Presque Isle’s new city-run E911 emergency ambulance service is set to start in April, and officials are promising a smooth transition with the current, longtime ambulance operator, The Aroostook Medical Center’s Crown Emergency Care.

TAMC and city officials, however, have not been able to agree on a two-year contract that would have governed roles and responsibilities between the city’s new E911 service and TAMC’s Crown ambulance service, which covers 18 central Aroostook County communities.

Last fall, TAMC was unable to dissuade the city from going forward with the new service, after the city council approved the plan in August, and the two organizations recently failed to reach a contractual agreement for how the two services will cooperate and share responsibilities in the Star-City.

“The two key items that could not be agreed upon and led to the lack of a contract involved patient transfers and drug boxes,” said Karen Gonya, communications director at TAMC, referring to the transporting of patients between healthcare facilities and supplying of city ambulances with pharmaceuticals.

The contract that was being negotiated would have included provisions giving Crown the “right of first refusal” for patient transfers and utilizing TAMC for supplying the city’s ambulance drug supplies.

“TAMC had been seeking the opportunity for ‘first refusal’ for transfers, meaning that Crown would have the first option to provide the transfer of a patient based on Crown accessibility,” Gonya said. “This right of first refusal would have ensured that Crown retained enough business to keep a fully staffed station in Presque Isle to provide mutual aid to the city service.”

Without a contract, Gonya said the two organizations have worked out a “compromise” that will ensure ongoing, high quality emergency medical care for anyone in Presque Isle. “While there are no specific plans for further negotiations, both sides remain committed to ensuring the best care possible for the region.”

Going forward in April, the city will have the primary responsibility for all EMS service to city residents, while TAMC and Crown will “focus its capacity in the surrounding communities to provide quality 911 service and increased availability of transfer services,” Gonya said. The Crown Critical Care Transport unit also will continue offering higher-level advanced life support care across The County.

The city’s new service, run out of the Fire Department, will have six paramedics, two full-time ambulances and one ambulance in reserve, and is expected to be self-funding with reimbursement from the likes of Medicare and other health insurance plans.

Presque Isle city manager Martin Puckett said the city considered a range of municipal ambulance models during planning for the new service, including whether or not to provide patient transfers, a major source of revenue for ambulance services.

The city ultimately decided to include transfers in the EMS plan, and will provide transfers to Presque Isle patients who need to go to different medical facilities in Maine or other states, Puckett said.

“The addition of transfers and the associated revenues does help reduce the reliance on property taxes,” Puckett said, referring to the city council’s goal of taming recent property tax increases.

Presque Isle leaders have been discussing starting a municipal ambulance service since at least 2009, and the Star-City will be joining other municipal EMS providers in the region, including Caribou and Houlton.

TAMC and Presque Isle entered a two-year collaborative agreement for ambulance service in 2014 that TAMC had sought to renew last year. Under the arrangement, TAMC paid the city $100,0000 annually and provided an ambulance and paramedic stationed at the Fire Department, while the department provided an ambulance driver.