In the Boothbay Region Ambulance Service station training room, emergency medical responders are preparing for an era in which their role will be as much about preventing medical crises as responding to them.

As part of a pilot program approved by the state in January, ambulance services based in Waldoboro, Boothbay and Damariscotta are working with Lincoln County Healthcare to offer preventative care to homebound people referred by their primary care doctor or an emergency physician. Through connecting the most isolated patients to services, the program hopes to keep them healthier, longer.

By monitoring a patient’s blood sugar or blood pressure, for example, the partnership may be able to prevent a heart attack or the loss of a limb due to complications of diabetes and help patients stay at home longer with better quality of life.

Scott Lash, operations manager at the Boothbay Region Ambulance Service, said the paramedicine program(the first in Maine to cover most of a county) is part of an evolution in emergency care that will have a deep impact on how ambulance services work with hospitals and patients. For his crew, the first installment of that change means brushing up on skills like blood draws, wound assessment and medication reconciliation, which will become a bigger part of the job when they begin doing house calls.

To practice those skills, emergency medical responders have put together a simulation lab, a collection of medical teaching mannequins and other equipment that allows them to practice their skills under realistic circumstances. Lash said his crew has worked hard to create the lab by borrowing some equipment and applying for grants for other pieces.

Eventually, paramedicine will lead to an expansion of both the scope of services emergency responders can provide and their role within the medical system, Lash believes.

For Lincoln County Healthcare, which applied for the pilot program and will manage it, the payoff is in reaching patients sooner and preventing debilitating medical crises that can result in a permanent loss of quality of life.

As the population ages and needs more healthcare (Lincoln County is one of the oldest counties in the oldest state in the country) the challenge is to find ways to make scarce healthcare dollars stretch further and still offer high quality care.

The paramedicine pilot attempts to meet those goals by leveraging the skills of emergency crews and their down time between calls. It is made possible by improvements in technology and training that have made an increasing number of services not only possible in the field but cost effective.

Lash became an emergency medical technician about 20 years ago when ambulance crews were staffed largely with volunteers who could do little more than provide first aid on the way to the hospital.

Today as a paramedic, Lash can give heart attack patients several different potentially life-saving medications, begin intravenous therapy and use a 12-lead electrocardiogram to study a patient’s heart rhythm, all steps that were only possible in emergency departments a few years ago.

Even more central to the change is communication. When Lash takes a cardiac patient to the hospital, he is relaying symptoms, vital signs, test results and discussing treatment options with physicians.

That communication means patients now enter the medical system in the ambulance. By the time they arrive at the hospital, not only have they received potentially life-saving interventions, but emergency physicians have the information they need to begin the next phase of treatment.

The paramedicine pilot will take that communication a step further with iPads equipped with secure wireless connections. The iPads will allow emergency physicians to talk with patients face to face and better determine when they need treatment at a hospital and when they can safely stay at home.

For now, the program is just getting off the ground as physicians determine which patients best fit the program’s capabilities. If a patient needs too many services, for example, they may be better served by home health providers.

It will take time to work the kinks out, said Lash, but he knows there is a need for the service and making home visits between emergency calls will not only improve the skills of his crew, it will give his towns more value for their dollars.

Whether the program will save money in the short term is a difficult question, said Lash. But when asked how it will affect the communities he serves, he has little doubt.

“People are going to be healthier and have better quality of life,” he said.