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
Emergency response systems in the Pacific Northwest are facing a great deal of strain due to inadequate staffing levels and rising 911 call volumes.
In response, some cities are turning to nurse navigation programs to address that burden.
Under the program, dispatchers can direct low-level 911 calls to a team of nurses instead of sending an ambulance. Those nurses can give callers medical advice or help them set up an urgent care or telehealth appointment.
“Unfortunately, a lot of folks don’t know of the options that are out there to get the treatment that they need without having to go to an emergency room,” said Rocco Roncarati, regional director for American Medical Response’s operations in Southwest Washington.
AMR launched a nurse navigation program in Clackamas County in September, and has been operating its program in Southwest Washington since May 2023.
Over that time, Roncarati said more and more patients have been choosing to use the nurse navigation line, which connects to AMR’s nurse call center in Texas, rather than requesting an ambulance to the hospital.
“It’s becoming more recognizable. We have callers that call often who know the program,” he said.
Dr. Marlow Macht, medical program director for Clark County EMS, said patients often call 911 because they don’t have easy access to primary care or reliable transportation to the hospital.
He said the nurse navigation program is meant to provide those patients with the care they need while freeing up EMS resources to respond to life-threatening calls.
“I think anyone who’s had the experience of interacting with the health care system would describe it as frustrating,” Macht said. “People are trying the best they can, but the system can be hard to navigate. We want to do our best as an EMS system to respond to what people need.”
According to a report from AMR evaluating the program, the nurse navigation line has saved Clark County one fire department and EMS response per day on average since the program launched. It’s also freed up the equivalent of nearly three additional hours of ambulance availability during peak times per day.
Roncarati said officials in Multnomah County are considering implementing a nurse navigation program, but couldn’t speak to when it would be operational.
He said it could take anywhere from 6 to 12 months to fully implement the program in a new city.
Rocco Roncarati and Marlow Macht spoke with “Think Out Loud” host Dave Miller. Click play to listen to the full conversation: