maine ems week

2 Maine Emergency Medical Services Week 2013 • May 17, 2013

Maine Emergency Medical ServicesMaine Emergency Medical ServicesDirector: Jay BradshawMedical Director: Matt Sholl, MDAddress: 152 State House Station, Augusta, ME 04333-0152Phone: 626-3860 • Fax: 287-6251Email: [email protected]

Region 1: Southern Maine EMSMedical Director: Kate Zimmerman, DOCoordinator: Marc MinklerAddress: 176 Narragansett Street, Gorham, ME 04038Phone: 741-2790 • Fax: 741-2158Online: www.smems.org • Email: [email protected]

Region 2: Tri County EMSMedical Director: Rebecca Chagrasulis MDCoordinator: Joanne LeBrunAddress: 300 Main Street, Lewiston, ME 04240Phone: 795-2880 • Fax: 795-2883Online: www.tricountyems.org • Email: [email protected]

Region 3: Atlantic Partners EMSMedical Director: Timothy Pieh MDCoordinator: Rick PetrieAddress: 71 Halifax Street, Winslow, ME 04901Phone: 877-0936 • Fax: 872-2753Online: www.apems.org • Email: [email protected]

Region 4: Atlantic Partners EMSMedical Director: Jonathan Busko MDCoordinator: Rick PetrieAddress: 354 Hogan Road, Bangor, ME 04401Phone: 974-4880 • Fax: 974-4879Online: www.apems.org • Email: [email protected]

Region 5: Aroostook EMSMedical Director: Peter Goth MDCoordinator: Steven D. Corbin, EMT-BAddress: 111 High Street, Caribou, ME 04736Phone and Fax: 492-1624Online: www.reg5ems.org • Email: [email protected]

Region 6: Mid-Coast EMSMedical Director: Whitney Randolph DOCoordinator: Rick PetrieAddress: 123 John Street, Suite 1, Camden, ME 04843Phone: 785-5000 • Fax: 785-5002Online: www.apems.org • Email: [email protected]

Today, in Maine, we have Paramedics who can interpret 12-lead cardiac monitors (or EKGs) and activate hospital heart centers; administer medications to change cardiac rhythms and reduce the load on the heart, and medications to reverse a drug overdose or anaphylactic shock. Maine EMS has an organized trauma system; air medical transport; pediatric and neonatal intensive care units.

It hasn’t always been so.Emergency Medical Services has come a long way, considering it didn’t

even exist until about 40 years ago. In the 1970s, in Maine and elsewhere, there were no consistent training or testing standards for emergency care of the ill or injured before reaching the hospital.

The National Registry of Emergency Medical Technicians describes those days as, “… an abysmal state of affairs ... The patient was being twice victimized: once by the injury or illness and once by failing to receive competent emergency medical care.”

“What was once little more than a horizontal taxi service is now an Emergency Department on wheels”, says Kevin McGinnis, a longtime paramedic who is now Chief of North East Mobile Health Services, and former director of Maine EMS (1986-1996).

As Central Maine Medical Center trauma surgeon Dr. Larry Hopper-stead describes it, “In the old days a person would maybe be bandaged, put on a stretcher, and transported to the hospital, with no intervening care.”

Now, with basic EMT training, a person can control bleeding, apply a splint, administer oxygen and assist in childbirth, says Rick Petrie, Paramedic and Executive Director of Atlantic Partners EMS. Basic EMTs can also use a defibrillator to re-start a heart that has stopped beating, administer an Epi-Pen to avert potentially life-threatening allergic reactions, and save lives

Emergency Medical ServicesThen and Now

SUCCEED PAGE 3

BDN File photo By DiaNa GraettiNGer

This material contained in this section was produced for Maine EMS by Nancy McGinnis, a freelance writer and photographer who has also been a member of the Maine EMS community for 25 years. Learn more at communicado.us

Production of this publication was by the Bangor Daily News and its staff. LAYOUT: Debra Bell | AD SALES: Linda Hayes, Sam Hoad, and Heidi Martin | COVER: John Koladish

Maine Emergency Medical Services Week 2013 • May 17, 2013 3

In an emergency, we couldn’t ask for a better partner.

www.mmc.org

An emergency can happen anywhere. Thankfully, Mainers can rely on brave EMS professionals to be on the scene and provide care that can save lives. We’re proud to call these courageous responders our colleagues. Being Maine’s only ACS Level 1 verifi ed trauma center*

means we deliver the nation’s highest standard of emergency care. It also means we’re the fi rst place these brave men and women think of in an emergency. And for that, we’re truly honored.

*American College of Surgeons Level 1 designation is the highest level of emergency care.

by activating the trauma system or the code stroke program as necessary.

“Trained paramedics can do IV’s, medi-cations, intubations, EKG’s, chest tubes,” Hopperstead said. “When it’s needed, we can provide air medical transport to a specific hospital relative to patient’s specific, acute, time-sensitive needs.”

In addition to the establishment of na-tional and state standards for certification and licensure, the emphasis has shifted from mere transport to definitive prehospital care: treatment at the scene and en route that makes all the difference to the outcome. Over the past two decades especially, there has been tremendous progress in a col-laborative, statewide mission to develop a strategic and system-wide approach.

In 1992, Maine EMS succeeded in obtain-ing a federal planning trauma grant, and set out to create a forward thinking system to increase the likelihood that even in a vast, rural state like Maine, no matter how remote their location, patients would receive the care they needed within the critical “golden hour” from the time of traumatic injury.

“The HRSA grant was an important cata-lyst to getting everyone in the state together at Maine EMS to talk about organizing trauma care in Maine, and Dr. Bill Horner

and Dr. Larry Hopperstead emerged as sur-gical leaders in Bangor and Lewiston,” notes Dr. David Clark, of Maine Medical Center.

“I was impressed that once everyone was in the same room, it was not that difficult for EMS and medical professionals to agree on the design of a system that would be appropriate for specific types of injury at

specific locations in the state,” he said.Standards were created, modeled after

those of the American College of Surgeons but reflecting Maine’s unique challenges, says McGinnis. A Trauma Technical Advi-sory Assistance Program was established. Maine hospitals began using this voluntary self-assessment resource as a way to identify their strengths and weaknesses, in order to determine the types of patients they could help and the care they could provide.

Streamlined clinical decision-making now benefits Maine patients, who are treated at Designated Trauma Hospitals, or sent to the state’s three Regional Trauma

Centers: Eastern Maine Medical Center, Maine Medical Center, and Central Maine Medical Center.

Dr. Kevin Kendall cites the outstanding success of the catheterization lab activation program at CMMC that has already benefited hundreds of STEMI (a common type of heart attack) patients. While Kendall was Director of

EMS at CMMC, the hospital partnered with United Ambulance to conduct a feasibility study, in which paramedics were empowered to not only perform and transmit but also to interpret 12-lead EKG’s in the field.

The Paramedics’ success rate at identifying STEMI’s was 100 percent. Beginning in July, 2005, Central Maine Heart and Vascular In-stitute authorized United Ambulance Service medics who diagnosed a STEMI to activate the catheterization lab en route to the hospital, thus bypassing the Emergency Department and saving critical time for the patient.

