Health care is an issue problematic countrywide, but it’s particularly complicated for small communities surrounded by water. At an Aug. 10 meeting of the Maine Islands Coalition, the discussion quickly turned to two separate issues: emergency services and general health care.
For emergency medical service (EMS) providers, problems include call volume, transportation, and retaining people frustrated by time-consuming training requirements and paperwork.
With a growing elderly population on the islands, island rescue and fire departments are seeing increased numbers of calls. However, most of these calls are for EMS personnel, who require significant amounts of training and experience that can often only be done on the mainland. In addition, each call requires significant paperwork for responders. Each time a “transfer of care” occurs (when a patient is transferred from one EMS provider to another), there’s paperwork. For EMS personnel on islands, this can occur several times in a call as patients are transferred off-island.
Tom Judge, Executive Director of Life Flight, a Port Clyde-based nonprofit that provides helicopter transfer statewide and is the primary coverage for 60 islands including Monhegan, related that islands are particularly challenged by transportation. His organization has collaborated with islands to establish approaches and helipad sites. But Life Flight is a very expensive transportation option.
Alternatives can be limited. Coast Guard and ferry service limits on the length of piloting shifts often require that the morning ferry be cancelled if a late-night emergency trip has been made. Fishermen are often hesitant to assume the liability of transporting a patient in their own boats.
Nurse Sharon Daley of the Maine Seacoast Mission described her effort to provide preventive care for island residents served by the Mission’s boat, Sunbeam. Daley noted that lots of agencies want to provide services, but have no connections to islanders or are intimidated by the fact that they cannot use the same programs that they would use on the mainland. She is working with providers to develop “island-specific” programs and to bring successful programs from other rural areas, such as Healthaids in Alaska, to Maine islands.
Pommy Hatfield of Island Commons, an assisted-living home on Chebeague Island, stressed the impact of elderly residents on island communities. Island Commons was established because of concerns that few people were able, or know how, to best provide for elderly family members who wanted to remain on the island. A repeated problem is educating Medicare and Medicaid officials about the high out-of-pocket expenses of island care. While both programs cover the cost of procedures, they don’t cover ferry, parking and other expenses necessary for medical care.