Need: With the nearest hospital more than an hour away, the local community health center in rural Jackman, Maine struggled to maintain its ability to offer 24/7 care to due to staffing and budgetary challenges.
Intervention: Critical Access Integrated Paramedics provide urgent care to patients after hours and on weekends.
Results: The Jackman Community Health Center has been able to offer round-the-clock care to clinic patients, while also increasing the level of EMS service available to the community.
The Critical Access Integrated Paramedics program lets
local paramedics broaden their skill set through online
courses and laboratory sessions with Eastern Maine
Community College and clinical rotations at the emergency
department of St. Joseph Hospital. With this expanded
training, the paramedics are able to perform services
including ultrasounds, splinting, and wound care. The
program also utilizes telemedicine technology, allowing
the paramedics to communicate with healthcare providers
at St. Joseph Hospital while they are with the patient.
The paramedics, most of whom live in other parts of the
state, each work a 48-hour shift in Jackman once a week
on an eight-week rotation; in the seventh and eighth
weeks, they work a 24-hour shift and spend an additional
12 to 24 hours in clinical rotations at St. Joseph's to
maintain and sharpen their skill set. While on shift in
Jackman, the paramedics stay in apartment housing
converted from a former nursing home in town.
The initiative is funded primarily through local property
taxes in Jackman and Somerset County. The program also
received a four-year, $1.2 million federal grant from the
Health Resources and
Services Administration in 2020 to help cover costs
related to launching the program, such as equipment,
training, and education.
Paramedics trained through the Critical Access Integrated
Paramedics program are available 24/7 to provide services
to residents of Jackman and the Moose River Valley.
Patients can access care after-hours in several ways:
Patients requiring after-hours care or assistance can
call the clinic's phone number from home. Those in need
of services, such as scheduling an appointment to see a
primary care physician or getting lab results, are
referred to a night nurse triage system, while those who
need urgent care treatment are told to come to the
Patients who show up to the clinic after hours
without calling ahead first can let the paramedic on
shift know they are there by using a phone stationed
outside the door that rings directly to the on-duty
Patients who call 911 with an urgent care need can
also have a Critical Access Integrated Paramedic
dispatched and the 911 call may be converted into a
telehealth urgent care visit.
Urgent care procedures that the Critical Access
Integrated Paramedics can perform include but are not
Local and regional anesthesia
Soft tissue acute foreign body removal
Eye, ear, nose and throat procedures
Non-sedated joint dislocation reduction
The Critical Access Integrated Paramedics may also be
called upon to assist the local ambulance service with
911 calls that require Advanced Life Support (ALS). The
local ambulance service, which responds to about 80 calls
per year, is volunteer-run and can provide service at the
Basic Life Support (BLS) level. If a call that may
require Advanced Life Support comes in, the Critical
Access Integrated Paramedic on duty can be dispatched
along with the volunteer ambulance service. Conversely,
the Critical Access Integrated Paramedics may call on
volunteers from the ambulance service for assistance if
the paramedic needs an extra set of hands to help with an
after-hours urgent care procedure at the clinic.
The Critical Access Integrated Paramedics program has
allowed Jackman Community Health Center to continue
offering round-the-clock care to clinic patients, while
also increasing the level of EMS service available to the
The program has trained four full-time paramedics and
three part-time paramedics so far, and serves an average
of three to four patients each week.
Paying for the program is an ongoing challenge. The local
community has committed to funding the bulk of
operational costs through local tax revenues, with the
remainder offset by grants and other revenue streams, but
there is currently no other mechanism in place to
reimburse the paramedics for their work.
There is also currently no way to fulfill medical
prescriptions after hours in Jackman, although the
Critical Access Integrated Paramedics initiative is now
working with a local pharmacy to develop a pilot program
for remote dispensing.
The Critical Access Integrated Paramedics program in
Jackman was designed and developed with input from the
local community, with multiple community-wide meetings to
hear feedback from local residents on potential models
and approaches. The leadership team for the program sees
this informed community self-determination process as
critical to the success of, and ongoing local support
for, the initiative, and encourages anyone attempting to
implement a similar program to be as transparent as
possible in discussions with community members.
Because the initiative is a first-of-its-kind pilot
program for the statewide Maine EMS system,
the process of designing and developing the program was a
relatively long one: 18 months were spent developing the
clinical practice structure, and seven months were spent
developing the final contracts. Other communities in
Maine wishing to implement similar programs in the future
may face a less time-consuming process.
In some other states, a program like this may not be
legal. In 2020, the Jackman program's leadership team
worked with Maine lawmakers to update state statute to
ensure that Maine EMS had the authority to oversee this
type of program; an earlier version of the statute
focused solely on EMS in a transport context.
The physical infrastructure for the Critical Access
Integrated Paramedics initiative already existed in
Jackman prior to the program's creation: The town already
had a clinic, and living quarters available at the former
nursing home. But the leadership team believes aspects of
the program could be adopted in rural areas that do not
have the same infrastructure available – for instance,
paramedics could provide urgent care services on a
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.