An American Medical Response ambulance on US 26 near Beaverton, Jan. 10, 2024.
Kristyna Wentz-Graff / OPB
Multnomah County has reached an agreement with its ambulance provider, settling months of disagreement over how to improve emergency response times.
“I’m so glad to report that we’ve reached agreement through mediation to pilot more flexibility in ambulance staffing and improve response times,” said County Chair Jessica Vega Pederson at a county board meeting Thursday.
The agreement temporarily allows changes to ambulance staffing requirements that some emergency management leaders and elected officials have demanded for months. This includes allowing some county ambulances to be staffed by just one paramedic and an EMT, rather than two paramedics.
While most commissioners expressed relief at finally reaching a conclusion in the board meeting, many expressed frustration with how long it had taken to fix a problem impacting the public’s health.
“There’s a whole lot to be mad about and there’s also a whole lot to be hopeful about in reaching this agreement,” said Commissioner Jesse Beason. “But it’s taken far too long to get here.”
American Medical Response, the county’s sole ambulance provider, is contracted to respond to 90% of all life-threatening calls within eight minutes. It hasn’t met that expectation since March 2022. The company has since accrued more than $7 million in fines from the county for not improving response times.
AMR has argued that the issue is due to a shortage of paramedics caused by training delays during the COVID pandemic. In March of this year, the company proposed a solution: switch the county’s original requirement to staff each ambulance with two paramedics to a model requiring just one paramedic and one EMT per vehicle. EMTs can provide basic life support, including CPR, to patients. Paramedics have additional training to administer medications and intravenous drugs.
AMR said this switch would free up more paramedics to respond faster to more emergencies. This agreement had the support of the Portland City Council, Gresham City Council, local fire chiefs and several county commissioners, including Commissioner Sharon Meieran, an ER doctor. Yet Multnomah County medical leaders and County Chair Jessica Vega Pederson argued that this change could endanger patients.
The county has been in closed-door negotiations with AMR since March to address both the accruing fines and staffing issues. Both sides reached a long-awaited agreement Wednesday.
The proposal strikes a compromise from both parties and is expected to last one year. After that point, it will be up to the county and AMR to decide whether or not to make these changes permanent.
Currently, the county has up to 44 ambulances staffed with two paramedics on the street at any time. Under this settlement, AMR would only need to ensure that 20 dual paramedic vehicles are available.
The county also has eight to 10 basic life support ambulances, which are vehicles staffed by two EMTs, meant to respond to lower-level medical emergencies. The agreement requires that there are enough basic life support ambulances available at any time to respond to 85% of lower-level calls. This number will be determined by looking at monthly averages and is expected to stay between eight to 10 vehicles.
If these two requirements are met, AMR can then deploy ambulances staffed by one paramedic and one EMT – dubbed “hybrid” ambulances.
If AMR meets the requirements of this new agreement, it will be able to shave off 60% of the $7 million in fines levied against it by the county in monthly increments. The remaining 40% of the fine – just under $3 million – can be slashed over time by deploying more than the minimum required 20 dual paramedic ambulances on the road at a time.
The deal also allows AMR to offset some fines by investing in staff recruitment and retention through bonuses, stipends or other investments.
Commissioners expressed support for the settlement – but not without reservations. Commissioner Meieran lamented that it took the outcry of local politicians, emergency service providers and the public before the county agreed to adjust its ambulance model. Meieran, who introduced a proposal last week urging Vega Pederson to change the ambulance staffing plan, went so far as to accuse her of prioritizing her political aspirations over people’s lives.
“It’s no surprise county leadership finally got to an agreement,” Meieran said. “What is a surprise is how long it took for the Chair to do the right thing. The failure of our emergency system meant nothing until it became a personal political emergency.”
Vega Pederson pushed back: “You are lying.”
“I was very clear in starting this that the goal of what we were working for was to hold our contractor accountable and deliver a consistent, timely ambulance response in our community,” she said.
While Vega Pederson and AMR leadership have both signed off on the settlement, the agreement requires a county board vote before going into effect. That vote is expected to take place before the end of August.
Rob McDonald, regional AMR director, called the settlement a “real win” for Multnomah County residents in a statement.
Ambulance staff agree. AMR paramedics and EMTs in Multnomah County are represented by Teamsters Local 223. Austin DePaolo, a spokesperson for the union, said that the agreement respects the needs of frontline workers.
“For us this issue has always been about prioritizing the safety and well-being of our residents by preserving the expertise and experience of our paramedics,” said DePaolo in a statement, “and we think this agreement does both.”