Multnomah County Wants AMR To Follow Contract

Photo: Ford, Brad

Multnomah County Chair Jessica Vega Pederson today announced a four-point plan to address delayed ambulance response times, taking a major step toward revising emergency medical services in Multnomah County. 

The following statement was released by Vega Pederson:

Since 2022, the County’s longtime ambulance provider, American Medical Response (AMR), has consistently failed to meet the ambulance response times required by its contract. The Multnomah County Health Department, which oversees Emergency Medical Services (EMS), has worked with AMR to identify potential solutions that are allowed under the County’s current Ambulance Service Plan. These include increasing hiring, adding retention pay, subcontracting with outside agencies and fully staffing an Emergency Medical Technician (EMT) Basic Life Support ambulance service for non-urgent calls.

AMR has failed to meaningfully take those steps, and instead, proposes a significant change in Advanced Life Support ambulance staffing from two paramedics to one paramedic and one EMT. 

AMR’s proposed change would save the company money by shifting costs to taxpayers — who currently pay nothing directly for ambulance services — because Portland’s and Gresham’s fire departments would need to respond to a larger number of 911 medical calls. Or, our community would have to accept a lower standard of care on scene for some life-threatening emergencies.

“If staffing changes are going to come at a cost to the public, that should be transparent,” said Chair Vega Pederson. “Our community must know and understand the implications.”

The Chair has been briefing East County leaders and her colleagues on the issues. Today, the Chair also announced she is:

  1. Moving to formal mediation with AMR to address these issues. AMR has accrued at least $1.6 million in additional penalties for delayed response times, for a total of over $2 million in fines since August. Multnomah County will move to collect those fines next month if AMR doesn’t show a clear plan of action to:
  • Shore up their staffing by subcontracting
  • Provide hiring and retention incentives to hire and retain staff in Multnomah County
  • Fully staff Basic Life Support ambulances
  1. Asking the Board of Commissioners to immediately reopen the Ambulance Service Plan — two years ahead of schedule — a required procedural step to make significant changes and fully assess ambulance staffing, response times and other major elements of the County’s emergency medical response.
  2. Asking the cities of Portland and Gresham to review their fire department services to show what it would take to absorb the responsibility of AMR’s current staffing proposal, which could have fire agencies respond to more medical 911 calls.
  3. Convening experts from the County and Oregon Health Authority in the next 30 days to advise and consult on Multnomah County’s Ambulance Service Plan review.

The national standard of care for medical emergencies is for a minimum of two paramedics to respond. Using this staffing model, Multnomah County residents receive high-quality, sophisticated emergency care with cardiac arrest survival rates in the top 10% nationally because at least two paramedics respond to every high-risk 911 medical call.

Many medical emergencies in Multnomah County also receive a rapid response from fire departments whose vehicles arrive with a paramedic and multiple EMTs.  

Washington and Clackamas Counties have similar survival rates and also have two paramedics on those calls — but the system for delivering those paramedics differs. In Multnomah County, an AMR ambulance brings both paramedics. In Washington and Clackamas counties, the AMR ambulance brings one paramedic plus an EMT. But those counties’ fire departments have the capacity to respond to all 911 medical calls and can assure that a second paramedic is always present. Crucially, response times in those counties have also lagged.

In Multnomah County, because of the growing 911 call volume, fire agencies in 2023 were able to respond to just 75% of 911 medical calls that were ultimately found to be life-threatening.

AMR’s proposal to switch to one paramedic and one EMT on Multnomah County ambulances means that some patients will not get the national standard of medical care. The alternative is to have fire department paramedics respond to every 911 medical call — which is not currently feasible. In December, AMR’s own paramedics issued a statement that retaining the Multnomah County two paramedic standard is “crucial for the safety and well-being of our community.” 

“Any changes we make to staffing have to be informed by a thorough process to avoid unintended consequences that could impact patient safety and our first responders. This is both a statutory requirement for counties, and the responsible way to decide significant policy changes,’’ Chair Vega Pederson said. “For Multnomah County, this is about maintaining some of the best survival rates and outcomes in the country and continuing to focus on patient safety today and in any future changes we consider.”

Both Chair Vega Pederson and the Health Department believe that a systemwide review is warranted due to the increased number of 911 medical calls in the County, emerging preventive interventions (including nurse triage, video conferencing, mobile health care, home health and integrated health care), and the challenging health care landscape.

“AMR has put their hardworking frontline staff in the middle of this. Yet, despite all the disruption since COVID-19, our first responders and AMR paramedics have continued to deliver the highest-quality care,’’ said Chair Vega Pederson. ”It’s important to me to acknowledge their efforts, guard against causing them further burnout and give them the best chance to maintain this excellent record.’’

The Ambulance Service Plan required by the state specifies how emergency medical services are delivered in Multnomah County, including the role of fire agencies, ambulance deployment, staffing, response times, medical direction and quality improvement.

The Plan was last revised in 2016. The Health Department is requesting $167,086 from the County’s General Fund contingency to immediately initiate an early review of the Ambulance Service Plan. Chair Vega Pederson will bring the Health Department’s proposal to the Board of County Commissioners’ regular meeting Feb. 29. 

Reviewing the plan requires both Health Department staff and an external consultant with subject matter expertise in emergency medical service systems. The assessment will identify the strengths and challenges of the County’s current system, explore possible system wide changes like staffing — including potential benefits and tradeoffs — and produce recommendations to build a County EMS system.

“I am committed to making sure we solve this crisis in a way that is logical, transparent, and protects the public’s health and interest,” Chair Vega Pederson said.

AMR released the following statement in reaction Vega Pederson:

We are disappointed with the statement Chair Vega Pederson released earlier today regarding ambulance services in Multnomah County. AMR presented a proposal on February 12 to the Chair with an immediate and pragmatic solution to address the ambulance service crisis and we have yet to receive any feedback or communication from the Chair.

What we’ve heard and seen from the Chair does not solve the problem, save lives or mitigate the County’s accountability. She essentially restated excuses that have all been determined to be incorrect. A solution needs to be found through collaboration and understanding of the system; we are in crisis and the Chair is ignoring the facts. We need an actual plan that is attainable in the post-pandemic national paramedic shortage we find ourselves in. Assessing fines on AMR will not create paramedics. Our team is dedicated to finding serious solutions that will address this shortage and allow us to provide the timely and compassionate care the citizens of Multnomah County deserve.

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