Since then, many more services have joined in this initiative, and over 250 cath lab activa-

tions have taken place. Astonishingly, the “door-to-balloon time” which refers to the time from patient arrival to successful surgical remediation of the cause of the STEMI has averaged less than an hour and a half.

“It’s so exciting,” says Kendall. “We were able to get a hiker who collapsed from a cardiac arrest on the Appalachian Trail transported by LifeFlight [helicopter] and into the cath lab in under 60 minutes. A fire chief who collapsed from a STEMI at the scene of a fire was in the cath lab within 20 minutes, and well enough to go home within a couple of days.”

As an emergency physician at EMMC and Medical Director of Maine EMS Region 4, Dr. Jonathan Busko has been treating stroke pa-tients in Maine since 2005. “Until 20 years ago, stroke was considered a disease with a grim prognosis and no good treatment,” he says.

In the mid 1990s, the advent of thrombo-lytics, or clot busters. revolutionized hospital care — but not EMS. Those advancements all depended on high-tech studies including CT scans and expensive medications.

“For almost a decade after the first study, while hospital care continued to evolve and improve, there was no real change in EMS care because people focused on the tech-nique of care, not the process,” he said.

Emergency Medical ServicesThen and Now

SUCCEED FROM PAGE 2

RESPOND PAGE 15

“What was once little more than a horizontal taxicab

service is now an Emergency Department on wheels.”PARAMEDiC AND fORMER MAiNE EMS DiRECTOR KEviN MCGiNNiS


Stroke Strikes Fast.You should, too — Call 9-1-1.

Act F.A.S.T.Face� Look for an uneven smile.

Arms� Check if one arm is weak.

Speech� Listen for slurred speech.

Time� Call 911 right away.

Stroke is a brain attack, cutting off vital blood flow andoxygen to the brain. It is the third-leading cause of death inthe United States.

MaineGeneral has launchedthe Massachusetts GeneralHospital TeleStroke programto provide advanced strokecare to our communities.

Augusta Campus, 207.626.1000 Thayer Campus, 207.872.1000

Advanced stroke care. Right here in the Kennebec Valley.

If you have questions about MaineGeneral’s services, call toll-free 1-855-4MGH-INFO

Emergency Medical ServicesWeek 2013

Thank you to the men and women of Capital Ambulance for

the outstanding service they provide to the residents of

eastern and northern Maine.

AFFILIATED HEALTHCARE SYSTEMS

The town of Ogunquit’s Fire and EMS department is staffed 24/7 by two full-time firefighter/medics: a Paramedic and an Advanced EMT. Mark O’Brien, who started out as a Junior Firefighter 31 years ago, was named Chief of the service last July.

About 20 volunteers assist, and from mid-June until after Labor Day the de-partment also has a contingent of 18-20 lifeguards.

“Mike Roche, who’s a Division 1 Foot-ball referee in the off season, has done a great job for us as our lifeguard captain for 15 years now,” says O’Brien.

The department maintains two am-bulances as well as four wheel drive ATV vehicles for beach rescue, and just added a new Jet-ski last year.

Ogunquit Fire & Rescue responds to about 650 calls a year — about 400 of them are EMS-driven, says O’Brien. The majority calls are medical to hotels and restaurants.

The service also responds to vehicle accidents on a five mile portion of Inter-state 95. While drownings are rare, keep-ing the crowds safe during the Fourth

of July fireworks is an annual challenge. 70 percent of all Ogunquit calls occur between June and September, when the population of this 4.5-square-mile town skyrockets from 1,200 to 40,000 with summer residents and tourists.

Maine EMS Service ProfileRegion 1: Ogunquit Fire & Rescue

Enthusiastic lifeguards gathered for a photo op on the

beach last summer with Laura Rose (center), her sons

(l to r) Alexander, Kevin, and Nicholas Lumenello, and

dad Chris Lumenello. The rescue Jet Ski was presented

by the family to the Ogunquit Lifeguard Service, thanks

to donations raised at Christian’s Lifeguard Dash. The

5K race/walk on the beach has become a yearly tradi-

tion to celebrate the life of Christian Lumenello (1994-

2010); and to raise funds for the Lifeguard Service.

Learn more at christianslifeguarddash.com

The average person dials 9-1-1 for medi-cal help once in a lifetime,according to na-tional statistics. But at the other end of the phone line, Emergency Medical Dispatchers may be responding to those calls dozens of times in one shift.

“Most people have no idea what happens at the other end when you call 9-1-1,” says Paramedic Drexell White, EMD Program Manager for Maine Emergency Medical Services. “When you need help, seconds can seem like minutes, and minutes like hours.” In Maine, some 700,000 to 800,000 calls are placed annually; more than 110,000 of those calls are for medical emergencies.

When EMD receives a 9-1-1 call, White says, a proprietary software system called Priority Medical Dispatch is used to ensure accuracy.

Emergency Medical DispatchThe first of the first responders

DISPATCH PAGE 5

Calling 9-1-1If you call 9-1-1 for a medical emergency, keep in mind that:

1. The dispatcher is doing everything possible to provide services and get help.

2. The information that you will be asked to provide is needed to help both the patient and the responders.

3. Emergency Medical Dispatchers strive to consistently give all callers excellent service, whatever the reason for the call.

photo By NaNcy McGiNNis

Emergency Medical Dispatcher and volunteer firefighter John Thibodeau and his colleagues at the

Sagadahoc Communications Center are some of the voices on the other end of the 9-1-1 line.


“In it for life” is the tagline of Med-Care Ambulance, providing emergency medi-cal response to the towns of Andover, Byron, Canton Dixfield, Hanover, Mexico, Newry, Peru, Roxbury, and Rumford in Oxford County, as well as to the town of Carthage in Franklin County.

Chief Dean Milligan, Paramedic says that Med-Care’s service area covers 550 square miles, with a mostly rural popula-tion of about 17,000. Three of their six ambulances are staffed daily and the ser-vice is licensed at the Intermediate level, permitted to Paramedic.

“Our policy is to staff two Paramedic level ambulances everyday,” says Milligan, who oversees 65 employees, about 15 of them full time.

Covering Maine’s western mountains

region, Med-Care responds to hiking and other outdoor mishaps, logging accidents, and occasional paper mill industrial injuries as well.

Annual call volume averages 4,000 and is divided about equally between emer-gencies and transfers.

“For the past seven months, we’ve been working on building a new ambulance facility in the center of our service area, at 290 Highland Terrace in Mexico,” says Milligan, who started his EMS career in 1989.

He and his Assistant Chief Chris Moretto, also a Paramedic, are looking forward to welcoming the entire com-munity next month to an open house celebration, with tours, speakers and refreshments.

Maine EMS Service ProfileRegion 2: Med-Care Ambulance

Med-Care Ambulance will be welcoming the entire

community next month to an open house celebration

with tours, speakers, and refreshments.

“Specific questions are asked in a specific order,” he said. “The goal is to get the right EMS response to the correct place in the appropriate time frame, according to the emergency.”

