HILLSBORO, Ore. — Washington County is pushing ahead with a planned overhaul of its emergency medical services system, which could mean a new ambulance provider and new ways to track how well EMS responders are saving lives.
County leaders said the modernization has been in the works for years and is not a product of lacking EMS performance, however public records show ambulance response has fallen short of county benchmarks in recent months.
Washington County and Hillsboro-based Metro West Ambulance have worked together under an emergency services agreement for the past 25 years, first signed in 1997.
"Just in the fact that it’s been that long it’s antiquated and our ability to modernize our system and move forward is halted by the actual agreement," said Adrienne Donner, program supervisor for EMS in Washington County.
In May, the county's EMS alliance, made up of the 911 center, MWA, local fire department chiefs and county leaders, recommended ending the agreement and requesting bids for the next service provider. Washington County commissioners unanimously agreed.
The county will end its current agreement with MWA on June 30, 2023.
Metro West spokesperson Jan Lee said the EMS provider supports that decision, even if MWA will have to compete for the next contract.
"This has not been a surprise and we actually welcome it; it’ll give a chance to do some needed updates to our EMS system that the current contract doesn’t allow," Lee said.
Washington County wants a centralized 911 center dispatch system, unified and consistent data sharing between the ambulance provider, fire departments and dispatch, and greatly improved quality metrics.
These metrics could include detailed ways to track how well EMS workers are serving the community and what happens after first responders arrive to a call.
"We're looking at how quickly they can identify a heart attack, how quickly they can let the emergency department know, that’s much more telling for the outcome for the patient," Donner said.
Currently, the county’s agreement with MWA is limited in scope. It mainly requires MWA to track and report ambulance response time, which falls into three categories depending on where someone lives in the county.
EMS teams have up to eight minutes to respond in the most populated areas, like Beaverton, Tigard and Hillsboro. They have 11 minutes to get to the middle portions of the county, with a 30-minute response time allowed the farther north and west you go in Washington County.
Donner said upgrading the county's EMS system is not connected to EMS performance, as modernization has been a goal of the county's for years. Lee said the same.
"Performance has not played a role in this decision moving forward, and so all of our performance is public record," Lee, a spokesperson for Metro West, said.
However, public record shows MWA is falling short of county benchmarks and the most recent review of the ambulance company recommended that the county not renew its agreement with MWA.
As part of the contract, Washington County requires Metro West to respond to 911 calls within time requirements at least 90% of the time.
In the county’s most recent 18-month review, ending in December, Metro West failed to meet that benchmark throughout the last 5 months of 2021, falling to about 83%.
Lee said staffing issues throughout the healthcare industry are to blame.
"I would say that staffing has been a big issue, definitely, along with call volume, the types of patients, the surges in COVID, there’s a lot of different factors that come into play there," Lee said.
Metro West also failed to meet another county requirement — availability to transport patients — which affects local fire departments as well.
The county monitors a figure called ARMUP, which represents the amount of times another agency must go beyond responding to also transport and take care of a patient.
MWA can turn over no more than 1% of its calls to another agency, such as a fire department crew.
For most of 2020 and 2021, MWA had no problem keeping below this threshold. But by the end of 2021, MWA had surged past the allowed 1% level.
Lee said a surge in calls, how long it takes to get someone turned over to a hospital, ambulance staffing, and other variables may all play a role.
"When you take a look at the performance, that’s been discussed with Washington County and again, several different factors," she said.
In the summary of this review, Washington County said Metro West Ambulance 'did not satisfactorily meet their obligations,' lapses in performance were not singular events, and performance improvement plans were started earlier this year.
The summary reads, in part: "With the material submitted and continued review, it is the recommendation of the Washington County EMS Program, that an additional eighteen-months NOT be granted."
By June 6, when this 18-month review was published, Washington County had already voted to move forward with updating its EMS system, which requires ambulance providers to submit bids for the work.
Donner said the county hopes to have an updated EMS system and ambulance provider in place by the summer or fall of 2023.
"We’ve been working for 10 years to really figure out where the system is going and how to build the best system we can," she said.
The county's monthly performance reviews for January through March of 2022 - the most recent to be released to the public - show mixed results of Metro West Ambulance performance.
MWA missed county standards on response times and ARMUP in January, met standards in February, and reported a mixed bag in March.
In the May 17 meeting in which Washington County commissioners approved the EMS system overhaul, commissioner Ro Rogers said he was concerned about rising ambulance costs for uninsured individuals.
County leaders said any increasing rates won't affect anyone covered with Medicare or change individual deductibles paid to insurance companies, but acknowledged the county may need to work to reduce the burden on uninsured patients moving forward.
Any details on rising rates would be dependent on the EMS contract bid and service provider responses.