By Austin De Dios
oregonlive.com
PORTLAND, Ore. 鈥� Following four months of private negotiations, Multnomah County Chair Jessica Vega Pederson has struck a deal with the county鈥檚 chronically late ambulance provider to temporarily change the staffing model that AMR officials claim is contributing to a shortage of medical units on the road.
The new agreement would also give 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.
The County Board of Commissioners must approve the staffing change before it goes into effect. They were briefed Thursday on the results of the mediation, which started in March. The Board could vote on the proposed agreement as early as next week.
鈥淲e pursued mediation with the goal of a responsible, balanced compromise that will make a real impact on ambulance response,鈥� Vega Pederson said at the meeting.
Vega Pederson and county officials reached an agreement with AMR Wednesday night for a one-year staffing change that would allow some ambulances to be crewed by one paramedic and one emergency medical technician 鈥� an ask Commissioner Sharon Meieran and city officials.
Under the flexible staffing model, AMR would still be required to staff 20 of its 34 to 44 ambulances with two paramedics every day, while others could be staffed with a hybrid EMT and paramedic pairing. AMR would also be required to keep its basic life support program, which sends ambulances with two EMTs for less urgent calls.
New benchmarks
The county proposal sets certain requirements for AMR to be able to keep flexible staffing, including maintaining enough EMT ambulances to respond to 85% of lower emergency calls and keeping the 20 ambulances with two paramedics on the road. It also bars AMR from picking up new contracts to provide ambulances on standby for sporting and other events.
If the ambulance company meets those benchmarks and is able within eight minutes at least 90% of the time, as laid out by the original contract, the county could waive up to 60% of the 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 $7.1 million in fines by spending money on staff recruitment and retention efforts.
Under the deal, the county would also release monthly reports on AMR鈥檚 performance via a public dashboard and would require AMR to contract some work out to ambulance providers like Metro West.
鈥淲e are now all pulling in the same direction,鈥� said Robert McDonald , AMR鈥檚 operations manager in Multnomah County. 鈥淭his feels like a new day and we have a lot of optimism going into this deployment reconfiguration.鈥�
Disagreements on staffing
Vega Pederson was to adopt the lowered staffing standards, citing concerns from county health officials that the quality of medical care would decline. Paramedics receive more education than EMTs and are qualified to perform more medical procedures.
Meieran, an emergency room doctor, and other critics pointed out that Clackamas and Washington counties use the one EMT and one paramedic staffing model and said it鈥檚 more important to get an ambulance to the scene on time. Meieran has also argued that two paramedics are rarely needed in an emergency because their job should be to get patients to a hospital as quickly as possible.
Some county health officials disagree. Richard Bruno , the county鈥檚 health officer, said that the two-paramedic model is used in cities like Houston , Boston and Madison. Bruno said having two paramedics in an emergency like a major car crash could be the difference between life and death.
Elected officials in Portland and Gresham called on the county to ditch its staffing requirements in February, backed by both of their fire departments. Firefighters have had to fill the gaps left by slow response times, in some cases forcing them to transport people to the hospital by unconventional and sometimes dangerous means.
The agreement comes a week after commissioners a proposal from Meieran to lower the staffing requirements.
Vega Pederson said Thursday she was never against hybrid crews on ambulances, but wanted to consult with medical experts and find a solution that would still keep AMR accountable. Commissioners Jesse Beason and Lori Stegmann raised those same concerns before the county entered mediation with AMR.
Some paramedics were also concerned about the strain the new staffing model would put on the workforce. In life threatening situations, the paramedic will do most of the medical work while the EMT drives. When an ambulance has two paramedics, they can swap to share the workload.
Austin DePaolo , a spokesperson for the union representing AMR paramedics, said the new agreement balances the needs of the public and with those of AMR employees.
鈥淲e are grateful to Multnomah County EMS for working to reach a compromise that respects the voices of frontline workers,鈥� DePaolo said in a statement.
Implementation and concerns
Under the proposed agreement, AMR will be given a 鈥渞amp up鈥� period through Nov. 1 to work with its union to implement the new staffing model. After that date, AMR must hit the new benchmarks set out in the agreement.
The county and AMR will revisit the one-year deal in February. In Thursday鈥檚 meeting, commissioner Julia Brim-Edwards said she was concerned about the agreement鈥檚 short timeline given how long it took to reach a compromise.
鈥淎n agreement to come back to the table does not an agreement make,鈥� she said. 鈥淣or necessarily do I see that the county has any additional or effective leverage, especially since the agreement is that they get their fines for noncompliance abated just by complying going forward.鈥�
Meieran said the agreement comes much too late.
鈥淚t鈥檚 wonderful that 911 will once again be a better choice than calling Uber or a bus if you need to get a loved one to a hospital quickly,鈥� she said. 鈥淲hat today proves more than anything is that Multnomah County leadership has wasted almost a year and a half of precious moments only to, in the end, do what could have been done immediately.鈥�
Stegmann said she was relieved to move forward after the extensive mediation. She called AMR a 鈥渕onopoly鈥� and said the county will play an important role in keeping the ambulance provider accountable under the new agreement.
鈥淭his has been a challenging, heartbreaking, lengthy process, and we can sit around and complain about what happened yesterday, last year, all we want,鈥� she said. 鈥淚t鈥檚 not going to make a bit of difference. What we can do is adopt an agreement, move forward and protect our community members as best we can.鈥�
鈥�
漏2024 Advance Local Media LLC.
Visit .
Distributed by