller departments might have found the process daunting without such assistance. “Not all of us have grant writers and other departments that can help (with) all the technical stuff,” he emphasized, illustrating a critical barrier to participation in the funding opportunity.
The extensive application required by the board included a robust nine-page guide detailing 49 multi-part steps, compelling agencies to outline their finances, emergency operations, stabilization plans, and project budgets, among other requirements. To facilitate smoother navigation of the funding process for the second round of grants, the board has designated two technicians to aid agencies in completing their applications efficiently and effectively.
The underpinning of the ongoing debate revolves around the decision to direct funds toward training centers, which play a pivotal role by offering necessary licensure classes and ongoing educational opportunities. Out of the ten training centers sanctioned by Maine EMS, some have struggled to attract educators, while others face inconsistent student demand for courses. This backdrop raises questions about resource allocation and the immediate needs of existing EMS agencies.
William O’Neal, director of Maine EMS, defended the decision to allocate funds to training centers, positing that it addresses critical elements of the EMS workforce shortage. He articulated that while distributing funds equitably was the task at hand, he consulted various stakeholders and believed their collective approach aligned with the blue ribbon commission’s recommendations, which emphasized the urgent need for long-term support for training programs.
O’Neal remarked, “Our workforce pipeline is too narrow,” underscoring the deep staffing challenges particularly faced in rural regions. He contended that bolstering training centers would establish a much-needed infrastructure for technicians, enabling better service delivery in underserved areas. “It’s a robust approach and it still continues to account for that great need in the rural areas of Maine in addition to having the discussion about widening that workforce pipeline,” he added, highlighting the need for a sustainable EMS system going forward.
However, a significant number of Maine EMS members expressed dismay at the proposed allocation plan, viewing it as a reduction in direct support for struggling EMS agencies. “To take away that money now for services that are struggling… would be an unfortunate slap in the face to EMS services that are doing everything they can to keep their head above water and try to continue to respond,” argued Petrie. This sentiment resonated with others, including Maine Fire Chiefs’ Association executive director William St. Michel, who warned that without sufficient revenue to operate, any additional investments would prove futile.
McAdams, reflecting on the financial needs of his department, said, “It’s supposed to help us, to stabilize us – not secure our jobs for other places.” Nevertheless, O’Neal maintained that bolstering advanced training centers with research capabilities would pave the way for durable EMS agencies in the future. “It’s about building the skeleton that’s going to allow (Maine EMS services) to function,” he concluded, emphasizing a long-term vision for the state’s emergency medical services infrastructure.
This story was originally published by The Maine Monitor, a nonprofit civic news organization. To get regular coverage from the Monitor, sign up for a free Monitor newsletter here.
Interview with William O’Neal, Director of Maine EMS
Editor: Thank you for joining us today, William. As the director of Maine EMS, can you provide insights into the recent allocation decisions regarding the $31 million in funding for emergency medical services in Maine?
William O’Neal: Thank you for having me. The recent meetings and discussions have been critical in shaping how we utilize these funds. The original aim was to stabilize existing EMS providers, which, as you know, are facing an unprecedented crisis. However, we’ve found that addressing our workforce shortages, especially in rural areas, is equally vital.
Editor: There’s been some contention regarding the allocation of funds between immediate support for EMS providers and long-term training initiatives. Could you elaborate on this balancing act?
William O’Neal: Absolutely. We’re contending with an urgent need for immediate operational support for many EMS agencies, but we also must consider the future. Investing in training centers helps us build a sustainable workforce pipeline, which is a long-term solution to our staffing crisis. It’s essential to ensure that we not only keep agencies afloat but also prepare the next generation of EMS professionals.
Editor: Representative Sue Salisbury raised concerns about a shift in the trajectory of funding without public hearings. How do you respond to critiques regarding the transparency and stakeholder involvement in this process?
William O’Neal: I understand the concerns, and stakeholder input is indeed crucial. Our approach has included consultations with various EMS leaders across the state. While the immediate needs of current agencies are paramount, we believe that enhancing training infrastructure is a collective need that was reflected in the blue ribbon commission’s recommendations. We aim to strike a balance that benefits all parties involved.
Editor: You mentioned that 76 eligible agencies did not apply for the initial funding. What do you think were the barriers preventing them from participating in the process?
William O’Neal: The complexity of the application process has been a significant barrier. Many smaller agencies, particularly volunteer ones, do not have the resources to navigate lengthy and intricate application guidelines. We recognize this and are actively working to simplify the process for future funding rounds, including assigning technicians to assist agencies with their applications.
Editor: Regarding the allocation of almost $9 million to training centers, how do you justify this against the immediate financial crises many EMS agencies are facing?
William O’Neal: The long-term success of our EMS system relies on having a qualified workforce. If we only address immediate funding problems without investing in training, we risk perpetuating the cycle of workforce shortages. Our training centers will provide essential educational programs and licensure classes that are vital in attracting and retaining talent in EMS, especially in underserved areas.
Editor: what are the next steps for EMS agencies after this funding allocation?
William O’Neal: The next steps involve setting clear, streamlined guidelines for grant applications, providing technical support for agencies, and fostering ongoing communication about how these funds can best be utilized. We aim to establish a collaborative approach to ensure that the allocated funds effectively address both immediate operational needs and the long-term viability of our EMS workforce.
Editor: Thank you, William, for shedding light on these critical issues. It’s clear that the path forward requires careful consideration and cooperation among all stakeholders.
William O’Neal: Thank you for the opportunity to discuss this important topic. We’re committed to working together to strengthen Maine’s EMS system for years to come.
Ed with? Wouldn’t that money be better spent directly supporting those agencies first?
William O’Neal: I hear that concern deeply, and it’s a valid point. However, our intent with the $9 million for training centers is to establish a systematic solution to our ongoing workforce issues. While immediate funds are necessary for some agencies, if we don’t invest in training, we risk facing a more profound crisis in the years ahead. By elevating our training capabilities, we ensure that new recruits are well-prepared, which ultimately benefits all EMS agencies across the board. It’s about creating a stable environment not just for today, but for the future of emergency services in Maine.
Editor: Some EMS members feel that shifting funds to training centers feels like a step back from direct support. What reassurance can you offer to those who argue that this takes vital resources away from struggling agencies?
William O’Neal: I empathize with those feelings. It’s critical that we listen to the voices of those on the front lines. However, the unfortunate reality is that we can’t solely focus on short-term fixes without acknowledging underlying systemic issues. The training centers, along with support for agencies, are part of a comprehensive strategy. My goal is to create a balance that fosters immediate capabilities while also building resilience for the long term. We need everyone on the same page working collaboratively towards a more robust EMS framework.
Editor: what are the next steps for the Maine EMS Board regarding this funding process, and how do you envision the pathway forward in light of both training and direct support needs?
William O’Neal: Our next steps involve refining the application process; we’re committed to making it user-friendly for all agencies, particularly those with limited resources. We’ll conduct follow-up meetings with stakeholders to continuously gather feedback. We don’t have the luxury of time, and every decision we make will be weighted against the immediate needs of our EMS providers while keeping the workforce pipeline strong. It’s a tightrope walk, but it’s a necessary one to secure not just the future of organizations, but of Maine’s emergency medical services as a whole. Thank you for having me and raising these important issues.