Maine boasts the third strongest overall emergency care environment in the nation, bolstered by high levels of Access to Emergency Care; a dedication to improving the Quality and Patient Safety Environment; and low rates of health risk factors and fatal injuries. However, the state's poor Disaster Preparedness score indicates that it may not be adequately prepared for largescale emergencies.
Maine continues its stellar performance in Access to Emergency Care, with the third highest mark in the nation. Only 11.0% of adults and 6.3% of children in the state have no health insurance. Additionally, only 8.2% of adults report an unmet need for substance abuse treatment. Overall the state's supply of health care providers compares favorably to most states, however gaps remain, including a lack of specialists such as neurosurgeons; plastic surgeons; ear, nose, and throat specialists; and, according to emergency physicians in the state, ophthalmologists and oral surgeons.
Maine has demonstrated a strong commitment to Public Health and Injury Prevention, with the fourth highest per capita injury prevention funds in the nation ($1,232.77 per 1,000 people) and funding that is dedicated to preventing injuries among both children and the elderly. Although Maine has a higher-than-average rate of traffic fatalities, few are alcohol-related, and the state has below-average rates of fatalities among bicyclists (2.7 per 100,000 cyclists) and pedestrians (2.0 per 100,000 pedestrians). In terms of health risk factors, Maine has relatively low rates of adult binge drinking and childhood obesity, although a high proportion of adults smoke cigarettes (22.8%).
Maine's dedication to its Quality and Patient Safety Environment has lifted the state to rank among the top 10 in the nation. Maine has dedicated funding for quality improvement within its emergency medical services (EMS) system, as well as an EMS medical director. It has destination policies in place for stroke, ST-elevation myocardial infarction, and trauma patients. In addition, Maine hospitals are more likely than those in most other states to have adopted computerized practitioner order entry (92.3%) and electronic medical records (97.4%).
While Maine has some of the highest rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals (97.1 and 662.1 per 1 million people, respectively), the state has implemented very few elements of Disaster Preparedness planning at the state level. The state does not have an Emergency Support Function 8 (ESF-8) plan in place and conducts planning for hospital surge only at the regional level. Instead, Maine has three trauma referral centers that are charged with helping regional health care organizations to carry out emergency planning and exercises. While regional-level planning can be robust and effective, particularly in a rural state, the lack of state-level planning may be problematic in the event of a large disaster or mass casualty event. These challenges could be alleviated by providing clear guidelines in a medical response plan for addressing special-needs and medication-dependent patients in a disaster.
Maine's Medical Liability Environment reflects some positive reforms, although more work could be done. The state has relatively low average medical liability insurance premiums for primary care physicians ($8,563) and specialists ($38,035). Of concern is the state's relatively high average malpractice award payment ($443,372), which is a significant increase since the 2009 Report Card.
While Access to Emergency Care fares well overall, emergency physicians in the state report that there are often long waits for psychiatric care beds, especially for children. Some waits in the emergency department are reported to last 8 days.
Maine should consider instituting state-level policies and procedures for Disaster Preparedness to provide guidance to, enhance, and support the current regionalized efforts. In particular, a statewide medical communication system with redundancy could help coordinate the emergency responses in the event of a disaster impacting multiple regions. The ability to communicate quickly and securely between responding agencies and units could prove critical to providing quick and appropriate care in the event of a large disaster or mass casualty event.
Maine should work to strengthen its Medical Liability Environment by passing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA) in which providers care for high-risk patients without a preexisting patient relationship and little to no knowledge of a patient's medical history. Instituting liability protections in these cases may attract additional specialists who provide critical on-call services to the emergency department. The state should also consider requiring expert witnesses to be of the same specialty as the defendant and licensed to practice medicine in Maine.