By Austin De Dios
oregonlive.com
PORTLAND, Ore. — The Portland area’s chronically late ambulance provider has reported modest improvements after reaching a compromise with Multnomah County to lower its staffing requirements.
American Medical Response began outfitting some of its ambulances with one paramedic and one emergency medical technician after its negotiations with the county concluded in August. A county rule had previously required each ambulance to have two paramedics on board.
The company said in a press release it fully shifted to the new approach to deploying ambulances on Sept. 16.
Figures from the Bureau of Emergency Communications show a steep decrease in “level 0″ calls, which is when there is no ambulance available to respond to an emergency since the new staffing model was implemented. In the five-day period from Sept. 16 to Sept. 20, there were 35 level 0 calls, according to the city’s emergency communications bureau. There were 188 such incidents in a similar five-day period at the beginning of August, the bureau said.
“We are proud of the progress we’ve made in such a short time,” AMR Director for Multnomah County Rob McDonald said in a statement Tuesday.
The ambulance provider also reported large gains in its EMT workforce, with 65 new hires in the last eight weeks, AMR spokesperson Amy Link said. Those hires need to be trained before hitting the road, officials said. The company said it also purchased 12 new ambulances.
The changes in ambulance staffing come after four months of private negotiations with Multnomah County Chair Jessica Vega Pederson and other officials. The new agreement also gives AMR a path toward lessening its $7.1 million in fines accrued for dangerously slow ambulance response times dating back to 2022, according to county officials.
Under the flexible staffing model, AMR is still required to staff 20 of its 34 to 44 ambulances with two paramedics every day, while others can be staffed with a hybrid EMT and paramedic pairing. AMR is also required to keep its basic life support program, which sends ambulances with two EMTs for less urgent calls. Those units must be able to respond to 85% of lower emergency calls.
If the ambulance company meets those benchmarks and is able to respond to “high acuity calls in urban areas” within eight minutes at least 90% of the time, as laid out by the original contract, the county could waive up to 60% of its total fines through monthly waivers, according to the agreement.
The other 40% can be trimmed monthly if AMR staffs more than 20 ambulances with two paramedics. The agreement would also allow the company to offset its fines by spending money on staff recruitment and retention efforts.
Vega Pederson was resistant at first to adopt the lowered staffing standards, citing concerns from county health officials that the quality of medical care would decline because paramedics receive more education than EMTs and therefore can perform more medical procedures.
Commissioner Sharon Meieran and other critics lobbied to have the standards changed much sooner. Vega Pederson initially blocked a proposal from Meieran to have the board vote on temporarily adopting the hybrid staffing model.
Some paramedics were also wary of the changes. Two AMR paramedics told The Oregonian /Oregonian Live in March that having two higher-trained employees on board can help reduce burnout and fatigue, as well as provide more consistent medical care.
While the early results are promising, there are still challenges facing the strained emergency medical system.
Austin DePaolo, a spokesperson for the union representing the county’s paramedics, EMTs and dispatchers, said that the EMTs staffing the hybrid ambulances were previously put on units that responded to low-urgency calls. The pressure and stakes have been increased, DePaolo said, putting new strains on those EMTs.
“We were worried about EMTs not being trained enough to do that,” DePaolo said.
In the early morning hours of Sept. 8 , an EMT crashed an ambulance into another vehicle in Portland, DePaolo said. AMR confirmed the crash, but said that “there were no injuries, no fault was associated and no citation was given.”
DePaolo said he’s optimistic that the new system will work, but that employees are still strained under the workload.
“We’re hopeful that this is going to put less stress on our members,” he said. “But people are still feeling overstretched and overworked and there’s a safety component to that.”
The county expects AMR to hit its agreed-upon goals starting Nov. 1 . County officials said they were happy to hear about AMR’s progress, but warned that it is too early to assess the impact of the staffing changes.
“It is a positive step that AMR has increased hiring EMTs but it is too soon to tell definitively that there has been clear improvement in ambulance availability and response times,” Sarah Dean, a spokesperson for the county, said in a statement. “AMR still has a lot of work ahead and we will continue to work with them in the coming months toward achieving our shared goal of increased ambulance availability and better response times for the people of Multnomah County.”
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