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V O L . X X V I N O. X X I I S E P T E M B E R 2 1 , 2 0 2 0 28 H E A LT H C A R E / W E L L N E S S F O C U S center, in apartments created out of the nursing home space. ey'll be on call, riding along with the ambulance crew on calls that require immediate emergency care, and also provide emergency care at the clinic, connecting with emergency physicians at St. Joseph for support. ey'll also help Doyle provide urgent care during business hours. Russell, of North East Mobile, says that paramedics are already in Jackman, helping out. e second phase, emergency room training at St. Joseph, will start this month with help from the $1.2 mil- lion Health Resources and Services Administration Rural Telehealth Network Grant that was announced Sept. 10. e hospital experience will help them beyond just learning hospital procedures, program officials say. While paramedics go through one to two years of training, there are things that will come up when they're the provider in Jackman they may have not dealt with before, Doyle says. "You can't just take a paramedic and park them at the door and plunk down an emergency case and say, 'You take care of this,'" she says. Taking it to another level Using paramedics to fill the health care gap around Maine has been used to a lesser extent for the past decade, says Jay Bradshaw, executive director of the Maine Ambulance Association. He says there has long been the need in many parts of Maine. "Someone has to be there 24/7 for emergencies, but you don't have emergencies 24/7," Bradshaw says. Community paramedicine — using paramedics for things like home-based health checks and other medical ser- vices in rural areas — began in the early 2000s. e program gained traction with legislation in 2012 that allowed up to a dozen paramedicine programs where there were health care access gaps in the state. e program didn't provide fund- ing. at had to come from the com- munity. It was also understood that the paramedics would practice mostly outside of a hospital setting, some- thing only cleared up with legislation this year that allows them to practice in a hospital setting with the permis- sion of the hospital. eir role was geared to the needs of the community, but it was largely to pro- vide episodic patient evaluation, advice and treatment directed at preventing or improving a medical condition, accord- ing to a 2015 evaluation by the state. Bradshaw says the fact that no fund- ing source was provided was one reason the program is still not widely used. "Free isn't a sustainable model," he says. Some communities, however, have successful programs, though they focus on immediate on-site care and taking the person to the hospital. "Jackman is taking it to another level," Bradshaw says. "It's exciting." Creating a career pathway It's always been difficult to recruit doc- tors to practice somewhere like Jackman. Doyle, the clinic's physician, arrived 33 years before through the National Health Services Corps. pro- gram. Most leave after their required service time is up. ose involved in the program say that it will be easier to hire paramed- ics, and the program itself may make the job more enticing. e added training with the Jackman pilot "is a pathway to a more lucrative career," Russell says. ere are four stages to emergency medical service providers, beginning with emergency medical technicians and ending with paramedics, but the further clinical training bridges the gap between paramedic and becom- ing a registered nurse or physician's assistant, he says. Bradshaw says, too, that "EMS is a young person's game. e physical demands take a toll." But the ability of paramedics to work in a clinical setting and do more of a variety of jobs means it could be a long career. "ey already have a career where they're talking to patients, they're deal- ing with emergency medicine, they're doing procedures," he says. "ey're ideal for it, for a long career." 'There has to be collaboration' e grant is also paying for a small similar program in Winterport, where physicians in PCHC's primary care practice can connect with emergency room doctors at St. Joseph to perform emergency care. Dwyer says that primary care doc- tors don't have the extensive emergency room training emergency doctors do, and emergency patients are trans- ported to the hospital. e Winterport program will serve the same purpose as the one in Jackman – provide emer- gency services for the town, which is a half hour or more from the nearest hospital, in Bangor. e grant will also be used to find a way to make the Jackman pro- gram, and future ones, economically sustainable. e tangle of insurance, what Medicare covers, who gets billed and more, can make paying for such pro- grams difficult, those involved with the Jackman pilot say. Dwyer says that Jackman, while unique, is a perfect place to test it out. "e roads to the closest hospi- tals aren't great roads, they're not safe roads," she says. "In a lot of ways, Jackman is an island." For such a program to work "it has to be collaborative," with buy-in from the entire community. "is is a grassroots, bottoms-up community-based health care decision," she says. "It's a different way of doing things in health care. It's non-competitive, it's inclusive, it's demo- cratic. PCHC isn't carrying all the water on this, because we can't." Of all the partners involved, it's the community that was key to making it happen. "e community rightfully sees health care as a key to the econ- omy. You can't get tourists to come here if there's no emergency care." She says that, in the bigger pic- ture, Maine will likely react the same way. "It's almost a uniquely Maine approach," Dwyer says. "It's Yankee ingenuity. We have this problem, now how do we solve it?" Maureen Milliken, Mainebiz senior writer, can be reached at mmilliken @ mainebiz.biz » C O N T I N U E D F RO M P R E V I O U S PA G E Jay Bradshaw, executive director of the Maine Ambulance Association, praises the Jackman program. P H O T O / M A U R E E N M I L L I K E N A lot of this project is a credit to how tenacious that community is. There are 800 people, but it can feel like 8,000. — Lori Dwyer Penobscot Community Health Care

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