On a recent morning, Jerrad Dinsmore and Kevin LeCaptain of Waldoboro EMS in rural Maine drove their ambulance to a secluded house near the ocean, to measure the clotting levels of a woman in her 90s.
They told the woman, bundled under blankets to keep warm, they would contact her doctor with the result.
鈥淚s there anything else we can do?鈥 Dinsmore asked.
鈥淣o,鈥 she said. 鈥淚鈥檓 all set.鈥
This wellness check, which took about 10 minutes, is one of the duties Dinsmore and LeCaptain perform in addition to the emergency calls they respond to as staffers with Waldoboro Emergency Medical Service.
EMS crews have been busier than ever this year, as people who delayed getting care during the covid-19 pandemic have grown progressively sicker.
But there鈥檚 limited workforce to meet the demand. Both and in Maine, staffing issues have plagued the EMS system for years. It鈥檚 intense work that takes a lot of training and offers low pay. The requirement in Maine and elsewhere that paramedics and emergency medical technicians be vaccinated against covid is another stress on the workforce.
Dinsmore and LeCaptain spend more than 20 hours a week working for Waldoboro on top of their full-time EMS jobs in other towns. It鈥檚 common in Maine for EMS staffers to work for multiple departments, because most EMS crews need the help 鈥 and Waldoboro may soon need even more of it.
The department has already lost one EMS worker who quit because of Maine鈥檚 covid vaccine mandate for health care workers, and may lose two more.
The stress of filling those vacancies keeps Town Manager Julie Keizer awake at night.
鈥淪o, we鈥檙e a 24-hour service,鈥 Keizer said. 鈥淚f I lose three people who were putting in 40 hours or over, that鈥檚 120 hours I can鈥檛 cover. In Lincoln County, we already have a stressed system.鈥
The labor shortage almost forced Waldoboro to shut down ambulance service for a recent weekend. Keizer said she supports vaccination but believes Maine鈥檚 decision to mandate it threatens the ability of some EMS departments to function.
Maine is one of 10 that require health care workers to get vaccinated against covid or risk losing their jobs. Along with Oregon, Washington and Washington, D.C., it also explicitly includes the EMTs and paramedics who respond to 911 calls in that mandate. Some ambulance crews say it鈥檚 making an ongoing staffing crisis even worse.
Two hundred miles north of Waldoboro, on the border with Canada, is Fort Fairfield, a town of 3,200. Deputy Fire Chief Cody Fenderson explained that two workers got vaccinated after the mandate was issued in mid-August, but eight quit.
鈥淭hat was extremely frustrating,鈥 Fenderson said.
Now Fort Fairfield has only five full-time staffers available to fill 10 slots. Its roster of per-diem workers all have full-time jobs elsewhere, many with other EMS departments that are also facing shortages.
鈥淵ou know, anybody who does ambulances is suffering,鈥 said Fenderson. 鈥淚t鈥檚 tough. I鈥檓 not sure what we鈥檙e going to do, and I don鈥檛 know what the answer is.鈥
In Maine鈥檚 largest city, Portland, the municipal first-responder workforce is around 200 people, and eight are expected to quit because of the vaccine mandate, according to the union president for firefighters, Chris Thomson.
That may not seem like a significant loss, but Thomson said those are full-time positions and those vacancies will have to be covered by other employees who are already exhausted by the pandemic and working overtime.
鈥淵ou know, the union encourages people to get their vaccine. I personally got the vaccine. And we鈥檙e not in denial of how serious the pandemic is,鈥 Thomson said. 鈥淏ut the firefighters and the nurses have been doing this for a year and a half, and I think that we鈥檝e done it safely. And I think the only thing that really threatens the health of the public is short staffing.鈥
Thomson maintains that unvaccinated staffers should be allowed to stay on the job because they鈥檙e experts in infection control and wear personal protective equipment such as masks and gloves.
But Maine鈥檚 public safety commissioner, Mike Sauschuck, said EMS departments also risk staff shortages if workers are exposed to covid and have to isolate or quarantine.
鈥淲in-win scenarios are often talked about but seldom realized,鈥 he said. 鈥淪o sure, you may have a situation where staffing concerns are a reality in communities. But for us, we do believe the broader impact, the safer impact on our system is through vaccination.鈥
Some EMS departments in Maine have complied fully with the mandate, with no one quitting. Andrew Turcotte, the fire chief and director of EMS for the city of Westbrook, said all 70 members of his staff are now vaccinated. He doesn鈥檛 see the new mandate as being any different from the vaccine requirements to attend school or enter the health care field.
鈥淚 think that we all have not only a social responsibility but a moral one,鈥 Turcotte said. 鈥淲e chose to get into the health care field, and with that comes responsibilities and accountabilities. That includes ensuring that you鈥檙e vaccinated.鈥
Statewide numbers released last week show close to 97% of EMS workers in Maine have gotten vaccinated. But that varies by county: Rural Piscataquis and Franklin counties reported that 18% and 10% of EMS employees, respectively, were still unvaccinated as of mid-October.
Not all EMS departments have reported their vaccination rates to the state. Waldoboro is in Lincoln County, where only eight of 12 departments have reported their rates. Among those eight, the rate of noncompliance was just 1.6%.
But in small departments like Waldoboro, the loss of even one staff member can create a huge logistical problem. Over the past few months, Waldoboro鈥檚 EMS director, Richard Lash, started working extra long days to help cover the vacancies. He鈥檚 65 and is planning to retire next year.
鈥淚鈥檝e told my town manager that we鈥檒l do the best we can do. But, you know, I can鈥檛 continue to work 120 hours a week to fill shifts,鈥 said Lash. 鈥淚鈥檓 getting old. And I just can鈥檛 keep doing that.鈥
This story is from a reporting partnership that includes , and .