On a recent morning, Jerrad Dinsmore and Kevin LeCaptain of Waldoboro EMS drove their ambulance to a secluded house near the ocean, to measure the clotting levels of a woman in her nineties.
They told the woman, bundled under blankets to keep warm, that they'll contact her doctor with the result.
"Is there anything else we can do?" Dinsmore asked.
"No," she said, "I'm all set."
This wellness check, which took about 10 minutes, is one of the duties Dinsmore and LeCaptain perform in addition to the emergency calls they respond to as staffers with Waldoboro's Emergency Medical Services (EMS). The EMS crews have been busier than ever this year, as people who delayed getting care during the pandemic grew progressively sicker.
But there's limited workforce to meet the demand. Dinsmore and LeCaptain spend more than 20 hours a week working for Waldoboro, on top of their full-time EMS jobs in other towns. It's common in Maine for EMS staffers to work for multiple departments, because most EMS crews need the help — and Waldoboro may soon need even more of it.
The department has already lost one EMS worker who quit because of Maine's Covid-19 vaccine mandate for healthcare workers, and may lose another two.
The stress of filling those vacancies keeps Town Manager Julie Keizer awake at night.
"So we're a 24-hour service," Keizer explains. "If I lose three people who were putting in 40 hours or over, that's 120 hours I can't cover. In Lincoln County, we already have a stressed system."
The labor shortage almost forced Waldoboro to shut down ambulance service for a recent weekend. Keizer says she supports vaccination, but believes Maine's decision to mandate them threatens the ability for some EMS departments to function.
Maine is one of 10 states that require health care workers to get vaccinated against Covid-19 or risk losing their jobs. Along with Oregon, Washington state, and Washington, D.C., it also explicitly includes the EMTs and paramedics who respond to 911 calls in that mandate. Some ambulance crews say it's making an ongoing staffing crisis even worse.
Two hundred miles north of Waldoboro, near the border with Canada, is Fort Fairfield, a small town of 3,200. Deputy Fire Chief Cody Fenderson explains that two workers got vaccinated after the mandate was issued in mid-August, but eight quit.
"That was extremely frustrating," Fenderson says.
Now Fort Fairfield only has five full-time staffers available to fill 10 slots. Their roster of per diem workers all have full time jobs elsewhere, many with other EMS departments that are also facing shortages.
"You know, anybody who does ambulances is suffering," says Fenderson. "It's tough. I'm not sure what we're going to do and I don't know what the answer is."
Both nationally and in Maine, staffing issues have plagued the EMS system for years. It's intense work that takes a lot of training and offers low pay. In Maine's largest city, Portland, the municipal first-responder workforce is around 200 people, and 8 are expected to quit because of the vaccine mandate, according to the union president for firefighters, Chris Thomson.
That may not seem like a significant loss, but Thomson explains those are full-time positions, and those vacancies will have to be covered by other employees who are already exhausted by the pandemic and working overtime.
"You know, the union encourages people to get their vaccine. I personally got the vaccine. And we're not in denial of how serious the pandemic is," Thomson says. "But the firefighters and the nurses have been doing this for a year and half, and I think that we've done it safely. And I think the only thing that really threatens the health of the public is short staffing."
Thomson maintains unvaccinated staff should be allowed to stay on the job because they're experts in infection-control measures and wear personal protective equipment such as masks and gloves.
But Maine's Public Safety Commissioner, Mike Sauschuck, says EMS departments also risk staff shortages if workers are exposed to COVID and have to isolate or quarantine.
"Win-win scenarios are often talked about but seldom realized," he says. "So sure, you may have a situation where staffing concerns are a reality in communities. But for us, we do believe the broader impact, the safer impact on our system is through vaccination."
Some EMS departments in Maine have complied fully with the mandate, with no one quitting. Andrew Turcotte, the Fire Chief and Director of EMS for the city of Westbrook, says all 70 of his staff members are now vaccinated. He doesn't see the new mandate as being any different from the vaccine requirements to attend school or to enter the healthcare field.
"I think that we all have not only a social responsibility but a moral one," Turcotte says. "We chose to get into the healthcare field, and with that comes responsibilities and accountabilities. That includes ensuring that you're vaccinated."
Statewide numbers released Wednesday show close to 97% of EMS workers in Maine have gotten vaccinated. But that varies by county: rural Piscataquis and Franklin counties reported that 18% and 10% of EMS employees, respectively, are still unvaccinated as of mid-October.
Not all EMS departments have reported their vaccination rates to the state. Waldoboro is in Lincoln County, where only 8 of the 12 departments have reported their rates. Among those 8, the rate of noncompliance was just 1.6%.
But in small departments like Waldoboro, the loss of even one staff member can create a huge logistical problem. Over the past few months, Waldoboro's EMS director, Richard Lash, started working 120 hours a week to help cover the vacancies. He's 65 and is planning to retire next year.
"I've told my town manager that we'll do the best we can do. But, you know, I can't continue to work 120 hours a week to fill shifts," says Lash. "I'm getting old. And I just can't keep doing that."
This story was produced as part of NPR's health reporting partnership with Maine Public Radio and Kaiser Health News (KHN).
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