At every one of Maine’s 26 Public Safety Answering Points, or 9-1-1 centers, each

of Maine EMS’ 488 licensed dispatchers uses the same protocols to process a call for medical assistance, explains White.

For every call, Emergency Medical Dispatchers are trained to follow a specific script that is being generated by the caller’s information as it is received and entered into the computer data system. The soft-ware, originally devised by a physician 30 years ago, is now used in 15 languages and 37 countries. In addition, it is continually updated and revised to reflect best medi-cal practice and to maximize successful communication and comprehension under stressful conditions. Last year, White notes, 63 million calls for medical assistance were processed globally using the same protocols as are employed in Maine.

It may come as a surprise to learn that the very first question is not “what’s the nature of the emergency?” — but rather, “what is your location?”

It is critical to know this — and to repeat the question or cross-verify the answer via caller ID or GPS — in case the connec-

tion is lost. The call may be coming from a hazardous scene such a fire or flood, or the caller may be a victim of domestic violence, a shooting or terrorist act with limited communication options. If the call for help is coming from a cell phone a dropped connection due to lost cell reception could be disastrous.

After the location of the emergency

is determined, the next concern is the reason for the call. Some responses, such as “trouble breathing,” will trigger an immedi-ate dispatch of emergency medical services personnel to the scene. The caller may not even realize this, because the information is being recorded and shared with others as it is received. The dispatcher who answered the call may stay on the line to obtain more information and offer further instructions — while a second dispatcher is using the preliminary information to radio dispatch EMS to the scene.

For other scenarios, the dispatcher will methodically and efficiently ask more questions to help provide the best response before dispatching assistance.

“All of this typically takes place within the space of a minute and a half,” he said.

While not acting as a diagnostician, by following the EMD protocol the dispatcher can identify the priority of the need and the appropriate response. In communicating with the caller, EMD’s can often do much to

EMD PAGE 12

DISPATCH FROM PAGE 4

“You can help us to help you, when you call 9-1-1. Answer

the questions as they are asked. The protocols we use are

established and tested. Know that we are not delaying,

just getting the most appropriate help to the scene, in the

shortest possible time.” LAuRA DOWNiNG, EMD, SAGADAHOC COMMuNiCATiONS CENTER


m i d c o a s t h e a l t h . c o m

Our community. Our health.

For what you do everyday.

We value your partnership.

Pat Rawson, Chief of Mt. Vernon Rescue, has been with the service since its inception 33 years ago. She and June Leighton are the remaining members of the founding five. The squad has 12 active members, all Basic EMT’s.

“We’re all volunteers, with a range of ages, experience and professional back-grounds,” says Rawson, a grandmother and retired educator at Maranacook Middle School. “Mt. Vernon is a separate entity with our own vehicle and station, under the Fire Department’s umbrella.”

Four of her EMT’s also happen to be firefighters. Two people are on call when-ever possible, covering 12 hour shifts from 6 a.m.-6 p.m. Her crew responds to calls such as car accidents, falls, chest pain, and difficulty breathing.

With 20 area lakes and ponds, their service area of Mt. Vernon and Vienna plus camp roads and a section of Fayette off Sandy River Road encounters a dramatic

seasonal population increase. The EMT’s sometimes respond in their

own vehicles, and whoever is closest to the station will get the rescue truck. Their mis-sion is to use their basic EMT skills to care for and treat patients at the scene, while waiting for Winthrop Ambulance covering Mt. Ver-non, or North Star covering Vienna, to arrive.

“We strive to provide continuance of care, rather than just handing over the patient,” saws Rawson.

Keeping volunteer numbers sustainable is an ongoing challenge. Volunteering takes a commitment of time, motivation, train-ing, and skills practice to remain current. Mt. Vernon recently sponsored a new EMT class and will sponsor a summer class for first responders who will be paired with EMT’s to respond to Mt. Vernon Rescue calls, beginning in June.

Contact Kelly Roderick, Atlantic Part-ners EMS to learn more: 877-0936.

Maine EMS Service ProfileRegion 3: Mt. Vernon Rescue

photo courtesy JoN lJuNGGreN

The basic EMT’’s of Mt. vernon Rescue are a dedicated group. Standing (from left): Joe Lemieux, 5 years;

Susan Lemieux, 7 years; Tony Dunn, 10 years; Pat Rawson, 33 years; Laura Reville, 14 years; and Mi-

chelle Pelton, 20 years. Seated (from left): Janet Mciver, 1 year; Leslie Grenier, 31 years; Amanda Mills,

7 years; and June Leighton, 33 years. Missing: Roger Scott, 5 years; Becky Kent, 2 years.

No question, doing what it takes to become an EMT is challenging, and to be a Paramedic, even more so. But across the state, men and women of all ages are rising to the challenge. Some are pursuing their studies through community-based courses and local continuing education, while oth-ers are enrolled in college degree programs.

At 55 years of age Jeff Toorish is one of the latter, a nontraditional student and the oldest in his paramedic class at Southern Maine Community College. An avid adven-turer and a successful business entrepreneur with a communications background and a bachelor’s degree in theater, Toorish admits he never intended to study science or medi-cine. But a near-disaster during a Yucatan cave exploring expedition propelled him to acquire skills beyond the now-rusty basic first aid training he received in the Navy.

At first Toorish was surprised at the in-

tensity of both the coursework and the pace, but he also found EMS “utterly captivating.” Seeking “ride along” experience as part of his EMT education, Toorish joined North Yarmouth Fire and Rescue, and then Yar-mouth Fire and Rescue, attracted by their dive team. By the time Toorish was hired by Old Orchard Beach as a per diem EMT, he was hooked… and he knew he wanted to go beyond the basics and become a Paramedic.

Toorish describes the transition from basic first aid to Basic EMT is comparable to the leap from riding a bike to driving a car.

“But from Basic to Paramedic — that’s like learning to fly a plane,” he said.

Beyond medical knowledge requirements, there are leadership considerations, he says. Every student will one day be in charge, in the back of that ambulance.

His advice to would-be EMT students?

A day in the lifeWhat it takes to become an EMT

continued on next page

“Ready When You Least Expect It”

Southern Maine Medical

Center’s medical and emer-

gency response team trains

regularly with emergency

response personnel throughout

York County to ensure emer-

gency preparedness. Training

exercises often include

practicing decontamination of

patients exposed to chemical,

biological, radiological nuclear,

or explosive hazards. Hospital

staff must wear advanced per-

sonal protective clothing and

treat patients using nontradi-

tional measures.


We’re Proud and Ready to be a Part of the Team...

At St. Joseph Hospital’s Emergency Department, we salute our region’s

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work, dedication and extraordinary service to our patients and our communities.

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Emergency Department. Nurses and providers work quickly to evaluate the

needs of each patient. In most instances the initial evaluation is within twenty

minutes. Our goal is to provide quality, ef�cient and comfortable care.

