Changing demographics, requirements, rules fuel rising EMS costs in Falmouth
FALMOUTH — Recent changes in medical protocols, an aging population and a growing tendency to call an ambulance for minor ills are all contributing factors for an 8.5 percent budget increase for public safety in fiscal year 2015.
The rising trends prompted Fire-EMS Chief Howard Rice to request an additional $50,000 to pay salaries for part-time emergency medical technicians – a first for the largely volunteer service.
The budget increase will help ensure that the station on Bucknam Road is always staffed by at least two EMTs, one of whom will be a certified paramedic.
Finding volunteers to staff the station has become more difficult in recent years and, perhaps paradoxically, the daytime hours are more difficult to fill than overnight, because the daytime hours often conflict with volunteer's full-time careers, Rice said.
While volunteer firefighters might get called away from their jobs once per day or less to staff a truck, volunteer EMTs need to be at the station throughout the day for the sake of response times, Rice said. And, those EMTs are called into service an average of three times a day.
"People have other jobs. They have lives," Rice said. "It's a lot to ask for someone to come here for 12 hours and get paid nothing."
The plan to pay EMTs to work the day shift will also allow Rice to direct the remaining pool of volunteers to the overnight shift, where an existing stipend pays $25 per night, plus a per-call rate.
In the past five years, EMS call volume in Falmouth has gone up by 5 percent. It might seem like a trivial amount, Rice said, but the number of transports to the hospital increased by 16 percent. Last year, the service provided 844 transports to the hospital, compared to 730 transports five years ago.
Part of the increase is due to a growing population in Falmouth that is also aging. Between 2000 and 2010, the population in Falmouth increased by 13 percent. During that time, the median age increased from 41 to 45.
Last year, 61 percent of all ambulance transports were for patients older than 65, compared to 51 percent five years ago. The average age of patients last year was 67, Rice said. Of the total calls for service last year, 331 calls were for patients older than 85, versus 262 calls five years ago.
"It's not uncommon to transport people in their 90s," he said. "When I started in 1997, and if you got one (nonagenarian) a year, it was surprising."
The aging sets the stage for an exponential rise in calls.
"As they get older, they use the system more," Rice said.
Patients are also more likely to call the ambulance for minor injuries and ailments.
"People are going to the emergency room for a cold or the flu," the chief said. "Years ago, they would have driven themselves there."
Expansions in EMT duties also stretch resources thin, Rice said. Twenty years ago, EMTs' responsibilities were straightforward.
"Our only job as EMTs was to get them into an ambulance and get them to the hospital safely and quickly," he said.
After recent changes at the state level, EMTs are now expected to perform CPR on a patient for 20 minutes before transporting, because CPR en route is less effective and less safe for the EMT, who would be standing while the ambulance is in motion.
It's an effective change in terms of patient outcomes, but it also ties up ambulance crews much longer than in the past, when they would transport the patient to the emergency department as quickly as possible, then return to the station.
Other protocol changes, such as administering pain medications on scene or diagnosing heart problems with cardiac monitors, also consume resources.
The staffing difficulties are not new to Falmouth.
Six years ago, when Rice moved to Falmouth from Vermont, the station was in the midst or a near-crisis. There were nights when his pager would go off three times before a volunteer would step forward to drive the ambulance, he recalled.
To improve matters, Rice took simple measures, like adding a big-screen television and comfortable chairs at the station "to encourage volunteers to hang out." He also added the $25 stipend for overnight volunteers, and introduced an incentive program that rewards the volunteer who has responded to the most calls per year.
Rice also increased the pool of potential volunteers by expanding into neighboring towns. In years past, volunteer spots were offered solely to Falmouth residents.
The simplest measure of all is simply thanking each volunteer at the end of every shift, he said.
Rice also implemented more complicated measures, like an EMT course for students at Falmouth High School. The station also accepts live-in students who study fire science at Southern Maine Community College. The students receive free living quarters in exchange for a minimum of 12 hours of volunteer service per week. That resource, however, dries up during school vacations, particularly summers.
Rice predicted the additional funding will help the department for the next few years, but said its inevitable that the station's needs will grow, especially with retirements looming for some long-time volunteers. Eventually, salaries for daytime shifts won't be enough.
"We know that eventually there will be two people here for the ambulance around the clock getting paid," he said. "The volume will dictate it."