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Dr. Busco tells North Haven board regional letter can let nurse practitioners direct EMS care but statute change would be cleaner
Summary
At a Feb. 25 Zoom meeting, guest Dr. Busco told the North Haven Select Board that nurse practitioners can legally direct EMS care for clinic patients under Maine EMS protocols if the regional medical director issues a letter deeming island residents clinic patients; he recommended the board ask John to request that letter and pursue a legislative fix.
Dr. Busco, a physician invited to the North Haven Select Board’s Feb. 25 Zoom session, told the board there is a legal “gray area” in Maine EMS law that affects whether nurse practitioners (NPs) and physician assistants (PAs) can be treated the same as physicians when responding to island EMS calls.
The most practical near‑term fix, he said, is a letter from the regional medical director saying that, for protocol purposes, anyone on an island is considered a patient of the island clinic. That designation would let a nurse practitioner with an established relationship to a patient give direction to EMS crews within the scope of the municipality’s protocols, Dr. Busco said.
Why the distinction matters: Maine’s EMS statute, as explained in the meeting, lists physicians under a “license not required” clause that does not explicitly include NPs or PAs. “A physician can practice EMS without getting an EMS license,” Dr. Busco said. “A PA and an NP can’t practice EMS without getting an EMS license. However … both a PA and an NP hold independent licenses that allow them to do all the things that would be components of practicing EMS.”
Dr. Busco described two operational paths. The quicker operational option is the regional medical‑director letter that makes island residents clinic patients “for the purposes of the protocols,” he said; that letter means clinic providers can direct an EMS crew to provide care that the crew’s license and protocols allow. He told the board he had not seen North Haven request such a letter yet and suggested asking John (the board’s EMS liaison) to do so promptly.
A cleaner but slower fix would be a statutory change to Maine’s EMS licensing language to explicitly include PAs and independent nurse practitioners so they become official members of municipal EMS crews and gain municipal indemnification protections, which limit liability, Dr. Busco said.
On risk and frequency of advanced interventions, Dr. Busco gave the board a data point: in Maine EMS data he has reviewed, fewer than 5% of calls involve any emergency medical care; fewer than 0.5% require advanced‑EMT‑level care, and “in approximately one in 1,000 calls” a paramedic‑level intervention is needed. That, he said, is why the protocol‑letter solution is often sufficient operationally even if it does not fully alter statutory status.
Board members raised community expectations and operational tradeoffs: residents and crews reportedly value having an NP respond to calls on the island because the provider can help decide whether to transport a patient to the mainland, a decision that affects ambulance and ferry resources. Several members warned that routinely changing NP response expectations could slow response time if practitioners decide not to attend borderline calls.
Next steps reported at the meeting: the board asked Rebecca to email John to request an update on whether he will pursue a regional medical‑director letter, and to keep the issue on the agenda while staff and the island EMS work group pursue legislative avenues.
The board did not take a formal vote on policy changes at the Feb. 25 meeting; Dr. Busco’s recommendations produced an action request to staff to seek the regional letter and to track progress on the islands EMS work‑group legislative effort.
