By Hannah Kaufman
Morning Sentinel
AUGUSTA, Maine 鈥� After Kennebec County budget officials cut an emergency medical program from their budget in April, a grant from the Maine Recovery Council could give it a second life.
For more than a year, the MD3 program has deployed doctors to emergency calls around Kennebec County to provide hospital-level treatment in the field. While the program initially focused on emergency calls broadly, the $236,914 grant will concentrate more resources on overdose cases and recovery services.
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It鈥檚 one step toward combatting the growing substance use disorder crisis in the region.
Since 2009, Kennebec County has had the fourth-highest number of fatal drug overdoses of Maine鈥檚 16 counties. Home to an estimated 9% of Maine鈥檚 population, the county also accounted for 10% of the state鈥檚 nonfatal overdoses between January and December 2024, according to Maine Monthly Overdose Report data.
With years of experience working in hospitals and communities across central Maine, the seven physicians on the MD3 team who work rotating shifts will be well equipped to respond to overdose calls, Tim Pieh, MD3 doctor and emergency medicine physician at MaineGeneral Medical Center, said.
鈥淭hat鈥檚 our target, to try to keep those patients safe, and we鈥檙e uniquely set for it,鈥� Pieh said. 鈥淭hey鈥檝e given us the funding so we can keep our normal operations going for at least a year, and then really concentrate on that, and measure: Was our impact worth their investment? And can we objectively prove that?鈥�
Impact on scene
Pieh launched the pilot MD3 program in 2023, with a $345,000 in federal American Rescue Plan Act grant from Kennebec County and an additional $78,900 in county funds. With no more ARPA funding available, Pieh said the county likely had no choice but to cut the program from the budget.
鈥淲e are just a high acuity, low occurrence impact,鈥� he said. 鈥淢eaning that it鈥檚 very impactful to the individual patient that gets the benefit, but it doesn鈥檛 happen often enough for it to be on everybody鈥檚 radar. So how do you stay alive long enough for it to percolate into everybody鈥檚 consciousness? And that鈥檚 a challenge, but we鈥檙e up for it.鈥�
MD3 has since secured a two-year Maine Recovery Council grant for $236,914, one of 43 grants awarded through $13.9 million available this funding cycle.
The recovery council was established in 2022 to distribute nearly half of Maine鈥檚 $230 million share of opioid settlement funds awarded following years of litigation against pharmaceutical manufacturers and retailers.
Pat Kimball, chair of the Maine Recovery Council, said countless people have lost their lives and livelihoods to the opioid epidemic.
鈥淲e never forget this money is here because of tragedy and death,鈥� Kimball said. 鈥淭he pharmaceutical companies lied, and in that process of deceit and lying, we were able to receive funds. So we鈥檙e determined to ensure that the funding that we have is allocated out to the programs that we believe will have the largest impact, as well as reduce deaths in Maine .鈥�
In the next year, the MD3 doctors will continue to respond to emergency calls while increasing their efforts to respond to every overdose patient in the region they cover. The team responded to 211 emergency calls from December 2023 to December 2024, patrolling high-risk locations from 8 a.m. to 8 p.m. Monday through Friday to arrive on scene as fast as possible.
Among them was a call at the Travis Mills Foundation Veterans Retreat in Rome for a staff member having a medical emergency. The closest ambulance was 35 minutes away. Pieh got there in half that time.
His presence made a difference for the patient and those around her, according to Heather Labbe, executive director of the rehabilitation-focused retreat that provides programming for veterans and their families.
鈥淗e provided critical support to the first responders that were there, and support to the staff,鈥� Labbe said. 鈥淲e had no idea what was going on. Everybody was nervous, everybody was concerned. And having him on site, with his cool, calm demeanor, he reassured everybody: 鈥楾his is OK, she鈥檚 OK. Everything鈥檚 going to be OK.鈥欌��
Following up
The Maine Recovery Council distributed funds to programs based on their role in substance use disorder prevention, treatment, recovery and harm reduction. The 43 recipient programs are expected to submit updates to a statewide dashboard that will display how the funds are being used and what impact they have on Maine.
With the grant, the MD3 doctors will begin to provide day-after overdose care to patients, including needs assessments, referrals to peer support, addiction medicine clinic evaluations and distribution of Narcan and other appropriate treatments.
