PORTLAND, Ore. — Multnomah County will allow ambulance provider AMR to staff some of its ambulances with one paramedic and one EMT, loosening the county's long-standing 2-paramedic requirement to address the county's ambulance crisis. On Aug. 15, the Board of County Commissioners voted unanimously to approve the 12-month agreement with AMR.
The hybrid model for ambulance staffing is contingent upon AMR meeting county benchmarks over the next three months.
If AMR meets certain metrics, it could staff some of its ambulances with the mixed-experience model that the company has repeatedly insisted is necessary to improve ambulance response times amid a national shortage of paramedics.
Multnomah County says the staffing changes are temporary — a 12-month pilot, starting Aug. 1 — and subject to future review, with requirements to be in compliance by Nov. 1.
"This agreement improves ambulance response times and holds AMR accountable," Multnomah County Chair Jessica Vega Pederson said in a statement Aug. 1. "When someone needs an ambulance, every second counts ... I have high expectations for AMR over the next 12 months, and I believe they can be successful."
In a statement, Rob McDonald, regional director for AMR, called the decision a "real win for the citizens of Multnomah County."
McDonald continued, "AMR will now be able to invest in putting more ambulances on the road, supporting our goal to provide the right care at the right time. We look forward to working with the County and EMS Office to implement this solution and to continuously evaluating and improving it."
Multnomah County and AMR ended months of formal mediation talks on Wednesday, reaching the agreement after the two sides blamed each other for the county's dangerously slow ambulance response times.
"I won't be bullied into any kind of quick fix," Vega Pederson said in February before starting mediation. "The truth is that AMR is failing our community."
AMR leadership said the county's refusal to allow a hybrid staffing model, until now, showed the county was more committed to its unique 2-paramedic requirement than compromising to fix slow ambulance response times now.
"A fire chief said, 'I'd rather have a paramedic and an EMT in eight minutes than two paramedics in 25 minutes, no matter what the acuity of the call is,'" said Rob McDonald, then the Operations Manager for AMR Multnomah County. "The EMS system as it stands right now is ready for this change, clamoring for it."
In an emailed statement to KGW Aug. 1, Multnomah County Commissioner Sharon Meieran said, "It's about damn time we restored a sense of urgency to this county."
Meieran then reiterated her criticism of how long it took county leaders to find a compromise with AMR, as she and others have been raising the alarm for close to two years.
"What today proves more than anything is that Multnomah County leadership has wasted almost a year and a half of precious moments only to, in the end, do what could have been done immediately if we valued people’s lives, and the work that our amazing first responders do to try to save them," she said, in part.
"This is not a win, it’s a capitulation. And it’s shameful. It’s incredible to watch the Chair try to spin this as somehow a victory when in fact it’s an absolute embarrassment."
In a statement shared with KGW, Portland Fire & Rescue Chief Ryan Gillespie and Deputy City Administrator for Public Safety Mike Myers said they are "cautiously optimistic" about the agreement.
"For years, we’ve staunchly advocated for the entirety of AMR’s fleet to be staffed by the one paramedic, one EMT model," they said. "While we would have preferred this compromise to come sooner and become permanent, we believe this is a step in the right direction ... so no one will be told no ambulances are available when they or their loved ones are experiencing an emergency."
Staffing plan
The new 12-month staffing plan agreed to by both sides includes the following, per a county release:
- AMR is required to staff at least 20 Advanced Life Support (2-paramedic) ambulances, fewer than the 34-44 (out of a desired 50) that are currently deployed by AMR Multnomah County each day.
- AMR is required to deploy enough Basic Life Support (2-EMT) ambulances to respond to 85% of lower-acuity calls.
- AMR is allowed to deploy hybrid ambulances (1 paramedic and 1 EMT) to supplement the above requirements.
- AMR is required to produce monthly reports about its compliance with response times and contract metrics, with these reports to be shared publicly.
By contract, AMR is required to respond to 90% of life-threatening 911 calls in urban areas within eight minutes.
The company has failed to meet that target since March 2022, hovering around 60% for the first six months of 2023, meaning ambulance crews were late to respond to emergencies on about a third of calls.
Additionally, Portland's Bureau of Emergency Communications tracked more than 13,000 cases of "Level Zero" in 2023 — times when dispatchers called to send an ambulance to an emergency, but there were zero ambulances available to respond.
In November, Multnomah County fined AMR more than $500,000 for lagging ambulance response times and contract violations.
The Health Department, in its briefing to the Board, said that company has accrued $7.1 million in fines since 2022, and the settlement agreement outlines ways for AMR to reduce these fines by meeting response time requirements, increasing the number of ALS ambulances in the field, and investing in staff recruitment and retention.
Dr. Richard Bruno, the county's health officer, said city dispatchers are ready to send the appropriate ambulance teams to the different severity of 911 calls.
"We’ve been through all the numbers with AMR, we’ve gone through all the operations, all the staffing, so we both feel very confident now that we feel like we’ve come to an understanding that we can make this system work," Bruno said.
McDonald, now AMR's regional director, said he believes the hybrid staffing model could be the "bedrock" for EMS in Multnomah County moving forward.
"We can pilot the program, measure its efficacy and determine what the path forward is going to be, not just for the year in the mediated agreement but for the next five years of EMS," he said.