An American Medical Response ambulance in Portland, Jan. 11, 2024. In November 2023, Multnomah County fined ambulance service provider more than $500,000 for delayed response times to 911 calls. AMR has appealed the fine and blamed the delays largely on staffing challenges worsened by the county's requirement of two paramedics per ambulance deployed to an emergency.
Kristyna Wentz-Graff / OPB
Staffing changes won’t immediately be coming to Multnomah County’s beleaguered ambulance system. But a solution appears to be on the horizon.
County commissioners rejected a proposal Thursday that would have put pressure on Chair Jessica Vega Pederson to adjust ambulance staffing requirements as 911 response times continue to lag countywide.
Currently, the county requires American Medical Response, or AMR, to staff vehicles with two paramedics. Commissioner Sharon Meieran’s proposal would have pushed the county to switch that model to just one paramedic and one EMT per ambulance. A solution that she, and a number of other local elected officials, support.
EMTs can provide basic life support, including CPR, to patients. Paramedics have additional training to administer medications and intravenous drugs.
Meieran, who also works as an emergency room doctor, said she believes this staffing change will allow ambulances to respond to emergencies more swiftly and won’t impact the level of medical care patients receive.
“What matters most for patient survival is how fast they get to an emergency room,” Meieran told OPB earlier this week. “I see this in real time, through my work. This is not abstract for me.”
Related: Multnomah County chair continues to blame AMR for slow ambulances
Last year, the county fined the ambulance provider over alarmingly slow response times. AMR is expected to respond to 90% of life-threatening calls within eight minutes in urban areas, according to its contract with Multnomah County. In August 2023, AMR ambulances arrived late to those emergencies 14% of the time.
At the time, AMR argued that this was due to staffing shortages, and could be improved if the county agreed to relax its two-paramedic staffing requirements. The county and AMR have been in mediation sessions since to create a path forward, which are expected to resolve next week.
Chair Vega Pederson and Dr. John Jui, Multnomah County’s EMS medical director, have argued against the proposed staffing change. Both believe that a two-paramedic system is critical for patient survival, and that AMR simply needs to improve its staffing issues.
The hourslong discussion Thursday ended with Commissioner Meieran voting against her own plan after it was tweaked by other commissioners to reflect ongoing mediation with AMR. According to County Chair Vega Pederson, that mediation will wrap up next week and produce a solution to the staffing issue acknowledged in Meieran’s proposal.
Yet Meieran said she wanted her proposal to act as a standalone statement that condemned county leadership’s seemingly unhurried efforts to improve ambulance response times.
“While it’s great to hear that we may be on the verge of an agreement through mediation,” she said, “saying we’re about to do something and actually doing it are two different things. We should have done it a year ago. We didn’t. Every day matters.”
Related: Multnomah County fines ambulance company for slow response times
Her proposal had the support of Portland City Council, Gresham City Council, local fire chiefs and AMR management. At the afternoon commission meeting, Portland Fire Chief Ryan Gillespie gave numerous examples of “extremely unsafe” situations in which fire trucks were used to transport injured patients to an emergency room, due to AMR staffing shortages.
“Multnomah County’s inaction and unwillingness to take immediate measures continues to put lives at risk,” said Gillespie.
In an effort to get the proposal passed, Commissioner Jesse Beason attempted to change Meieran’s plan to reflect the coming agreement between the county and AMR. His amendment would have directed the county to temporarily change the ambulance staffing model to reflect the county’s final offer to AMR in the mediation process, if negotiations did not conclude by Aug. 1. It also required AMR to pay for all fines it has accrued for failing to meet response time standards agreed upon in the county contract.
Meieran opposed Beason’s agreement because of these fines.
“They get fined and it just makes the situation worse,” she said. “I think there could be constructive approaches to work toward with them.”
Her proposal, including Beason’s amendment, failed 3-1, with Commissioner Julia Brim-Edwards casting the only vote in support.
AMR paramedics and EMTs in Multnomah County are represented by Teamsters Local 223. Austin DePaolo, a spokesperson for the union, called Meieran’s decision to introduce a proposal while the negotiations are ongoing an act of “political grandstanding.”
“We want to respect the mediation process,” DePaolo told OPB, “and respect the employees of Multnomah County’s EMS department, who are making decisions based on data, not politics.”
Vega Pederson said the board would be briefed on the new proposal with AMR at next week’s commission meeting.