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Camden B. Olson is an EMT serving rural Maine with a background in public policy, including work in intelligence analysis and a U.S. Senate legislative fellowship.
Somewhere in Maine tonight, a volunteer EMT is driving 40 minutes to reach a patient who has fallen at home. This happens thousands of times a year. It is about to happen a lot more.
I work in Ellsworth. Last winter, I responded to a fall call in the depths of Hancock County. The patient was in her eighties, sharp, and embarrassed that we were there. She had tripped on a throw rug. She hadn’t seen her doctor in eight months and was on five medications nobody had reviewed together in longer than that.
We transported her. Medicare paid for the ride. Nobody paid for the visit that would have kept her off the floor. A few weeks later, we were back. That is not a failure of care; it’s a payment system working exactly as written.
Maine’s 2025 EMS Annual Data Report shows fall dispatches rose 30% between 2020 and 2025, from 32,189 to 41,925, more than any other emergency medical dispatch call type in the state. At the same time, Maine’s median age is 44.8, the oldest in the country. Twenty-three percent of residents are over 65, the highest share in the nation. The calls for falls are not going to stop.
Falls are not the problem, the flawed system is. Three things are breaking this system at once. Medicare will not reimburse emergency medical services (EMS) for care provided without a transport, so there is no financial model for the preventive visit that keeps patients out of the ambulance.
Rural volunteer departments across Hancock, Penobscot, Washington, Aroostook, and Piscataquis counties are already operating on margins so thin that rising call volume without reimbursement reform threatens their collapse.
And the same aging population driving call volume up is aging out of the workforce at the same time. Maine’s blue ribbon commission on EMS identified these pressures and called for roughly $70 million in stabilization funding. The Legislature provided some support, but the underlying payment problem remains.
We already know what works. Research published through the National Institutes of Health found that paramedics using the Center for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model identified that 59.3% of adults over 65 screened during 911 responses were at risk of falling, with nearly half taking medications known to increase that risk.
Maine already has proof of concept: Jackman’s community paramedicine program has demonstrated that paramedics making scheduled home visits reduce unnecessary hospital utilization and deliver timely care close to home. This is not experimental, it is just underfunded. Rural residents in Jackman would otherwise rely on a hospital an hour away for care.
Some will argue this duplicates existing home health services. It does not. Home health in Maine requires a physician referral, carries strict eligibility criteria, and has waiting lists in most rural counties. A patient in Hancock County who falls on a Tuesday and has no primary care provider is not getting a home health visit. She is most likely getting me, two weeks later, for the same kind of fall. Community paramedicine fills that gap at a fraction of the cost of an emergency department admission.
H.R. 7277, the Emergency Medical Services Reimbursement for On-Scene and Support Act, would allow Medicare to reimburse EMS for care provided without a transport. That single change makes the Jackman model replicable statewide. It has been introduced but has yet to move forward.
The woman I transported last winter is still living alone in Hancock County. She deserves a system that reaches her before she falls again. Congress, including Maine’s delegation, has the ability to act.
