By Austin De Dios
oregonlive.com
PORTLAND, Ore. — Portland-area ambulances are arriving faster, but county officials are warning that patient care may have declined.
American Medical Response has boosted recruiting efforts and made strides toward meeting response time goals since reaching a settlement with the county, but data shows complaints against the company are up and paramedics say that emergency medical technicians are being rushed onto ambulances with only minimal training.
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“Based on these patterns, we perceive a decline in the quality of care being delivered both in terms of direct patient care and overall operational performance,” Associate EMS Medical Director and doctor Matthew Neth told the county Board of Commissioners in a public meeting Tuesday.
Last year, the county agreed to let AMR outfit some of its ambulances with one paramedic and one EMT following months of debate and years of sluggish response times from the ambulance provider. Paramedics receive more education and are equipped to deal with more advanced medical problems than EMTs, and county health officials at the time warned the switch could result in worse health outcomes.
But AMR was struggling to get paramedics in the door and promised that staffing some ambulances with an EMT and paramedic pairing would speed up response times while the company worked on hiring.
A year after making the change, AMR is still missing response time benchmarks, although it has improved. An ambulance is expected to respond to life-threatening calls within eight minutes 90% of the time. The company hit 84% in July, up from 62% in July 2024, county data shows.
Since making the change, the ambulance provider has also all but eliminated situations where it doesn’t have an available ambulance to dispatch to an emergency.
AMR has also boosted recruitment, hiring 163 EMTs and 41 paramedics between August 2024 and 2025, according to AMR Regional Director Rob McDonald. But that hasn’t helped the company increase overall paramedic staffing levels, county officials said. When part-time employees are included, AMR has lost a net nine paramedics over the last year, county Emergency Medical System Administrator Aaron Monnig said.
Complaints against the company are also up. From January to July of this year, 18 complaints were filed against AMR by patients, family members, hospitals or others regarding their experience with the company. That compares to 22 complaints for all of 2024.
There has also been a decline in how often medical responders are reporting a potential stroke patient to a hospital. Those crews are expected to report someone exhibiting stroke symptoms 90% of the time. County data shows AMR had rarely hit that benchmark before, but that figure has declined since last year. Stroke alerts were performed around 50% of the time in July, compared to roughly 65% at the same time last year.
However, AMR data shows that ambulance crews are performing stroke screenings and assessments at a similar level to before the staffing changes.
“Our analysis of Multnomah County (key performance indicators) data predominantly shows no significant change,” McDonald said. “That isn’t to say, though, that AMR or (Multnomah County Emergency Medical System) are content with the performance as it stands.”
McDonald said the company needs to improve its response to traumatic injuries, as it has routinely missed benchmarks regulating how quickly an ambulance needs to leave those scenes to get someone to the hospital. Ambulance crews are expected to leave a major trauma injury scene within 15 minutes 90% of the time. In July, they did so just over 50% of the time.
“We are all in agreement that this metric needs focus,” McDonald said.
However, a memo from county officials noted that outcomes for heart attack patients showed “positive developments in pre-hospital emergency medical care.” This was a primary concern for the county in the debates leading up to the staffing change.
AMR paramedics with the union Teamsters 223 who came to testify Tuesday spoke grimly about the state of emergency medical response. They highlighted a lack of training for new EMT recruits, difficult working conditions and an overall decline in outcomes and safety.
They also said that the focus on response times is not addressing a wider problem: continued burnout among staff.
“We have paramedics that are now in Alcoholics Anonymous and some on suicidal care plans due to a multitude of reasons,” paramedic Michael Carlin said. “But yeah, compliance is better now. Any data you receive today showing a net positive in care is due to the perseverance of paramedics in distress.”
The paramedics who testified contended that EMTs were coming in without proper experience and that inexperienced paramedics were being tapped to be the “lead” in the ambulance. First responders need time to get comfortable with hospital routes, radios, inventory and to get familiar with technical driving of an ambulance, paramedic Elliot Peterson said.
“EMTs play a critical role in our system, but they’re better providers and more likely to become medics here if they don’t get thrown to the wolves and burnt out within a couple months,” Peterson said.
Although the working conditions and perceived lack of training has put strain on ambulance teams, paramedics said the workload has lightened since the changes went into effect.
“I will briefly acknowledge that I am getting off less late and the sheer volume of calls is much more manageable,” Peterson said.
AMR said in a statement that EMTs undergo extensive training, which includes a week-and-a-half of onboarding and 12 field training shifts. Eight of those shifts, paramedics said, are done on advanced life support ambulances that handle higher level calls.
Commissioner Julia Brim-Edwards said county leadership and AMR both emphasized not sacrificing quality medical care for faster response times when they struck the deal. Now, she said those fears may have had merit.
“It looks like, in some ways, that might have occurred,” Brim-Edwards said.
She called on the board to consider revisiting the agreement and finding other ways to hold AMR accountable for failing to meet required benchmarks. Brim-Edwards also flagged the number of ambulances being staffed by a hybrid crew, saying that staffing with EMTs, who are paid less, may be a tactic to save money. Paramedic and EMT teams made up around 59% of the hours worked in ambulances in the county in July.
“I don’t think we can continue on this path,” Brim-Edwards said. “It looks like AMR is reducing its expenses by increasing the use of the hybrid ambulance, which cost less to staff.”
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