Jamie Perry BSN, CEN Director

Charles F. Pattavina MD, FACEPMedical Director

St. Joseph HealthcareSt. Joseph Hospital

In the Spirit of HealingSponsored by Covenant Health Systems

Founded by the Felician Sisters

Your Doctors l Your Technology l Your Choice

360 Broadway l Bangor, Maine l www.stjoeshealing.org

We

Aw

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Maine’s largest and most innovative EMS provider proudly o�ers

www.MobileHealthMedics.pro(207) 510-0073

Bring your skills up to speed! Earn your AHA First Aid card in our 3.5 hour class, geared for the general public. Space is limited, $25 fee, day or evening sessions throughout central, southern & midcoast Maine.

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Mayo Regional Ambulance is one of a handful of hospital-based EMS services in Maine, says Mayo EMS Director Eric Young, Paramedic.

“We run 24/7 with a staff of about 60, including full time and per diem employees,” he adds. There are six “trucks” (or ambulances) in service, with crews responding from three bases: in Dover-Foxcroft, where the hospital is located, in Dexter, and in Corinth’s Fire Department. “We’re the seventh or eighth busiest service in the state,” Young said.

Covering 800 square miles in the center of Maine, Mayo EMS responds to 4,500 calls a year, including transfers and

emergencies. “A portion of the Appalachian Trail

is in our service area,” Young explains, “Most of our medics are trained in wil-derness rescue. Mayo EMS also provides [Advanced Life Support] back-up for surrounding services.

Young is justifiably proud of the Pisca-taquis County Crisis Intervention Team and the distinction his service has earned as the first rural program to offer a rigor-ous weeklong annual crisis training.

The training has been held for eight years, in collaboration with local hospi-tals and mental health facilities, police and corrections departments, and the sheriff ’s office.

Maine EMS Service ProfileRegion 4: Mayo Hospital EMS

“Most of our medics are trained in wilderness rescue.

Mayo EMS also provides [Advanced Life Support]

back-up for surrounding services.”

MAYO EMS DiRECTOR ERiC YOuNG, EMT-P

tensity of both the coursework and the pace, but he also found EMS “utterly captivating.” Seeking “ride along” experience as part of his EMT education, Toorish joined North Yarmouth Fire and Rescue, and then Yar-mouth Fire and Rescue, attracted by their dive team. By the time Toorish was hired by Old Orchard Beach as a per diem EMT, he was hooked… and he knew he wanted to go beyond the basics and become a Paramedic.

Toorish describes the transition from basic first aid to Basic EMT is comparable to the leap from riding a bike to driving a car.

“But from Basic to Paramedic — that’s like learning to fly a plane,” he said.

Beyond medical knowledge requirements, there are leadership considerations, he says. Every student will one day be in charge, in the back of that ambulance.

His advice to would-be EMT students?

A day in the lifeWhat it takes to become an EMT

Prepare to be focused and on your game all the time, and don't be surprised if, at least while you're in school, get-togethers with family and friends, and holiday celebrations tend to fall by the wayside. But through hands on practice, critical thinking exercises

and collaboration, you and your EMS stu-dent colleagues develop a close-knit bond.

At the opposite end of the spectrum, in terms of age and gender, is 20-year-old Sarah Jean Fallon, who also took a few minutes from her busy schedule to share her perspective earlier this spring. Fallon was juggling her Eastern Maine Community College studies with a two to three days per week work-study position at Atlantic Partners EMS.

“Everyone can become an EMT if you have the ambition,” Fallon said. “I knew it was what I wanted, because I found it fast paced in every respect, even the work-study part.”

Fallon previously acquired a familiarity with medical billing and coding by earning her Certificate in Medical Administrative Assistance.

To finish up her course requirements, Fallon was taking a two-and-a-half-hour

night class that met two evenings a week, as well as all day Saturday once a month, in addition to two required non-EMS electives. She was grateful that the nature of her work study position afforded her some flexible access to equipment for hands-on practice, but she still had to find additional time for 15 hours of studying every week — not including homework.

Fallon admits she thrives in an envi-ronment where there always seems to be something to be done, and always a way to get involved and be helpful.

“I’m a pharmacy technician in Milford, and hopefully I’ll be able to volunteer for

“Everyone can become an EMT if you have the ambition.”

SARAH JEAN fALLON

Age is just a numberphoto By NaNcy McGiNNis

flanked by Liberty Ambulance

Asst. Chief Kathy foley (L) and

driver Peter Maruhnic, Edna

Mitchell, center, is delighted to

hold the honor of being Maine’s

oldest practicing EMT. Mitchell,

who will celebrate her 85th

birthday next week, says her

interest dates back to her youth,

during World War ii. Her parents

had signed up for a community

first aid class, and the local game

warden who was teaching it

said he didn't mind if she tagged

along. Read more of her story on

page 12.


BY NANCY MCINNIS

EMS personnel from across the state, their families and friends, and the general public are all cordially invited to join Maine EMS on Saturday morning, May 18 on the capitol grounds in Augusta. This first-ever celebra-tion in observance of National EMS Week will take place on the site of the groundbreaking for the EMS Memorial and Education Center, between the Police and Firefighter Memorials adjacent to State Street.

The program, beginning at 9:30 a.m., will feature a celebration of the Maine EMS Memorial and Education project, the Maine EMS Board's annual statewide awards pre-sentation, and the kickoff of the National EMS Memorial Bike Ride.

THE MAINE EMS MEMORIAL AND EDUCATION CENTER SITE:

Remembering each sacrifice; honoring every contribution dedicated to those who have built the system; to those who gave their lives, saving others; and to those who make the system work every day.

The Memorial, located on the Capitol grounds in Augusta, is flanked by the exist-ing fire and law enforcement memorials near the State House.

Not a traditional memorial, it has been uniquely designed as a visually striking, contemplative space around an illumi-nated glass “Star of Life’ panel, a number of granite columns, and a remarkable audio component. Visitors can hear representa-tives of Maine EMS describe in their own

words and voices the system and how it was founded. Loved ones and colleagues recall those EMS providers whose lives have been lost in the line of duty. All will be lit for night display.

While the Memorial pays tribute to those who have sacrificed their lives during EMS duty, it also recognizes those who serve EMS patients every day throughout Maine, and those who have helped build the statewide system.

Using a cell phone, visitors can listen to interesting and moving stories on the audio tour. This innovative audio component was created to give the Memorial a meaningful public education role as well.

With Phase 1 of the site to be completed this summer, support is being actively

solicited for Phase 2, which will commence when funding is in place.

Donations for this non-profit project are welcomed in any amount. Individuals, businesses, groups and organizations are encouraged to support this 100% privately funded project. Gifts can be made in honor or in memory of loved ones or colleagues.

To learn more, follow the link at www.apems.org or find the Maine EMS Memo-rial on Facebook.

Make a donationDonations, payable to Maine EMS Me-

morial/APEMS, may be sent to: Atlantic Partners EMS71 Halifax StreetWinslow, ME 04901

You are invited to the Maine EMS CelebrationJoin EMS professionals, their families and friends, and the public on May 18

The Maine EMS Memorial Site is en-visioned to recognize the sacrifices of EMS professionals who have lost their lives in the line of duty, to honor EMS leaders who have helped build Maine’s EMS system, and to inform you about that system and those who make it successful every day.

