PORTLAND, Ore. — Despite Multnomah County and ambulance provider American Medical Response striking a compromise agreement last month over staffing rules, data thus far shows that there continue to be issues with ambulance availability for emergency medical calls.
County commissioners voted last month to allow AMR flexibility in staffing ambulances with one paramedic and one EMT, after previously requiring two paramedics per ambulance. This "hybrid model" is a compromise that AMR has been requesting for more than a year due to a shortage of paramedics.
The agreement also came with requirements for AMR to improve 911 response times.
Hybrid ambulance crews have been operating for weeks now, and starting Monday, the 911 dispatch system was updated with a new identifier for these types of crews so that dispatch can now see which ambulances are Advanced Life Support (two paramedics), Basic Life Support (two EMTs) and hybrid (one of each).
Nevertheless, not all issues with response times have been solved in the weeks since the compromise. "Level Zero" events, a designation used by dispatch when there are no ambulances available to respond to a call, remain prevalent.
On Monday morning, a crew with Portland Fire & Rescue opted to take a patient to the hospital in the back of a fire engine because there were no ambulance crews available. The patient had cut himself with a chainsaw and firefighters worried the accident could become critical due to blood loss or other issues.
Audio recordings capture the back-and-forth between 911 dispatch and Portland firefighters.
911 Dispatch: Engine 29, AMR is Level Zero, priority 2 delta injury
Portland Fire & Rescue: Is there a BLS (Basic Life Support) ambulance attached to this?
911: Negative, we're at Level Zero and I don't show any BLS available
PF&R: Ok, copy that, thanks.
PF&R: Is there any ambulance yet?
911: Negative, they're working on seeing if they can get one from Clackamas
PF&R: Ok, we're going to package this guy and go Code 3 in the fire engine to PA (Adventist Health Portland)
911: Copy, going Code 3 to PA
According to a PF&R spokesman, firefighters were able to reach the scene within a few minutes. Less than 10 minutes after arriving, they loaded the patient into a fire engine and took him to Portland Adventist. When they arrived at the hospital, an AMR crew was there sterilizing their ambulance from a previous call and contributed a gurney so that the patient could be wheeled into the emergency room.
"PF&R is encouraged that the county and AMR have elected to pursue this hybrid model of staffing that should enable an ambulance to be available at each and every incident that requires a hospital transport under professional medical care," a PF&R spokesman said. "As with any new program, there will be growing pains and although the hybrid (1 and 1) model began this morning, the expected date of official operation is not until November so it is our hope this incident today is rare as we move forward."
For their part, an AMR spokesperson said that they've been using some hybrid ambulances since Multnomah County passed the new agreement, but they've been working in the meantime to "redesign the entire system" around the hybrid model. Monday marked the launch of an initial iteration of that redesign.
"We are excited to see improvement in our response times and plan to report the good news to all stakeholders in the coming weeks," AMR said. "Today, hybrid units have a unique identifier in the dispatch system that allows both AMR and Multnomah County EMS to quickly identify how many hybrid units and dual paramedic units are deployed at any given time."
Multnomah County's agreement with AMR on staffing changes is temporary — a 12-month pilot that became effective Aug. 1 — and subject to future review, with requirements for AMR to be in compliance by Nov. 1.