NEWFIELD — Sonja Nielsen loves her job as one of the paramedics in the tiny fire and rescue service in this town of 1,600 people, 35 miles west of Portland, based in a three-bay garage the staff calls “the little station that could.”

She joined student rescue as a high school student in Scarborough, where her uncle and older brothers were firefighters, and remains passionate about emergency medical services, helping her neighbors and supporting her community.

The downside: Despite having expensive, professional lifesaving training that’s in great demand, this single parent works four other jobs to make ends meet, including two other per diem paramedic gigs and part-time jobs as an EMT instructor and as an internal communications dispatcher at Maine Medical Center.

The tiny EMS service’s annual budget is just $112,450, which has to cover gas, vehicle maintenance, insurance, medical supplies, equipment, personnel and anything else that comes up. Last year its personnel responded to 17 road accidents, five seizures, five drug overdoses, three cardiac arrests, eight mental health crises, two assaults, two unattended deaths and 141 other calls, but many barely made the minimum hourly wage and none of them a living one.

“I was told when I started full-time EMS that I would need two jobs to make it work, and I knew I wouldn’t be able to retire on a paramedic’s income, that I’d have to supplement it with other things,” Nielsen says matter-of-factly. “But it’s a sad state of affairs for the people who go into homes in the middle of the night, not knowing if you’re walking into a domestic violence situation or if you’re seeing a woman who nobody has talked to for three days.”

“They don’t pay you to get yelled at or punched on,” she adds.

As Maine’s emergency medical services have been squeezed between rising costs and a jury-rigged and inadequate funding model, 911 callers have yet to feel the pinch.

That’s because the paramedics and emergency medical technicians who keep those services going have been feeling it for them, working long hours for low pay even though most of them could make as much or more at a convenience store or some other job where a wrong decision isn’t a matter of life or death. With fewer and fewer of them on the job, those who are left sometimes work full schedules at more than one service so that when somebody dials for help in a rural community, an ambulance can be at their door in minutes.

Morgan Wass, an EMT at Limerick Fire/EMS, backs the town’s fire engine into the garage after performing a daily inspection. Cash-strapped EMS services are often unable to pay EMTs much above minimum wage. As a result, fewer people are entering the field and many move on to better-paying jobs like nursing. Staff photo by Ben McCanna Buy this Photo

“These are people who do it because they want to help people,” says paramedic Eric Wellman, director and department chairman of the Emergency Medical Services program at Southern Maine Community College, one of the largest training centers for EMTs and paramedics in the state. “They evaluate themselves and don’t really want to work in a hospital or behind a desk, they want to be mobile and in an environment that’s changing, same as people who are in the military and fire and police services.”

Nobody does it to get rich.

Cash-strapped EMS services are often unable to pay EMTs much above minimum wage – in Newfield they get $13 an hour, and paramedics $16. As a result, fewer people are entering the field and many who do move on to better-paying medical jobs like nursing. Those who stay typically work multiple jobs to make ends meet, and sometimes two or more of those jobs are as EMS responders, as services are so short of personnel. Nationally, 75 percent of EMS professionals work more than 40 hours a week, and 71 percent report relying on overtime and multiple jobs to make ends meet, according to a recent survey by researchers at the Ohio State University College of Public Health.

At North Star EMS’s main base in Farmington – center of a regional service covering an area larger than Delaware and Rhode Island combined – responders work 24-hour shifts, 7 a.m. to 7 a.m. the next day, eating and sleeping when they can. “You usually wait until the afternoon to take a nap, but that depends on what you came from before your shift,” says full-time paramedic Steve Smith, who has a second job as an administrator for the regional ambulance office. “The life of EMS is unfortunately you have to have more than one job, and hopefully the other one isn’t also EMS because that’s dangerous – you can wind up working two 24-hour shifts in a row.”

It’s a job that can be emotionally demanding as well.

On Sept. 16, Smith was manning the first aid station at the Farmington Fair when the crowds heard a thunderous sound and a cry for help came from a fire department crew that they themselves were on fire. His ambulance crew, because it happened to be close, was one of the first on the scene: a new, two-story building blasted into nothingness by a massive propane explosion, with six badly burned and one – Farmington Fire Capt. Michael Bell – dead. They did their jobs, assisted by an army of other first responders, and the critically injured had been evacuated by air ambulance to Maine Medical Center and Massachusetts General Hospital in Boston. Processing it will take much longer.

Rural EMS crews are often alone with scared, critically sick or injured people, on long trips to the nearest appropriate hospital. “When I worked for the city of Portland, we were always about five minutes to the nearest hospital, so a lot of times we didn’t have to do a lot of stuff we knew how to do because we were so close to ‘the Castle on the Hill,’” says paramedic Cheryl Munn-Watley of Limerick Fire and EMS in northern York County, referring to Maine Medical Center, the state’s largest trauma center, now nearly an hour’s drive to the east.  “I’ve got an hour where I’m responsible for this person, and that’s a lot of time, pressure and responsibility.”