Because this memorial is made possible entirely thanks to donations, it is being established in two phases, as funding allows. During your visit, you will find both visual and audio features. When the second phase is completed, there will be an additional glass panel depicting the Maine EMS system, more benches, landscaping, and illuminated granite posts for each person honored and each EMS role described in the Audio Tour.

AUDIO TOURTo listen to the voices of Maine EMS, call

(207) 480-3104. You may select any story at any time. Just press the number of the story on your keypad.

1 Welcome!2 The “Star of Life”: EMS’ Symbol3 The Story of the Memorial4 A Two Part Building Project: Help us With Part 2!5 For Those Who Have Given Their Lives

6 Richard Farrar, Paramedic, 1/30/927 Matt Jeton, Flight Paramedic, 11/19/938 Donald MacIntyre, Flight Nurse, 11/19/939 Robert Washington, Paramedic, 1/27/9610 Don Martin, Paramedic, 8/3/9811 Alan Parsons, Paramedic, 7/5/0712 Peter Carbonneau, Paramedic, 4/8/1213 For Those Who Helped Build the System14 Dr. Alan Hume15 Dr. Larry Hopperstead16 Dr. Robert Tredwell17 For Those Who Make the Maine EMS System Successful Every Day

18 Volunteer EMS Responder (Wayne Seeley; Dennysville)19 EMT (Randy Bossie, Patten)20 Paramedic (David Buccello; Southwest Harbor)21 Emergency Physician/ EMS Medical Director (Dr. Rebecca Chagrasulis; Norway)22 Trauma Surgeon (Dr. David Burke; Bangor)23 Interventional Cardiologist (Dr. Mirle “Bud” Kellett; Portland)24 Trauma Nurse (Tammy LaChance; Portland)

25 Emergency Nurse (Carmen Hetherington; Lewiston)26 Emergency Medical Dispatcher (Jennifer Rairdon; Houlton)27 Flight Nurse/Flight Paramedic (Lori Metayer; Lewiston)28 Community Paramedic (Adam Michaud; Presque Isle)29 Regional EMS Director (Joanne LeBrun; Lewiston)30 State EMS Director (Jay Bradshaw; Augusta)

About the Memorial

richarDsoN aND

associates DrawiNG


Carmen Hetherington, Registered Nurse and Clinical Educator at CMMC “Because emergency medical practices are dynamic and changing on a daily basis, education is essential

for EMS personnel.”

Emergency Medical Services: in their own words...

Tammy Lachance, Trauma Program Manager at Maine Medical Center

“Emergency nursing tends to attract people

who like variety and chaos. it also has to be

somebody who’s physically and emotionally

tough and doesn’t mind blood and guts.”

Dr. Larry Hopperstead, Central Maine Medical Center trauma surgeon

“in years of performing trauma surgery at

CMMC, i’ve saved hundreds, perhaps thousands

of lives. But what i think is even more important

is my role in helping to build a system. One that

can be reliably counted on to make decisions

about where you need to go, how you need to

get there, and what needs to be done in the time

frame before you can get there”

Dr. David Burke, Trauma Medical Director, Eastern Maine Medical Center“One person doing this doesn’t work.”

photo By roB roseNthal

Mary Jeton, mother of Maine EMS professional Matthew JetonMother of the late Matthew Jeton, shares her thoughts on the Maine EMS Memorial audio tour. Air

medical transport was relatively new to Maine when her 25 year old son lost his life in the Casco

Bay crash of an Airmed Skycare helicopter on November 19, 1993. Jeton, of Portland, was a

Paramedic with united Ambulance of Lewiston as well as for Airmed. flight Nurse Donald Macintyre

of Concord, NH also died in the crash, that occurred while they were transporting an elderly burn

victim from Ellsworth to Portland. Rick Petrie, a fellow Paramedic at united at the time, organized

the memorial service for these first line of duty deaths in Maine EMS history. “Matt and Don will be

with us always, urging us to learn and grow and improve,” said Kevin McGinnis, then director of

Maine Emergency Medical Services. Petrie and McGinnis have worked tirelessly for almost a decade

now, leading a dedicated volunteer committee toward making their vision of a EMS Memorial and

Education Center a reality.





Maine Emergency Medical Services Week 2013 • May 17, 2013 1110 Maine Emergency Medical Services Week 2013 • May 17, 2013

Located in the northern most section of Maine, in Aroostook County’s year-round outdoor recreation hub, Caribou Fire and Ambulance relies on snow sleds, five ambulances and two fixed-wing aircraft operated in collaboration with Cary Medical Center.

Fire Chief, Service Director, and Para-medic Scott Susi oversees three crews of four, working 24 hours on and 48 off.

His crews, which include Paramedic InterFacility Transport Paramedics, cover eight communities in a 348-square-mile area. Each year they respond to about 2,300 ambulance calls.

“With all-season trail systems running from here to Cross Lake, and the sum-

mer influx to Madawaska Lake, we cover everything from snowmobile to four-wheeler to summer boating accidents,” says Susi.

In addition to outdoor sports, the Cari-bou area’s forestry activity occasionally brings rescue calls for logging accidents, skidder injuries and falls on job lots, and even extricating folks who have become trapped under fallen trees.

“We can bring patients in on one of our ambulances and fly them out on a plane, taking off from Presque Isle or Caribou,” says Susi. His service also holds the north-ern region contract serving transfers for veterans residing from Millinocket to the Canadian border.

Maine EMS Service ProfileRegion 5: Caribou Fire and Ambulance

“With all-season trail systems running from here to

Cross Lake, and the summer influx to Madawaska Lake, we

cover everything from snowmobile to four wheeler to

summer boating accidents.”

fiRE CHiEf AND SERviCE DiRECTOR SCOTT SuSi, PARAMEDiC

No one enjoys a trip to the hospital emergency department, but most people are grateful this resource exists for, well, emergencies.

Emergency departments are never closed, and no one in need of care is turned away. The MaineGeneral Medical Center Emer-gency Departments in Augusta and Water-ville receive a total of 63,000 visits a year.

But is the emergency department the best place to go? And are there things to know ahead of time, to make the experience as successful as possible?

“It’s important to keep in mind that the priority is making sure that people who are in need of quality medical care receive it, whether it’s delivered by us or facilitated by other care options,” says Dr. Tim Pieh, who spent two years as a primary care physician

before joining the MaineGeneral Emergency Department six years ago.

“Your primary care provider should be your central resource,” he continues. “When you’re not feeling well, the first phone con-versation you have should be with the PCP."

Even at night or over the weekend, he adds, there is a covering provider, whether a physician, nurse practitioner, or physician’s assistant.

What’s behind this advice? It assures continuity of care, Pieh said, something that is more difficult to achieve when a patient is seen for the first time by the attending phy-sician who happens to be covering the ED.

Instead, the primary care provider, who already has an established relationship

The Emergency DepartmentWhat to know and when to go


in the MaineGeneral Emergency Department in Augusta, (from left) registered nurse Nancy Jackson and

physicians Tim Pieh and Tom Liscord discuss a patient’s care.

