MULTNOMAH COUNTY, Ore. — Multnomah County has set a deadline of next Wednesday to find an agreement or settle with ambulance provider American Medical Response (AMR) in its long-running saga of the county’s ambulance response crisis.
County commissioners in a public meeting discussing poor ambulance response times implied that the county may compromise on its strict two-paramedic requirement for ambulances, with an announcement expected on August 1.
On Thursday, city and fire leaders from Portland, Gresham and Fairview testified in support of a change to a one-paramedic and one-EMT model, something AMR has been lobbying for, pointing to a nationwide shortage of medical responders, saying that it has been exacerbated by Multnomah County's requirement that ambulances be staffed by two paramedics.
Though Chair Jessica Vega Pederson stated in February that she "won't be bullied into any kind of quick fix," there may be some wavering on the county's hardline stance. County EMS leaders have previously insisted that two paramedics provide better patient care and outcomes.
But Multnomah County Commissioner Sharon Meieran said Thursday if a change to a 1-and-1 model or a hybrid model is the ultimate result of mediation, it took too long: The county has held formal mediation sessions with AMR for six months, and Meieran and others have been raising the alarm for close to two years.
"Doing the right under pressure now does not erase the year-and-a-half of suffering that we've seen, of people calling 911 not getting an ambulance," Meieran said.
Fairview City Council member E'an Todd — along with Portland city commissioner Rene Gonzalez, deputy chief Mike Myers, and Portland Fire & Rescue Chief Ryan Gillespie — all asked county commissioners once again Thursday to switch to a 1-and-1 model.
"On a personal note, 47 months ago, I found my wife unresponsive one morning," Todd said. "I don’t know whether a faster response time getting to the hospital would’ve changed the outcome of her unfortunate passing. I do know that when I got my EMT training I was taught time equals tissue — the speed in which you get to a hospital is the only thing that matters in outcome; EMTs can drive."
Gillespie said the county didn't consult externally with PF&R during the months of mediation talks with AMR.
"Meanwhile, this crisis continues and has gone on far too long, with a short-term solution being proposed by us doing the work on the streets," Gillespie said. "Multnomah County’s inaction and unwillingness to take immediate measure continues to put lives at risk."
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The 2-paramedic model has backers. The union representing most paramedics in the county wants to keep it, saying most paramedics enjoy working alongside someone with the same level of training.
Vega Pederson has previously pointed out that AMR is failing to meet its contractual obligations, and the county shouldn't feel compelled to change its standards to benefit the company, paramedic shortage or not.
Ultimately, ambulance availability and the quickness of response times are top priority, Meieran said.
Vega Pederson said she'd share more details on the next steps with AMR at the upcoming August 1 meeting.
Background
The county’s lagging 911 response times have remained the core issue in the years-long battle, along with contention over the shortage of paramedics, squabbles over fines and the feud over ambulance staffing best practices.
In Multnomah County, AMR ambulances are frequently unavailable to respond to emergency 911 calls. Through public records requests, KGW tracked more than 14,000 incidents in 2023 in which emergency dispatchers called for an ambulance, but no ambulance crews were available.
In November of last year, Multnomah County fined the ambulance provider $513,650 for late ambulance responses during the month of August, escalating the standoff over poor 911 response times, in which both parties have blamed each other.
In February, AMR sent its formal proposal to fix slow ambulance response times to Vega Pederson, which was rejected. In the letter, AMR Multnomah County asked 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.
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.
But AMR; Multnomah County Commissioners Meieran and Julia Brim-Edwards; Portland Fire & Rescue; Gresham Fire & Rescue; Corbett Fire; Portland Emergency Management; and East County mayors in Troutdale, Wood Village, Fairview, and Gresham have advocated for a change to the one-paramedic and one-EMT model, along with Portland city council member Rene Gonzalez, who is running for mayor.