PORTLAND, Ore. — Ambulance provider American Medical Response (AMR) has sent its formal proposal to fix slow ambulance response times to Multnomah County Chair Jessica Vega Pederson.
In the letter, sent earlier this week, AMR Multnomah County asks the county to agree to a temporary switch in ambulance staffing, allowing AMR to staff ambulances with one paramedic and one EMT instead of the currently mandated two-paramedic model.
If Vega Pedersen and county leaders approve the change, AMR Multnomah County Operations Manager Rob McDonald said the company would be fully staffed within three months — reversing trends of a shrinking EMS staff and slowing 911 response times.
AMR leadership has long insisted that the 1-and-1 model is the answer to its current problems, which have been exacerbated by a national shortage of paramedics.
"We urge them to make this change and make it immediately," AMR Vice President Randy Lauer previously told KGW. "Let us start adding more ambulances, improve the response times, get to people faster, reduce the fatigue and burnout in our paramedics, and get back to a sustainable system. The system today is not sustainable."
However, Multnomah County leadership, including Vega Pederson and EMS medical director Dr. Jon Jui, have resisted any reduction in staffing requirements, saying the two-paramedic model produces the best results for patient care and significantly contributes to high-ranking heart attack survival rates in the county.
Not to mention, AMR signed a contract with Multnomah County that requires two paramedics on all 'Advanced Life Support' ambulances — ambulances that respond to life-threatening calls. Why should the county lower its standards because AMR has missed response time performance benchmarks for more than a year?
That line of thinking resulted in Vega Pederson issuing a $513,650 fine for AMR in September 2023 for late 911 response times.
Since then, the ambulance 'crisis' has only gotten worse.
McDonald wrote that AMR Multnomah County should be staffed with 50 ambulances on the streets each day. Currently, it only has enough paramedics to staff 32-34 ambulances per day.
The company is down 60 paramedics and loses two more each month. Hiring incentives and full-time scholarships for paramedic programs have had little effect on overall staff volume, according to AMR. It's been significantly easier for AMR to hire EMTs, who require less training than paramedics.
As a result, McDonald said that a temporary staffing change is the only way forward.
"If we continue the current path, this system could collapse in a matter of months as the impact of the national paramedic shortage worsens," he said.
He referenced an example given to him by a local firefighter.
"I'd rather have a paramedic and an EMT in eight minutes than two paramedics in 25 minutes, any day," McDonald previously told KGW.
In response to AMR's formal proposal, a Multnomah County spokesperson said Vega Pederson is "declining to comment until she has briefed her colleagues on the Board of Commissioners on next steps."
Vega Pederson said at a commission meeting in December that 'next steps' could include a 6- to 9-month review of EMS staffing before making any changes.
Commissioner Sharon Meieran responded by saying that timeline is outrageous, and the county should make this change to a 1-and-1 model immediately.
To change or not to change?
As it stands, here's where notable or interested parties land on either side of the issue:
In favor of keeping the two-paramedic system:
- Multnomah County Chair Jessica Vega Pederson
- Multnomah County EMS
- Led by Dr. Jon Jui, a longtime advocate of the two-paramedic model
- Teamsters Local 223, the union representing paramedics in Multnomah County
In favor of switching to a one-paramedic and one-EMT model:
- AMR
- Portland Fire & Rescue
- Gresham Fire & Rescue
- Corbett Fire
- East County mayors in Troutdale, Wood Village, Fairview, and Gresham
- Portland Emergency Management
- Multnomah County Commissioners Sharon Meieran and Julia Brim-Edwards
Portland city council member Rene Gonzalez has also advocated for the change.
Gonzalez plans to introduce a resolution to Portland City Council next week calling on Vega Pederson to direct the switch to "combat the critical lack of ambulances available to respond to emergencies" in Portland.
"This combination of insufficient paramedics is putting too much stress on the whole ecosystem of public safety," Gonzalez said. "We've been analyzing this at Portland Fire for a year, engaged with the County and AMR for a year on this project. We've been patient, we've been doing the work analyzing the problem, but we're just at a breaking point now."