MULTNOMAH COUNTY, Ore. — Multnomah County could fine ambulance provider American Medical Response $500,000 solely for late ambulance responses in the month of August, a county health administrator told county commissioners Tuesday.
The Multnomah County Board of Commissioners held a hearing on the county's persistent ambulance response problems Tuesday morning — a topic KGW's investigative team has covered for months.
Frequently, ambulances in the county have failed to meet standards for quick emergency response. On thousands of occasions this year, there have been no ambulances available to respond to 911 calls deemed to be life-threatening emergencies.
The hearing exposed some friction over the county's commitment to a two-paramedic ambulance system for emergency 911 calls. County health leaders, including longtime EMS medical director Dr. Jon Jui, swear by the two-paramedic requirement.
"There is data on cardiac arrests showing better outcomes with two paramedics rather than one paramedic and one EMT," Jui said. "Even if we went to a split system, data from adjacent counties that are (one paramedic and one EMT) show they have similar issues, one-plus-one does not actually solve the problem."
Multiple commissioners asked Jui and county health leaders about switching to a one paramedic and one EMT model — a change which AMR has said would greatly improve ambulance response times in the county.
Commissioner Sharon Meieran said she believes a change to the one paramedic and one EMT staffing model is the right approach.
"I would choose the quick response of a paramedic and an EMT, ideally with (firefighters also arriving), over waiting excruciating minutes for a two paramedic system, any day, any time," Meieran said.
County health officials shared updated AMR response data with commissioners at the hearing. It showed response times did not improve between March and June of 2023.
Per the county's EMS Service Agreement, AMR ambulances are supposed to arrive to emergency calls within eight minutes at least 90% of the time. Currently, ambulance crews are arriving to emergencies within eight minutes about 60% of the time.
Meieran said the data shows something needs to change quickly.
"People are not getting their emergencies responded to fast enough," she said.
In August, Multnomah County Chair Jessica Vega Pederson threatened to fine AMR for poor performance, a right that's included in the county's contract with the ambulance company.
The first fine could be issued in the coming weeks, as Multnomah County reviews response time data from the month of August, according to EMS administrator Aaron Monnig.
"The preliminary ballpark of the fine for (August) is $500,000," Monnig said. "That's a significant amount of money, and once we get the final report, we'll be discussing how we're assessing that fine and where it's going to be used."
This fine estimate is much higher than the baseline fine for noncompliance — $10,000 — with Multnomah County likely calculating additional "outlier" fines for incidents in which AMR ambulance crews took longer than 13 minutes to respond to emergencies.
Previously, AMR told KGW that nationwide paramedic and EMT staffing shortages were to blame for the slipping response times, disagreeing with the Vega Pederson's announcement that she would start pursuing fines:
"American Medical Response takes the responsibility of staffing its Multnomah operation and meeting obligations very seriously. We have made extensive efforts to communicate the severity and external causes of paramedic staffing shortages nationwide to the County. However, we disagree with the County's current stance.
"AMR wants to assure members of the community that we are doing everything within our power to fulfill our responsibilities and address the staffing shortages. We remain open to working collaboratively with the County to find a resolution, including moving to a Paramedic and EMT staffing model like systems across the country."
County commissioners did not decide on any plan of action at the Tuesday hearing, with Vega Pederson saying she wanted the briefing to get everyone on the same page about the current problems and changes already in progress.
These changes include the introduction of all-EMT "Basic Life Support" crews to respond to low-risk or low-acuity calls. The county, AMR and Portland's Bureau of Emergency Communications also recently changed its 911 dispatch system to better triage different types of emergency calls.
Both changes are intended to free up and reduce the workload of two-paramedic AMR crews, helping them respond to emergencies quicker and be more available for incoming 911 calls. The BLS expansion and dispatch modification are both in early stages of implementation.
Monnig said AMR needs to hire and onboard more EMTs to create what the county is looking for — a 10% reduction in the number of calls that two-paramedic crews respond to.
"There are not enough EMTs still, we have nine, we need about 40 to effectively take all these calls out of the 911 system," Monnig said.