Multnomah County Chair Jessica Vega Pederson won't change the county's two-paramedic requirement for ambulance staffing. Instead, the county is moving to formal mediation with AMR, Vega Pederson announced Tuesday, Feb. 20.
"AMR's conduct in this crisis is irresponsible and unacceptable. They're allowing a crisis in our community to worsen, so they can make more money instead of recruiting, hiring and retaining enough first responders on staff to provide the services that they've agreed to," Vega Pederson said.
American Medical Response, the ambulance service provider in Multnomah County and much of the Portland metro area, hasn’t met response time standards in Multnomah County in nearly two years. The company has blamed that on paramedic shortages, which have been an issue across the country since paramedic training programs shut down during the pandemic, and the county’s two-paramedic requirement.
Multnomah County requires that AMR staff its ambulances with two paramedics. Many cities and counties only require one paramedic and one EMT, which is a lower level of medical training.
A growing number of leaders from around the county have urged Vega Pederson to reconsider the two-paramedic model, including Portland Fire & Rescue Chief Ryan Gillespie, Multnomah County Commissioner Sharon Meieran, and city councils of Portland and Gresham.
On Tuesday, Feb. 20, Vega Pederson affirmed she wouldn't change the two-paramedic requirement.
"I won't be bullied into any kind of quick fix," Vega Pederson said. "The only way that we are going to truly solve this crisis is by trusting medical experts and by holding AMR accountable."
AMR's proposal "would give their company bigger profits and it would shift the cost of the system to taxpayers," by putting more burden on taxpayer-funded fire departments, Vega Pederson said.
Vega Pederson will ask county commissioners to immediately reopen the county's Ambulance Service Plan "to fully assess ambulance staffing, response time and other major elements of county emergency medical response."
"Any changes we make to our system have to be informed by a thorough process to avoid unintended consequences that could impact patients and our first responders," Vega Pederson said. The chair also will convene county and Oregon Health Authority experts "within the next 30 days to advise and consult on our ambulance service plan review."
The county’s EMS medical director, Dr. Jon Jui, has been a strong advocate for the two-paramedic model, arguing that the higher level of medical training is needed to ensure good outcomes for people experiencing medical emergencies. Vega Pederson did not directly answer questions about if she had consulted with outside medical experts for another view as ambulance shortages have dragged on.
The county issued a $514,000 fine against AMR for slow response times just in August 2023. AMR has since accrued another $1.6 million in fines, which the county said it will enforce next month if AMR doesn't show a clear plan for how it will increase staffing through subcontracting, provide incentives to hire and retain staff, and fully staff Basic Life Support ambulances.
On Feb. 12, AMR submitted a formal proposal to county commissioners to change the staffing model.
“If we continue the current path, this system could collapse in a matter of months as the impact of the national paramedic shortage worsens. We are now short 60 paramedics, with that number increasing by two per month,” AMR Operations Manager Rob McDonald wrote. If paramedic-EMT staffing was approved, AMR said it could get fully staffed, with 50 12-hour ambulance shifts per day, within three months. AMR averages 10 EMT hires for each paramedic hire, the company said. Under the proposed model, AMR would split up current paramedic duos and pair each paramedic with an EMT.
