By Austin De Dios
oregonlive.com
MULTNOMAH COUNTY, Ore. 鈥� When Multnomah County agreed to lower for its ambulance provider in exchange for improved response times, it also provided the company a path to reduce $8 million in fines accrued for responding too slowly to life-threatening emergencies.
, American Medical Response has improved its response times but is still failing to respond to the scene of 鈥渉igh acuity calls鈥� within eight minutes 90% of the time, a key benchmark that was included in the county鈥檚 original contract with the company.
鈥淭o date, AMR has not achieved response time compliance for any individual month, so no fines have been waived under these provisions,鈥� Emergency Medical System Administrator Aaron Monig told the Board of Commissioners on Tuesday.
American Medical Response began outfitting some of its ambulances with one paramedic and one emergency medical technician after its negotiations with the county concluded last August. A county rule had previously required each ambulance to have two paramedics on board.
Since that time, AMR has steadily climbed closer to the 90% threshold, county data shows. Around 87% of ambulances made it to the scene of high acuity calls in eight minutes or less in February, the most recent update for which data is available. The county agreed to waive up to 60% of AMR鈥檚 total fines through monthly waivers if it can hit the threshold. Those $8 million in fines have been accruing since 2022.
Under the flexible staffing model, AMR is required to keep at least 20 ambulances staffed with two paramedics every day, while others operate with a hybrid EMT and paramedic pairing. The company has routinely exceeded the 20 ambulance requirement, hitting 27 in February, officials said. The county agreed to waive up to 40% of the fines if the company hit the staffing requirements, along with the response time benchmark.
AMR has also met requirements to maintain 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 low-emergency incidents.
AMR has hired 28 paramedics since August, and 18 paramedics have graduated from its scholarship program and have either started training or entered the workforce, according to Rob McDonald , the company鈥檚 director for Multnomah County .
McDonald said the increased staffing and altered requirements have reduced the strain on employees. He said near the end of 2024 crews would typically respond to 10 to 12 calls in a 12-hour shift. That number is now closer to five to seven, he said.
鈥淭his workload mitigation has provided improved work life balance for our paramedics and EMTs,鈥� McDonald said.
Under the new staffing model, AMR has nearly eliminated 鈥渓evel 0鈥� calls, which occur when there is no ambulance available to respond to an emergency, according to McDonald. Between Aug. 4 , and Aug. 10, 2024 , there were around 80 incidents where no ambulance was available. For a similar period in March, that number was zero.
This is the first time the issue is coming in front of the Board of Commissioners since new members were sworn in at the beginning of this year. The slow response times were a pain point for the previous board, who deeply disagreed on how the problem should be resolved.
Commissioners raised concerns Tuesday about health outcomes for people in medical crises and training for AMR staff. County health officials had argued that having two paramedics on board an ambulance improved survival rates for people who may be experiencing a heart attack or stroke. County Health Officer Richard Bruno said the county is working to gauge the impact of the loosened staffing requirements on quality of care.
The board will take up the issue again in August, at which time it will decide whether or not to continue the altered agreement, modify it or end it altogether, officials said.
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