EMERGENCY DEPARTMENT PAGE 11


with the patient and knows their medi-cal history and prescriptions will make arrangements to see a patient in need, even outside of office hours. Some PCPs schedule regular acute visit hours, when patients can walk in and be seen with little or no waiting time. If it is determined there is a critical need for care, the office can call 9-1-1 on the patient’s behalf, and fax a medication list, office notes, and other information directly to the ED.

“Before you need it, now is the time to find out what care options are avail-able through your primary care provider,” echoes Nancy Jackson, a registered nurse at MaineGeneral for 25 years who has worked in its Emergency Department for the past 13. “The next time you see your own doctor, be sure to ask how he or she recommends you should handle an emergency.”

Express Care — also known as “Urgent Care” — can sometimes be an expedient and cost effective alternative to the emer-gency department. MaineGeneral main-tains Express Care facilities in Augusta and Waterville, open daily including weekends and holidays, for non-emergency illnesses and injuries such as cold, cough, flu, sea-sonal allergies, ear and urinary infections, fractures, and wounds.

“Every health system in Maine has the equivalent of this,” says Dr. Barbara Crowley, a longtime area physician who is now Execu-tive Vice President at MaineGeneral Health.

Last year, MaineGeneral Health launched a new initiative to connect patients with primary care. By calling toll-free (855) 464-4463, community members can find a PCP or specialty care provider.

“More than that, they can get personal-ized help finding a provider, a class or sup-port group, or just answers to any ques-tions they may have about MaineGeneral’s health care system,” says Jackson.

Pieh echoes that. “We’ve been working to get the word out that we maintain a list, updated monthly, of area practices accept-ing new patients,” he said. “Primary care is available on a sliding fee scale basis, so the services are based on need, not ability to pay.”

Other Maine hospitals offer similar assistance. Maine Medical Center, for example, has created a user-friendly website, findadoc.mmc.org to make it easy to search for a specialty or primary care provider, including those accepting new patients.

Another valuable resource for Maine residents searching for a PCP is

EMERGENCY DEPARTMENT PAGE 11

EMERGENCY DEPARTMENT FROM PAGE 10

MAINE ED PAGE 15

Going to the EDWhen it is necessary to go to an Emergency Department, remember these tips:

• Bring a complete, up-to-date medi-cation list or bring the actual medica-tions in a paper bag.

• Inform ED staff of any implanted devices or hardware, such as a pace-maker, artificial hip or surgical pins.

• Bring a family member or trusted support person to be your advocate. In a stressful situation such as an ED visit, MaineGeneral Emergency De-partment’s Dr. Tim Pieh explains, the average patient only hears and retains about 10-20 percent of information presented. A support person can provide comfort and advocate for your care; and later help you understand your care instructions and treatment plan.

Biking for a MemorialDuring the National EMS Memorial

Bike Ride last year, “Muddy Angel” Carl

french, firefighter/EMT-P with Sanford

fire is shown relaxing in Eastern PA “on

a 90 degree day in the shade.” french,

who is also a member of the Maine

Honor Guard, will be riding for the third

time this year. Over a hundred cyclists

are expected to participate in the 2013

Ride, which will depart from the Maine

EMS Memorial and Education Site on the

state capital grounds Saturday morning.

photo By isaac GreeNlaw, coMMuNicatioNs

specialist, MeDcoMM llc, BaNGor MaiNe.

FireFiGhter/eMt with GleNBurN puBlic

saFety

help the caller and the person in need, before the arrival of EMS. In addition to reassur-ance, they can provide detailed, step by step coaching so that the caller can deliver a baby, perform CPR or use an external defibrillator, or restore a choking victim’s airway.

Licensed Emergency Medical Dispatch-ers complete a three-day course, as well as extensive orientation, job shadowing their experienced counterparts before they start answering calls.

“You have to build confidence in order to

do this job,” says John Thibodeau, an EMD at Sagadahoc County Communications Center and a longtime volunteer firefighter. EMD’s are required to complete vigorous training and continuing education require-ments to be eligible to renew their licensure. For quality assurance, their calls, which are automatically logged and recorded, are fre-quently sampled for review and feedback.

Determinant codes — identified by using the protocols — can be used to categorize calls from “alpha” (lowest priority: perhaps a twisted ankle) to “echo” (top priority: such as respiratory difficulty, altered mental sta-tus, chest pain, and bleeding). The codes can avoid misuse of resources, such as sending an advanced life support ambulance lights and sirens to a patient with a sprained ankle.

If the patient’s condition is unstable, the

EMD will stay on the line with the caller until help arrives. If the patient is stable, before signing off the EMD will advise the caller that the ambulance is on its way. In preparation, pets should be secured, and the patient’s medications gathered; noth-ing should be given to the patient to eat or drink. It is helpful to turn on the porch light, and of course, to call 9-1-1 back immedi-ately if anything changes.

EMD’s are the ultimate customer service agents, White affirms, with a unique skill set. At any given moment, they must be able to communicate effectively over the

phone, remain calm and courteous, follow the protocol, stay grounded and focused for the duration of the call, and simultaneously acquire and enter data while monitoring the computer screen and radio traffic. They may be using touch screens, keyboards, a phone, a headset, a radio, even a pen and pa-per — or all of the above. They are trained to employ techniques such as repetitive persistence to handle callers who may be understandably hysterical.

“When someone is panicked and out of it you need to bring the person back down by saying, several times if need be, exactly what you need them to do and why they need to do it,” says White. There may be minutes or hours between emergencies, yet EMD’s must be alert and ready to handle a call whenever it comes in.

It’s an art as well as a science to succeed in such a non-visual environment, without the advantage of eye contact or body language,” said longtime Sagadahoc Communica-tions dispatcher Laura Downing, EMD and EMD-Q, EMT-I. Downing is also the EMD representative to the Maine EMS Board.

“Unlike other EMS providers, we’re obliged to trust the caller or the patient for information, relying on what they say and the tone of their voice… and when people are distraught we need to reassure them, without being able to pat their shoulder or hold their hand,” she said.“EMD’s are the first of the first responders.”

Maine Emergency Medical Services Week 2013 • May 17, 2013 1312 Maine Emergency Medical Services Week 2013 • May 17, 2013

Liberty Ambulance is a private, non-profit service covering the towns of Liberty and Montville, each with a population of 800 to 900, says Director Chris Birge. He is one of the service’s eight Basic EMT’s, along with two Intermediate EMT’s and one Paramedic, who respond with their one ambulance to 160-190 calls a year.

It’s a small, friendly bunch, and their calls include neighbors who have suffered a fall, the occasional chain saw accident, bee stings and other outdoor injuries at the Damar-iscotta Lake State Park, and sadly, some sui-cide attempts. “Half of us have been doing this for 10 years or more,” says Birge.

And then there’s Edna Mitchell. A former local school teacher, she’s an active EMT who has been a member of Liberty Am-bulance since 1978. Though Mitchell will celebrate her 85th birthday next week, she still keeps her sneakers handy every night, with the laces loosened just in case the pager goes off. Her colleagues miss her when she and her husband spend winters in Florida. She is warmly welcomed back every spring.

“Edna’s such a wonderful resource — not just as for her great skills as a medic but because she knows the area and the townspeople, at least those who’ve been here a while, better than anyone,” says As-sistant Chief Kathy Foley, who relocated with her family in 2010 from Washington state to a working farm in Montville.

