Caribou firefighter/paramedic Eric Dickinson drives the ambulance to the scene of a medical emergency. Credit: Hannah Catlin / Aroostook Republican

CARIBOU, Maine — It’s getting harder and harder to manage rural ambulance departments and everyone knows it.

In The County, ambulance services have been the subject of innumerable town and city council meetings in the past several years as revenues shrank and the cost of emergency services rose across Aroostook.

While much of the large scale book balancing falls on department administrators and local governments, the precarious ambulance economy is affecting individual EMTs, too. From noncompetitive wages, to long and unpredictable hours, to the looming threat of staff shortages, paramedics say the job — which was always hard — is more challenging now than ever.

Caribou is one of the lucky departments — it still has enough cross-trained firefighter-paramedics to have a full crew on each of its three shifts. But where Caribou used to have a long list of volunteer backup EMTs and a slate of young hopefuls — starting at the department in the summers and working up to full-time positions — the department now has the minimum possible staff.

Caribou firefighter/paramedic Ryan Hall takes notes as he listens to a 911 caller on a phone in the Caribou Fire Department garage. Credit: Hannah Catlin / Aroostook Republican

“My major concern is sustainability,” Caribou Professional Firefighters IAFF Local 5191 president Scott Dow said. “We have three guys that are retiring [age] right now. Should they retire … we don’t have anyone to take their place.”

It’s getting harder to convince people to join and stay in emergency services. For one, wages are low. The median salary for a working EMT or paramedic nationally is $36,650, while registered nurses make $75,330 by the same metric, with just a year or two more of training.

Including benefits and countless hours of overtime, most Caribou paramedics make more than the national average for EMTs, but only the department’s three longest serving employees make more than $17 an hour. The last time the union reupped contracts with the city, representatives negotiated using an employment ad for a position as a night-stocker at Walmart in Presque Isle offering $17.50.

“It’s disappointing working here, knowing I can get paid more at Walmart,” paramedic Ryan Hall said.

The majority of the staff keep second or even third jobs to cope with the low wages and job insecurity associated with EMS and firefighting, Dow said. From carpentry to seasonal farm work, people need a backup plan.

The job of a paramedic can be traumatizing, dangerous and economically unpredictable. You never know when your last day on the job might be, and the threat of Post Traumatic Stress Disorder from particularly gruesome calls is always at the back of your mind, Dow said.

“Sometimes doing something totally different is the difference between dealing with the demons or succumbing to them,” he said.

Caribou firefighter/paramedics Chad McCarthy (left) and Ryan Hall climb the ladder of one of the department’s fire trucks during a routine training exercise. Credit: Hannah Catlin / Aroostook Republican

Other fire department staff are in higher education — one of the Caribou full-timers, Angela Fuller, is still working her way through paramedic school. Eric Dickinson, who’s been in the department for years, gets back from a 24-hour shift and starts homework for his public administration degree, which he’s going to school for online.

“I take it day by day and there’s no such thing as a weekend or a holiday,” Dickinson said.

Even with second jobs, in 2020, Caribou Fire Department’s first responders worked double time at the department. Its 15 full-time staff clocked the equivalent hours of 26.5 full-time, 40-hour-per-week employees over the course of the year. It’s not unusual to work a 70-hour week, Dickinson said.

The long hours are another thing that make it difficult to recruit and retain employees.

Firefighters are some of the only workers in America who don’t get paid for overtime at 40 hours — the pay increase doesn’t kick in until 53 hours. Caribou’s schedule assumes each employee will work an average of 57.5 a week over the course of a year, and then Caribou’s firefighter/paramedics vie for extra overtime hours beyond that.

Caribou firefighter/paramedics Ryan Hall (back) and Captain Danny Raymond wash down one of the department’s ambulances during routine morning chores at the Caribou Fire Department. Credit: Hannah Catlin / Aroostook Republican

The things keeping Caribou’s Fire Department running, paramedics said, are the brotherhood between emergency service workers and a desire to help people no matter the cost. You have to have a spark for it, Hall said.

Even so, as the financial hardships of ambulance departments make paramedics themselves the subject of public scrutiny, some of the pride has lost its sheen.

When Caribou City Council raised ambulance rates to outlying towns in 2020, the fire department staff, including Chief Scott Susi, stopped wearing department gear in public. The department still enjoys the support of most of the majority of the community, Susi said, but all of a sudden finding himself in the public eye was shocking.

“Whenever I’m out now, I’ve stopped wearing anything to do with the department because people do pull you over and ask what’s going on,” Susi said. “The pride is there, but when  you’re off [duty], you’re off.”

Dickinson said an acquaintance of his from Stockholm, one of the towns that contracts with the Caribou Fire Department, actually came to his home to question him about the rate changes — which of course, individual employees of the department had no hand in making.

The paramedics at the department are well aware that rate changes and tax hikes are painful for the community, Dow said. That’s why most of the employees agree the state and federal government need to step up in supporting departments.

Caribou firefighter/paramedics Chad McCarthy (left) and Ryan Hall speak to each other at the top of the ladder of one of the department’s fire trucks during a routine training exercise. Credit: Hannah Catlin / Aroostook Republican

Many of the problems plaguing rural ambulance services — poor insurance reimbursements from Medicare and MaineCare and the rising costs of emergency equipment — could be assuaged by legislators. For example, regulatory bodies make constant updates to the equipment required in modern ambulances, but the government rarely passes along grants to acquire the new technology, which can add tens of thousands of dollars to the budget, Dow said.

But in Maine, ambulance departments aren’t even considered an essential service. The fear among paramedics is that if the problem is left alone, it may never get solved.

“We’re already in a crisis but it seems like nobody wants to hear it, nobody’s listening,” Dickinson said.

Hannah Catlin is a reporter at the St. John Valley Times/Fiddlehead Focus in Madawaska, Maine.