It has been a few generations since doctors made house calls, and if they did, there are many large, rural parts of Maine that are beyond the reach of the “local” doctor.

There is, however, one part of our health care system that will still respond to your home to provide emergency care — the local Emergency Medical Technician or EMT. These paramedics, as we often call them, are part of the Emergency Medical System, or EMS.

The Moose River Valley, located in the greater Jackman area, has seen significant decreases in access to health care over the decades. The loss of access to after-hours urgent and emergency care poses an immediate threat to the health of the citizens of this region.

The cost of staffing physicians and advanced practice providers has become prohibitive and requiring 24-hour-a-day emergency call makes it almost impossible to recruit new providers.

This isn’t just a problem in the Moose River Valley or other parts of Maine; several states face this same issue and have successfully implemented EMS-based models where specially trained paramedics work in conjunction with physician telemedicine collaboration to treat and discharge some patients rather than transport them all to a hospital or emergency department.

Dr. Jonnathan Busko is an emergency physician and ED Medical Director at St. Joseph Hospital in Bangor. He drafted a change in state law that would allow EMS trained personnel to work cooperatively with a physician via telehealth to provide some critical health care services in rural areas. Dr. Busko testified on the bill, saying that the current system is not designed to serve as primary care in rural locations, but it could.

The concept uses the existing background screening and skills of a paramedic. The intent is to have the EMS Board, through its Medical Direction & Practices Board, develop and approve a clear and well-identified set of about a dozen procedures and medical conditions common to Jackman that would be added to paramedic training in that geographic area and credential them to provide those emergency skills.

The goal is for every potential after-hours patient to get a telemedicine visit if needed. To be clear, a remote emergency room clinician would guide all of the care — the “Clinical Access Integrated Paramedics” would only serve as the hands, not make medical judgments or be the medical decision maker. Paramedics would simply carry out the procedure that they have been trained and credentialed to do under the orders of a physician.

According to Dr. Busko, “EMS is one of the few of health care services that still make house calls for urgent care needs. But the EMS system was fundamentally designed for one purpose. Put bluntly, ‘you call, we haul, that’s all.’ I see so many ways that EMS agencies in Maine could improve Maine citizens’ health outcomes.”

Jay Bradshaw, executive director of the Maine Ambulance Association also testified, saying, “We think this is an exciting and appropriate role for both paramedics and emergency physicians to address a health care need not just in Jackman, but in many other rural and remote parts of Maine.”

To make this system legal in Maine required a simple change in one sentence of state statutes. At Dr. Busko’s suggestion, I sponsored L.D. 1290, which makes that change, and I am happy to report that it passed unanimously out of committee and appears well on its way to becoming law in the next few weeks.

Brad Farrin, a Republican from Norridgewock, is in his second term in the Maine Senate.

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