For years, fire departments around the state have struggled to hire enough staff and volunteers to handle an increasing number of calls.

But in many places, those calls are no longer to fight fires — instead, departments are spending most of their time responding to medical emergencies.

In Ellsworth, just 2 percent of the calls last year were for fire. The vast majority — 73 percent — were for emergency medical services. In the Canadian border town of Calais, only 20 percent involved extinguishing flames.

In the Franklin County town of Phillips, 46 of the department’s 254 calls were for medical response, even though the department is not certified in emergency medical services.

“In today’s world, if you’re getting into the firehouse you have to have an EMT license,” said William Lee, the Calais Fire Department chief. “It’s a given.”

At the state level, a mere 4.5 percent of the 160,435 calls for service in 2022 (the latest data available) were for fires, according to a Monitor analysis of State Fire Marshal data. Seventy percent of those calls were for emergency medical response.

More than half of Maine’s 338 registered fire departments are also licensed at some level to provide emergency medical services, according to Maine EMS, and more — like Phillips — are considering doing so. 

As rural EMS struggles, fire departments step in

The closure of ambulance services and lack of EMS responders around the state has prompted other departments to consider training firefighters as medical personnel. 

Captain Sean Allen of Phillips said the town will decide in July whether his fire department should become licensed as a first responder agency, which Allen said is very likely to happen. Franklin County has 71 communities and only 75 EMTs, he added. 

An influx of new residents in Franklin County has put added pressure on the department. Allen said his department responded to roughly 90 calls in 2018; in 2022 it was 150. Last year the department responded to 254 calls, including 46 medical assist calls from NorthStar Ambulance Service, which is part of MaineHealth.

The department already shares a building with the ambulance service, which covers six towns from its Phillips base, some as far as 30 minutes away.

If the town decides to certify firefighters as EMTs, the Phillips Fire Department will cover the same area.  

Allen and Chief James Gould said they try to make sure there is always a core group of responders in the area, but most people on the 21-person roster don’t work in Phillips.

Allen said they’re in good shape with 21, the best they’ve been in a while, but the list has gotten as low as eight, and they’re always looking for recruits. 

“There are some days we’ll get 15 people to show up to a call and other days we’ll get three,” Allen said. “It just depends on the day.”

The department has two fully licensed emergency medical responders, including Allen, two in training and five more on a wait list. Allen and his medically trained colleague are allowed to administer emergency care when NorthStar isn’t available. 

It costs just over $2,000 to complete the training, paid for by a grant awarded to NorthStar. But like Calais, trainees aren’t paid for their time in class and often juggle the hours alongside other life commitments. Once completed, Phillips offers pay rates for firefighter-EMTs that range from $14 to $18. 

Once a department is licensed to respond to medical emergencies, it typically sees a corresponding increase in calls, in part because some licenses obligate departments to respond to all medical calls. 

That’s what happened in Ellsworth, which saw its medical call volume soar 4,500 percent between 2016 and 2022. 

Ellsworth firefighters had long helped ambulance crews, and some firefighters were already certified as EMTs. The department became a licensed EMS provider several years ago after a longtime ambulance service shut down and it became clear the city needed liability coverage in case firefighters helped on a medical call.

Another ambulance service took its place and is the primary medical response team, but the Ellsworth Fire Department license obligates it to respond to all medical calls, something officials did not realize when they entered into the agreement.

“If communities can actually do the transition, it actually provides a more complete emergency response service,” said William St. Michel, executive director of the Maine Fire Chiefs’ Association, who previously served as fire chief for the town of Durham, which started providing a full-time medical transport service roughly 20 years ago. “But it’s not easy.”

A tough transition

Rural fire departments have always worn a lot of hats, and firefighters have long provided basic medical tasks, like lift assists and CPR.

But the shift from primarily fighting fires to responding to medical calls is relatively new, and has been a strain in some places.

When the Calais Fire Department transitioned into a combined fire and medical emergency response service in 2009, it lost nearly a quarter of its team, said Lee, its chief. 

“Some people don’t necessarily want to do both, some just want to be firefighters and others just want to be EMTs, so it puts a strain on things,” Lee said. “The lack of medical personnel is getting really difficult. Everyone is competing for the same handful of individuals.”

The department operates four ambulances, and nearly all of Lee’s 30-person crew are trained to perform advanced medical care. The department always has two people on medical duty, and two on fire. If the medical call is severe, the fire crew goes along. CPR calls are department wide. 

Calais pays for training but recruits do not receive an hourly wage to take it. Training can last 12 to 16 weeks and is offered primarily online, with some in-person sessions.

Almost everyone who signs up also has full-time jobs, families and other obligations. Once trained, depending on the level of certification, emergency responders can earn anywhere from $16 to $26 an hour. 

Lee said it’s about a 50/50 split of people that joined to be medical and those for fire. But in the end, almost everyone ends up doing the same tasks. 

“Most people that come on as EMT-only end up getting fire certified. They all have to do fire duties. They have to know the equipment and support the firefighters, just like the firefighters support them,” said Dale Purton, the assistant chief.

Purton has been part of the department for 44 years. For most of his career only basic medical needs were performed — CPR and lift assists. But he sees the change to more medical care as positive.

“We have to be able to provide these services. The more services we can provide, the better. And it’s keeping us in business.”