Sometimes, the back of the ambulance can be a harrowing place, says her colleague Richard McGlincey, a former Newfield fire chief – like when a patient goes into cardiac arrest and three volunteer firefighters cram in to take shifts doing CPR to keep him alive until they get to the ER. Other times it’s very quiet. “I can remember holding hands with an elderly lady getting near the end of her trip and I just talked to her and I even did the rosary with her,” he recalls. “I mean, I’m all she’s got there.” A week or so later, shortly after the woman had passed, her daughter told McGlincey she’d mentioned saying the rosary with him on each of her final days.

Richard McGlincey, an EMT-Advanced for Limerick Fire/EMS and former Newfield fire chief, says sometimes the back of the ambulance can be very quiet or it can be a harrowing place. Staff photo by Ben McCanna Buy this Photo

Other times, it’s dangerous, especially when drugs or domestic violence are involved. EMS crews have and can administer Narcan to save the life of somebody overdosing on an opioid, but they also carry a supply for themselves because there’s a slight risk that dangerous quantities of the drug can be absorbed by accidental inhalation or simply touching a user’s skin.

Nobody is supposed to enter a home alone during an emergency response because they can never know what kind of situation they might be walking into: domestic violence, psychiatric break, or a violent and disoriented drug user. Steve McLean of Newfield calls himself one of the dinosaurs – one of a dwindling cadre of volunteers who are willing and able to drop what they’re doing at work and rush to help drive an ambulance or firetruck for more than one area service. He’s seen plenty of crazy situations.

There was a strong man “fired up on drugs out in the middle of nowhere” who broke the straps holding him to the stretcher and was grabbing McGlincey, the Limerick EMT. It was all McLean – a strong fellow himself – could do to hold him down so his friend could get away. There are the addresses that, because of past experiences, they have had to flag so nobody ever enters them without a police escort. There was the time when they were trying to get a 400-pound woman in distress to their ambulance in icy conditions and one of their team slipped under the stretcher – itself weighing 75 pounds – and came a hair’s breadth from being crushed.

“People like me try to always take the stretchers,” McLean – who is a volunteer firefighter, not an EMT – says before gesturing to Nielsen, the Newfield paramedic. “Because if she gets hurt lifting, we’re screwed! I mean, if she called up sick today, there’d probably be nobody here at the station, because we don’t have an abundance of extra people who can fill in.”

Stephen McLean, a volunteer EMS worker for Limerick, stands in front of the town’s first ambulance, center, now decommissioned at his business, S.A. McLean, Inc. Staff photo by Ben McCanna Buy this Photo

In more remote areas, it can be an enormous community effort to have an EMS response at all.

Take Jackman, a town of 820 set in the forest wilderness of the upper Kennebec Valley on Route 201, 16 miles south of the Quebec border, and the final outpost of services in the United States. Heavy truck traffic passes through on the way to Canada, and a steady flow of hikers, hunters and snowmobilers makes for plenty of accidents and emergencies. But it’s 72 miles to the nearest McDonald’s (in Skowhegan), 48 miles to an ER (Greenville) and three hours to the trauma centers at Maine Medical and Eastern Maine Medical centers – all involving at least an hour’s drive over winding roads that are treacherous in bad weather.

In May 2017, MaineGeneral Health announced it would close the town’s nursing home and, with it, an ambulance service that acted as 911 responder for a 750-square-mile area. Fire Chief Bill Jarvis – who has his own full-time business as a forester – learned he would have to put together a community EMS outfit on a shoestring budget with less than three months’ notice. “I can tell you, I’ve got a boat on the lake here, and I think I might have went on it twice that year,” he recalls.

It’s up and running, with 10 basic EMTs, two ambulances donated by MaineGeneral, and a $9,000 hole in the operating budget that’s covered by raffles and donations and the taxpayers of Jackman and three other organized towns in the valley. Even then it can function only because of a special provision written into Maine law that allows the service to bring patients to the local health center, rather than an ER, as all other EMS providers must. At night, an on-call doctor who lives in the valley meets them there to help stabilize the patient. There are no paramedics in the area, so the doctor has to start any necessary IVs. “We can maintain it by changing the bags, but we can’t start it,” Jarvis explains.

As a call comes in over the radio, paramedic Sonja Nielsen and EMT Adam King, left, check the maps on their phones to see whether the medical call originated within their coverage area during a shift at Limerick Fire and Rescue. Staff photo by Ben McCanna

The service area is vast, and most of it doesn’t have any roads. To rescue people injured on the 100 miles of groomed snowmobile trails, they trailer a snowmobile and rescue sled to the nearest access point and drive a half hour or more to reach the site. “A lot of it depends on the weather,” Jarvis says, “and sometimes it’s snowing like a son of a gun. The plows can barely keep up.”

Sometimes LifeFlight – Maine’s nonprofit air ambulance service – is called in, but with few roads, uneven terrain and lots of forest cover, it’s not easy to find a place for a helicopter to land. They look for gravel pits or the intersections of two timber company logging roads and radio in the coordinates. “If it’s night we put out blue blinking lights on the corners and other markers so they can see us,” Jarvis explains.

The EMTs aren’t compensated for the cost, time and travel to get and stay trained and certified. They make $11 an hour.

“We did a local class last fall for EMTs and we ended up, so far, with two people on the service, but we hoped we could get a couple more,” Jarvis says. “But we’re just such an isolated area, and there’s only a limited population.”