Aging population means greater need for rescue services

HARPSWELL — Joyce Thomas does not remember fondly a time last year when there were no emergency medical technicians available in Harpswell Neck for a 911 call. 

It was during the day, and like many of Harpswell’s volunteer EMTs, she was out of town. When no one answered their radios, the call was redirected to Brunswick, which sent an ambulance down the Neck right away.

Thomas, who is the Harpswell Neck rescue chief, didn’t want to discuss details of the medical emergency because doing so may have identified the patient. But one thing about the event was clear: it bothered her, a lot.

“It’s frustrating,” she said. “It’s getting harder to find any volunteers, let alone day volunteers.”

In recent years, the dwindling number of fire and rescue volunteers in Harpswell has made situations like this one more common.

In the past, each of Harpswell’s three fire departments – Harpswell Neck, Cundy’s Harbor and Orr’s & Bailey Islands – have had enough personnel to respond to medical emergencies in their areas without outside help. But now, fire and rescue chiefs say they call surrounding departments and local hospitals for medical assistance more often than they would like.

That can be problematic, especially in medical emergencies when the patient requires advanced life support – exactly the type of 911 calls that have become more frequent in recent years because of the town’s aging population.

“Time is a critical component, and any situation that extends that time is certainly not helpful. It has the potential of reducing a positive outcome,” Harpswell Neck Fire Chief David Mercier said.

Fewer volunteers

While Harpswell’s situation is exacerbated by an aging population, its decline in volunteers is not an anomaly. A 2007 study by the Federal Emergency Management Agency found volunteerism to be in decline around the country, especially in the Northeast, an area that “has traditionally been protected by volunteers more than other regions.”

Harpswell illustrates many of the study’s findings, including that changing social dynamics make volunteering less appealing.

“Back in the ’60s, the Fire Department had quite a social aspect to it,” Mercier recalled. People were introduced to firefighting or rescue through their friends and families, and stuck with it.

“That’s kind of been lost over time,” he said.

As more families require two-incomes, there is less time for socializing and volunteering.

“We’re a bedroom community where everybody goes out of town to work or goes offshore on a boat,” Cundy’s Harbor Fire Chief Ben Wallace said. Residents who work out of town commute an average of 31.9 minutes to work, according to recent U.S. Census data, making it harder for them to get back quickly for a 911 call.

Increased training requirements are also a deterrent to potential volunteers.

“Back in the beginning, you showed up and were given a black rain coat and a hat and hoped to do well,” Mercier said.

Now, 100 hours of class time are required to be a Level 1 firefighter. Training is even more demanding for EMTs, who must take 136 hours of class for their basic certification, and more than 350 hours to be a paramedic, according to the FEMA study.

“The amount of time it takes to train has doubled, or tripled, in the last 15 years,” Wallace said. “The time commitment is huge.”

As Harpswell’s volunteers decline, the ones that remain are getting older, and there are fewer young people to replace them. Harpswell’s average age in 2009 was 51.5 years, compared to 45.3 in 2000. Less than a quarter of the town’s population falls in the prime age bracket for volunteers, 18 to 44.

Thomas said she knows several older fire and rescue chiefs want to retire, but they are concerned that no one will step into their shoes.

Greater demand for services

Around the country, volunteer fire departments have experienced an increase in emergency calls.

The FEMA study found that 911 call volume at volunteer departments has increased 25 percent to 75 percent since the early 1980s, partially explained by an increase of non-emergency calls.

In Harpswell, the number of emergency medical services calls increased by 25 percent between  just 2000 and 2010, according to data provided by Town Administrator Kristi Eiane.

Nearly a quarter of Harpswell’s population is over the age of 65, and this presents a challenge to volunteer EMTS, because the elderly use a disproportionate amount of emergency medical services,  according to a 2008 study of Harpswell’s fire and rescue services by Emergency Consulting Services.

An aging population also means the types of 911 calls have changed. Wallace said he gets a lot of 911 calls now from elderly residents who live alone and have fallen out of a chair or bed, but are not hurt. He said he has had to approach frequent callers’ families to explain that they need to get more involved so that their elderly relatives don’t have to call 911 whenever they need help. 

Thomas said more callers are also reporting difficulty breathing, chest pain, and other symptoms of cardiac arrests, seizures or strokes.

“Broken arms aren’t the meat they used to be,” she said.

These types of calls require advanced life support and paramedics, something Harpswell’s volunteer fire and rescue departments cannot provide. When they receive a call requiring these services, fire and rescue chiefs will request a “fly car” – a paramedic from Mid-Coast Hospital in Brunswick.

At a March 29 meeting of the Harpswell Fire and Rescue Committee, the chiefs estimated that this happens approximately half of the time.

Longer response times

Serious medical conditions make speedy response time even more important, because the likelihood of surviving a traumatic event like cardiac arrest drops quickly as emergency medical care is delayed, according to the Emergency Consulting Services study.

Wallace said that many EMTs are taught the concept of the “golden hour”: that the time from rescue dispatch to the hospital should be no longer than 60 minutes. But that time frame doesn’t apply in serious medical emergencies, he said.

“Because ALS are a larger percentage of calls, (we) need to be at definitive care in less time,” Thomas said.

Harpswell’s challenging geography already pushes response times above the National Fire Protection Association’s recommended limit for rural areas – even when outside help is not requested, according to the ECS  study.

The NFPA recommends that for areas with Harpswell’s population density, at least 80 percent of 911 calls should have a response time of less than 14 minutes.

None of Harpswell’s three departments achieved this standard, according to the study. Cundy’s Harbor and Harpswell Neck each responded to 80 percent of their calls closer in closer to 18 minutes, and Orr’s and Bailey Island was just over 21 minutes.

Wallace estimated that whenever the Cundy’s Harbor Fire Department requests help from Orr’s & Bailey Islands, response time can be delayed by another five to 10 minutes. And if he does call the islands for help, he worries that he may be taking the one or two available EMTs away from that part of town.

A possible solution

Since December, the Harpswell Fire and Rescue Committee has been trying to figure out what to do to ensure adequate EMT coverage, especially during the day, when most volunteers are working.

Right now committee members are looking into privatizing emergency medical services. They have asked four providers, Mid-Coast and Parkview hospitals, Northeast Mobile Health Services and the town of Brunswick, for estimates of what it would cost to have a paramedic and basic EMT available in Harpswell from 6 a.m. to 6 p.m. daily.

The town has a $16,000-a-year contract with Mid-Coast Hospital for fly-car service. But the town shares that vehicle with four other towns, said the town treasurer, Marguerite Kelly, and occasionally it has not been available.

When that happens, a Brunswick paramedic will respond. Each time, the town pays Brunswick a flat fee of $200 to $300. Last year, Harpswell paid a total of $1,500.

If the town were to request that any of the four providers dedicate a paramedic and ambulance to the town, Kelley said the cost would be “much more than $16,500.” The Fire and Rescue Committee will be meeting with providers in the coming weeks to discuss pricing and services.

If none of the outside providers’ cost estimates are favorable, Harpswell will have to consider hiring a town paramedic, something the committee members view as a last resort. There are currently no volunteer paramedics in town, partially because training is so intensive, and there are opportunities to get paid for their work elsewhere, Wallace said.

Whatever the committee decides, it will have to include funding from tax revenue.

“We have to involve the town,” Thomas said. “Financially, there’s no way (volunteer fire departments) can support any kind of dedicated service.”

Emily Guerin can be reached at 781-3661 ext. 123 or eguerin@theforecaster.net. Follow her on Twitter: @guerinemily.