Pieh said the most high-risk overdose patients are those that get reversed with Narcan but refuse follow-up care.
鈥淭hat patient is really high risk, they鈥檙e in acute withdrawal,鈥� he said. 鈥淭hey鈥檙e looking to get out of that withdrawal, and they鈥檙e too scared to come into the ED for help and to be bridged into follow-up care.鈥�
Fentanyl is the leading cause of overdose deaths in Maine. In central Maine, Lewiston, Auburn, Augusta and Waterville have the most overdose deaths, but Kimball said substance use disorder affects people in every part of the state.
鈥淲e know that we鈥檙e in a crisis and that we have to do something in order to turn around the overdose deaths in Maine,鈥� Kimball said. 鈥淲e still know that too many people are dying, we鈥檙e losing too many people. And so the real goal is, how do we get to the point where we make changes?鈥�
Untold impact
A portion of MD3鈥檚 funding will go toward increasing overdose and addiction educational efforts, especially for local school staff, emergency department staff, nurses, physicians, law enforcement and firefighters.
Already, the program has a deep focus on education. During its first operational year, the team spent more than 200 hours teaching 748 students.
The doctors also work hand in hand with paramedics and EMTs on every call, talking through medical decisions and providing real-time feedback. That mutual support becomes critical during moments of crisis.
In January 2024, a boy in central Maine had a seizure at his home. He was not responsive when Delta Ambulance arrived, but with the help of EMTs and Pieh, he responded to medication and started breathing again.
Webb Shaw, a paramedic with China Rescue and Delta Ambulance who was on the scene, said the boy鈥檚 mother could not believe how many resources were focused on saving her son.
鈥淚 can鈥檛 tell you how impressed the mother of that child was that there was an actual doctor,鈥� Shaw said. 鈥淏etween the first responders that showed up, Delta and then Dr. Pieh, she was just almost in tears. She couldn鈥檛 believe the resources that came to help her in her time of need, especially a medical doctor. That really blew her mind.鈥�
In the program鈥檚 first year, MD3 doctors were the first to arrive on scene on 10 different cases, half of which were cardiac arrests.
A 2016 pooled analysis of CPR studies showed that EMS-physician-guided CPR had significantly improved outcomes over paramedic-guided CPR, with a 12.8% increase in the return of a sustained heartbeat.
The MD3 doctors visit classrooms to teach CPR and other medical tactics in a non-urgent environment, said Abigail McMahon, instructor of Mid Maine Technical Center鈥檚 EMT course, who regularly invites the physicians to teach her students.
鈥淗ere鈥檚 the thing: You leave my class, and you could be transporting on an ambulance, bringing a patient to Dr. Pieh tomorrow,鈥� she said. 鈥淪o my goal is to have these faces be comfortable, so they鈥檙e bringing in a patient and they鈥檙e like, 鈥極h, it鈥檚 Dr. Pieh. OK, I know what he鈥檚 looking for.鈥欌��
Several of her students have done just that.
But even with the grant and community support, the team has had to tighten its annual operating budget, which previously totaled $250,000 to cover fuel, liability insurance, medical equipment and salaries. Shifts may have to be shortened for the doctors, Pieh said, who already lose money taking an MD3 shift over a regular emergency department shift.
鈥淭o come take a shift on MD3 is about a 70% pay cut for them,鈥� he said. 鈥淚 mean, what do you do with that number? Right now, that鈥檚 enough to keep five or six docs. They鈥檙e willing to do that in order to be a part of this program.鈥�
The team recently received a $46,000 Maine EMS Sustainability Grant to purchase a blood refrigerator, which will allow the doctors to carry blood directly to patients in hemorrhagic shock 鈥� a service only LifeFlight of Maine currently provides in the region.
Pieh is also working to transition the program to a 501(c)(3) nonprofit organization, moving from county-based funding to donor- and grant-based funding. He is in the process of building a board of directors to help the program reach financial solvency.
Until then, he said, the MD3 doctors remain committed to their untold impact: Working with EMTs and paramedics, offering real-time feedback and inspiring the next generation of first responders.
鈥淚f we do a good job, we leave every EMT, every paramedic, with that lesson learned on that individual case, in a constructive, positive way,鈥� Pieh said. 鈥淎nd I think that probably has higher impact than any life that I save with my own hands.鈥�
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