Birge and Foley have collaborated diligently to keep the volunteer ambulance service in compliance with state regula-tions, policies and guidelines, and to explore ways to improve, such as reducing response times. Birge credits Foley with spearheading initiatives including a planned presentation, complete with simulators, on the dangers of distracted driving for the students in the

three Waldo County high schools. “That’s the one call we don’t want to go

to,” the mother of five said. Foley hopes to host a community CPR class and is ac-tively seeking funding to purchase AED’s.

“When you live in a rural area, it can seem like a lifetime waiting for the am-bulance,” she said. It could easily take 20 minutes or more, to traverse the service area’s 40 or 50 miles of roads.

“It was a really difficult decision for me, to jump into the back of an ambulance,” Foley confesses. After we moved here I would hear pages for Liberty Ambulance once, then again and even a third time, on my husband’s fire department radio… and I would think “what if that call were my family in need, and waiting? I joined Lib-erty Ambulance because it seemed really important for someone to come forward.”

But joining the ambulance service has also opened doors, she says, helping her feel part of the community and allowing her to get to know wonderful people, like Edna Mitchell, whom she might never have met had she stayed on the farm. “Everyone should think about volunteering — even auxiliary members can be a big help.”

Maine EMS Service ProfileRegion 6: Liberty Ambulance

Liberty Ambulance Basic EMT Edna Mitchell, a lifetime

local resident and longtime crew member, poses with

Asst. Chief Kathy foley and driver Peter Maruhnic.

EMD FROM PAGE 5

“unlike other EMS providers, we’re obliged to trust the

caller or the patient for information, relying on what they

say and the tone of their voice … and when people are

distraught we need to reassure them, without being able to

pat their shoulder or hold their hand.” LAuRA DOWNiNG, EMD AND EMD-Q, EMT-i, SAGADAHOC COuNTY COMMuNiCATiONS CENTER

WHERE EXCELLENCE HAPPENSEMS Responders

SMMC Salutes

1 Medical Center Drive, Biddeford smmc.org

Partnering to keep our communities healthy and safe.


“The sad truth is most people don’t survive a cardiac arrest,” stated the Ameri-can Heart Association. “Four to six minutes is the window of opportunity for someone to start CPR before it’s too late, but fewer than one-third of cardiac arrest victims get CPR from someone nearby.” Bystander CPR can double, or even triple, a cardiac arrest victim’s chance of survival.

It’s not just older folks who are suscep-tible to cardiac arrest, points out Joanne LeBrun, executive director of Tri-County EMS in Lewiston.

“These days, we’ve seen young people suddenly collapse on the ball field or ath-letic track,” she said.

That’s why taking prompt action is criti-cal and CPR is easier than ever to learn.

“Two things: if someone collapses in front of you, call 9-1-1 and immediately start chest compressions especially if the person is suffering from a particular, common kind of arrest known as ventricular fibrillation,” she said. “Your action can save a life by getting the heart, which is misfiring, back on track and pumping again in an organized fashion."

Since 2008, the American Heart Association

has endorsed CPR utilizing chest compres-sions alone, without mouth-to-mouth resusci-tation. Research has found that during the first six minutes after collapse, there is enough residual oxygen remaining in the system. Be-cause of that, restoring the heart is the focus.

How can you learn CPR? There are a num-ber of widely available classes offered through the American Heart Association, the Red Cross, and local adult education programs. Training for the general public is minimal, says LeBrun, and there is no written exam. Instead, the emphasis is on practical skills.

It takes just two minutes to watch the infor-mative hands-only CPR instructional video at heart.org. In addition to demonstrating the technique, the video suggests using the tempo of the classic disco song, “Stayin’ Alive” as a guideline for the correct chest compression timing of 100 beats per minute.

Knowing that without swift intervention the cardiac arrest will be fatal, what have you got to lose? Even if CPR attempts fail, Maine has a Good Samaritan law that protects citizens from liability, LeBrun advises. Another observation: when someone collapses in a public place, some would-be rescuers hesitate, thinking “there’s probably someone else more qualified than me.” But experience has shown that when one person stops to help, “others will jump in and we’ll get the job accomplished.”

She also recommends attending a class in order to build confidence, since participants

receive supervised, coached practice and the opportunity to ask questions, as well. In addition, classes include mouth-to-mouth or mouth-to-face-mask resuscitation, which can be helpful especially in circumstances such as drownings.

Classes also provide an introduction to the

Automatic External Defibrillator, or AED. Thousands of AED’s have now been installed in Maine and everywhere — in schools, shopping malls, churches, bingo halls, air-ports — wherever people gather. The AED is a portable device that can be used to shock the heart back to normal rhythm. While the AED is designed to be user friendly for the untrained person — just turn it on, and follow the instructions it provides — many

people benefit from the chance to learn more in advance, and while not in the middle of an emergency situation. It’s a good idea, says Lebrun, to find out the locations of AED’s in venues where you and your family spend time; and to look into getting them if they

are not already in place.“Over and over, I’ve seen bystander CPR

mean the difference between life and death,” Lebrun emphasizes. “CPR gives people who have collapsed in cardiac arrest the chance to survive to get to the hospital, receive treatment, and go home and be back to work in a matter of days. It’s really happen-ing, right here in Maine.”

Ensuring people are “Stayin’ Alive” Knowing the proper way to do CPR can keep your community safe

“Don’t be afraid; your actions can only help. if you see an unresponsive adult who is not breathing

or not breathing normally, call 911 and push hard and fast on the center of the chest.” AMERiCAN HEART ASSOCiATiON, HEART.ORG


On behalf of North East Mobile Health Services and its

staff, Division Commander Lori Rice, Paramedic (left)

presents an Automatic External Defibrillator to Bette

Horning, director of the Golden Oldies Senior Center.

The lifesaving device will be permanently installed in

the Center, where it can be employed in emergencies

to restart a stopped heart. The poster in the foreground

shows the NEMHS crew members and others at the

Polar Dip last December, where North East employees

collected on pledges by braving the frigid water — all

to support this good community cause.

photo courtesy MaiNe eMs

AEDs like this one can be found in public and the

Maine EMS community welcomes the public to

learn how to use one.


Community Paramedicine is a visionary opportunity for emergency medical services to identify other local health care partners and address unmet needs in their commu-nity, says Jay Bradshaw, director of Maine Emergency Medical Services, the bureau within the Department of Public Safety that is responsible for the state EMS system.

Especially in rural communities in Maine and elsewhere, though EMS providers are ready to respond 24/7 they may not be called upon often.

“Community paramedicine is a way to expand their sphere, not their scope, of practice,” Bradshaw explains.

This innovative approach has been catch-ing on across the nation since it was first conceived some years ago, with the land-mark publication of the Rural and Frontier EMS Agenda for the Future, authored by Kevin McGinnis in 2004.

The vision for Community Paramedicine in Maine is not limited to Paramedic level EMS providers, but would focus on any

EMS personnel with the training and skills to meet the needs identified in their local community, and required for proficiency in assessment skills.

