WASHINGTON COUNTY, Ore. — In its first three months in charge of ambulance service in Washington County, American Medical Response didn't improve on the 911 response times recorded by its predecessor, Hillsboro-based Metro West Ambulance.
Instead, AMR's start as the primary provider in Washington County produced 1,682 "Level 0 Events" — defined as when no ambulances are available to respond to emergency calls.
Between August and October of 2023, AMR ambulances were unavailable for a cumulative total of more than 75 hours, representing three full days in three months where firefighters were the only first responders able to get to a 911 emergency call, leaving people waiting for ambulance transport.
Still, Washington County leaders and AMR say improvements are coming as the county and AMR transition into a new emergency medical services (EMS) model that provides better data on patient outcomes.
"August through October was a time of development for AMR when they were focusing on increasing their staffing and building a new operation," said Washington County through an EMS system and compliance report. "During these months, they system they operated in was a heavier burden on their resources than they had expected."
AMR won a bidding war to become the sole ambulance provider in early 2023, pushing out longtime operator Metro West.
Weeks before taking over on August 1, AMR said its staffing in Washington County was nearly complete — having hired all EMTs needed and looking to hire a remaining nine paramedics by August 1.
However, in its compliance report, Washington County said a problem with the dispatch center led to poor response times.
In the first three months, Washington County Consolidated Communications Agency (WCCCA) could not directly dispatch Basic Life Support ambulances to lower-acuity calls — a key method of ambulance triage. Instead, dispatch sent Advanced Life Support ambulances to all 911 calls, contributing to slow response times.
Dispatch began directly deploying BLS ambulances in November, according to the county.
For most emergency 911 calls (defined as "Code 3 - Lights and Sirens" in urban areas), Washington County requires AMR ambulances to arrive to 90% of calls within 10 minutes.
AMR has similar requirements in the other three counties it services in the Portland and Vancouver area — Multnomah County, Clackamas County and Clark County. Multnomah County, for example, requires 90% response time compliance within 8 minutes.
KGW requested ambulance response time compliance data from each of the four counties by month for 2023.
Hover over the interactive graph to see data points for each county, by month.
AMR's performance in Clark County ranked the highest, including the only two months of 2023 where the company met the 90% compliance benchmark.
Response time percentages in Clackamas County averaged in the low 80s, followed by Washington County near 70%, which includes both Metro West and AMR statistics.
Multnomah County's ambulance service ranked last. On roughly two out of every five emergency 911 calls in Multnomah County, AMR failed to respond to the scene within 8 minutes.
County leaders fined AMR $513,650 in August for slow response times, reflecting that AMR ambulance crews often took much longer than 8 minutes to respond to scenes, ballooning the fine total for just one month of substandard service.
Washington County's compliance report says AMR continues to make improvements and actively seek solutions.
In December, AMR subcontracted with Metro West to add more ambulances into the Washington County system when AMR's resources are strained. KGW will share an in-depth report about ambulance subcontracting in the coming days.
The county, in its plans to "modernize" the way EMS care is measured, plans to start collecting and publishing metrics that show the "quality" of patient care.
"Throughout the first five months of the contract, AMR has been exceptionally transparent with their staffing progress as well as their work to address operations in the County," the compliance report said.
AMR has previously explained its challenges with paramedic staffing and response time performance in interviews with KGW.