With up to 12 services authorized by the Maine Legislature to participate in a CP pilot project, Maine EMS set about crafting a purposely open application process earlier this year.

“We didn’t create a box,” says Bradshaw. “We provided a framework, avoiding the ‘one size fits all’ route.”

Maine EMS strategically involved the

Maine Hospital Association, Maine Medical Association, the Board of Nursing, Office of Rural Health DHHS, hospital repre-sentatives, family practice and emergency department physicians, to form a steering committee involved with clinical as well as and administrative aspects.

Creative proposals were invited, through an application process which required ser-vices to learn more about the unmet needs in their communities, and develop partner-ships to address them.

To date, six services have been approved and all will have launched their CP Pilot Projects before the end of the year. In order to participate, each service needs to assess its own resources as well.

There is no provision for Medicare, Medic-aid or insurance company reimbursement at present, and for the purpose of this project, no charge to community members and patients. Each service is expected to pick up the cost of its three-year pilot project. Maine EMS provides an annual report on the pilot project

to the Legislature and others, and Bradshaw expects that the data will either support CP in Maine or not. It already has elsewhere.

“We’ll be looking to see if our hospital readmission rates are decreased, or there is a reduced number of patients being seen in emergency departments,” Bradshaw said.

Some applications have been specific and narrow in focus, says Bradshaw. In one project, North East Mobile Health Services will work with 9-1-1 ambulance services to help patients who have fallen to retain their independence. The goal will be to interact with these patients who have been identified as likely to fall again, and help them modify their activities and environment in order to significantly lower their fall risk — a major cause of morbidity and mortality.

North East is also piloting a CP project in conjunction with Maine Medical Center, us-ing telemedicine to work with their patients recovering from traumatic injuries.

Community paramedics can assess the pa-

Community ParamedicineA new role for Maine Emergency Medical Services

PARAMEDICINE PAGE 16

“This is all about relationships.”

DiRECTOR Of MAiNE EMS, JAY BRADSHAW


Eventually, however, hospitals realized that their practices and technologies ran into an unbreakable barrier: time.

EMS experts began to realize that EMS providers could give that precious resource to hospitals through early identification and early notification. Taking an integrated, parallel processing approach profoundly impacts the event to treatment window.

The Stroke Identification and Early Noti-fication Protocol Busko developed in 2009 for Maine EMS Region 4, later became, the MEMS Statewide Stroke Protocol. Since last year, when EMMC rolled out the EMS Blood Draw for Stroke program, “our percentage of door-to-drug times under one hour has gone up considerably, due to a combination of prehospital and hospital based practice changes to streamline patient movement flow,” Busko said.

At Mount Desert Island Hospital, for example, door-to-CT-scan time for EMS-transported stroke patients is now typically under 10 minutes. The expedited process is made possible by the early notification protocol: “a dramatic change” from four years ago. The clinician meets EMS on ar-rival, and performs the assessment while the

patient is being transported to imaging — where staff are ready and waiting.

Over the course of his 18 years performing trauma surgery at CMMC, Hopperstead has saved hundreds, perhaps thousands of lives.

“But what I think is even more impor-tant,” he says, “is my role in helping to build a system. One that can be reliably counted on to make decisions about where you need to go, how you need to get there, and what needs to be done in the time frame before you can get there.”

Hopperstead also takes enormous pride in how EMS has evolved in our state.

“EMS folks wanted to do more, and we learned that they could do more ... to the level where they are actually taking better care of patients. They have developed a sense of esprit de corps, and are now constantly pushing their own envelope to try to do more, within the limits of licensure.”

Thanks to trained and dedicated EMS providers in every nook and cranny of the state, “people in need don’t have to wait so long for help. EMS providers deserve the utmost respect for constantly putting them-selves in trying and difficult decision making situations — and making consistent and reliable patient outcomes a reality.”

RESPOND FROM PAGE 3

mainequalityforum.gov.Crowley has been spearheading a team

effort to craft a vision for population health management at MaineGeneral and beyond. The effort would provide area residents access to good, affordable medical care, options and resources, she notes that qual-ity, experience, and cost are among the key factors, and a variable delivery system is critical.

“Of the 190,000 residents in our primary and secondary service areas, 115,000 have indicated they are connected to a primary care provider,” she said. “When someone shows up in our ED or Express care, we’re paying attention to who should be receiving primary care, but isn’t.”

The effort will encourage people without a PCP who are seeking care at an express care or emergency facility to choose one. Assistance is offered.

The bottom line, she said, should be the bottom line, Pieh emphasizes.

“The Emergency Department is open 24/7. If you come here, we not only have to take care of you, we want to take care of you. But it’s always better when there is continuity of care.”

MAINE ED FROM PAGE 11

PARAMEDICINE PAGE 16

from Civil War Days to Modern Days: EMS was there

photos By NaNcy McGiNNis

Technology might have changed, but the need for emergency medical personnel doesn’t. Pictured at left is a Civil War era ambulance, pulled by horses to get

soldiers to urgent care areas. Times have changed, and so has technology, but the need for medical care in emergencies remains constant.


tient at home and using an iPad-like device to communicate findings to the doctor. This will spare the wear, tear, time, and expense of travel for patients — some of whom would have been originally transported to the Trauma Center from afar by helicopter.

Other proposals are taking a broader approach, focusing for example on patients after they have been discharged from the hospital. Delta Ambulance is working with MaineGeneral, along with Dr. Amy Mad-den and staff at the Belgrade Health Center, to identify patients whose follow-up needs could be met outside of a clinic visit.

Community Paramedics can check pa-tients’ weight and vital signs, draw blood and help them manage their prescriptions. Delta will schedule the CP visits and provide regu-lar reporting back to the physician. Patients will receive the care they need, provider time and resources will be better utilized, trans-portation logistics simplified, and hospital re-admission rates ameliorated.

These examples spotlight how some pa-tients are currently very resource-dependent largely because of the way their care is being managed. Bradshaw stresses that CP is in-tended to be conducted in collaboration with a primary care provider. It may benefit a pa-

tient who is not eligible for, or has exhausted, home health care services, but CP is intended to be limited to short term or episodic care.

In addition to Delta and North East Mo-bile Health Services, the first round of CP pilot projects also includes Crown Ambu-lance in Presque Isle; St. George Ambulance in Port Clyde; Calais Fire Department, and

United Ambulance in Lewiston/Auburn.“This is all about relationships,” he said.

“We’re increasingly aware of primary care clinics, hospice facilities, patient centered medical homes and other entities that al-ready work together as a team of sorts, with or without EMS providers.”

“And it’s really appropriate that EMS

would be involved. We are a great resource, as the mobile unit potentially bridging the gap for primary care, home health, hospitals and emergency departments. As providers, we are already uniquely experienced at going into patients’ homes, where we are given access to the individual and his or her property, and we’re viewed with high regard and trust.”

PARAMEDICINE FROM PAGE 14


in March 2012, at a forum hosted by Maine EMS, Jay Bradshaw and Kevin McGinnis members of Maine’s EMS, hospital and physician, nursing, home health care

and other institutional and professional organizations to learn more about Community Paramedicine.

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