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Multnomah County Commissioner Sharon Meieran is keeping up her campaign to change the composition of ambulance crews in the county, a move that she says will improve poor emergency response times.
For more than a year, Meieran has been pressing County Chair Jessica Vega Pederson to run a pilot program testing whether an ambulance staffed with one paramedic and one lesser-trained emergency medical technician performs as well as one with two paramedics, as Multnomah County requires.
The so-called 1:1 model would ease a staffing shortage that has hurt ambulance response times, Meieran says. She plans to introduce a resolution July 25 that calls on Vega Pederson to allow ambulances to run temporarily with one paramedic and one EMT, then study the outcomes to see if response times improve.
The matter is up to Vega Pederson, Meieran wrote in her request to put the matter on the county agenda, because the medical director for Multnomah County Emergency Medical Services, Dr. Jon Jui, has the “exclusive authority to address ambulance staffing, subject only to the direction of the county chair.”
“After 11 months, they have not acted to change the staffing model, while meanwhile the crisis is worsening and county residents are at risk,” Meieran wrote.
An emergency room doctor, Meieran has tried and failed to change ambulance staffing in the past. She has found a vocal ally in City Commissioner Rene Gonzalez, who wrote to Vega Pederson on July 3, complaining that a fire crew had to transport an accident victim because no ambulances were available.
“I realize your team has a tremendous amount on your plate, but it has been over 4 months since the cities of Gresham and Portland each adopted unanimously resolutions calling for Multnomah County to pilot the 1:1 Model to alleviate the crises,” Gonzalez wrote.
The two-paramedic requirement dates back to 1994, when Multnomah County adopted its ambulance service plan, Meieran’s resolution says. The county updated the plan in 2016 and changed county law to give the medical director authority to change ambulance staffing under “extraordinary circumstances.”
And circumstances have changed since 2016, Meieran writes. The pandemic put stress on first responders, paramedics are in short supply, street drugs have become more potent, there are more victims of gun violence, and more people suffer mental illness and homelessness.
“Residents throughout the county who call 9-1-1 with emergency medical conditions are at risk of worsening conditions and even death when they attempt to call for help but emergency medical care is delayed due to an insufficient number of ambulances available to respond,” the resolution says.
The county contracts with American Medical Response for its ambulance service. AMR is part of Global Medical Response, a Texas-based company that, in turn, is owned by Kohlberg Kravis Roberts & Co., a New York investment firm that buys up whole companies using borrowed money.
The county and AMR have been in mediation to remedy the slow response times. The talks are scheduled to end this month, and a briefing is scheduled for Aug. 1, the county said.
“My priorities have been clear: improve ambulance service and hold AMR accountable to our community and their contract,” Vega Pederson said in a statement. “We’ve been in mediation to get there in the most responsible way possible.”
In November, Multnomah County fined AMR $513,650 for failing to arrive at 911 calls in the amount of time required by its contract. In the announcement about that fine, the county said AMR had been unable to field enough paramedics to meet required response times. Most other Oregon counties allow ambulances to operate with one paramedic and an EMT.
Other counties aren’t a good comparison, Vega Pederson said at the time, because “those counties have a different model, in large part because their local fire agencies respond to nearly all their 911 calls, unlike in Multnomah County, where they respond to roughly 55%.“
But “even our partner counties with different models are still seeing delays in response times,” Vega Pederson said. “This problem was not created by a two-paramedic requirement.”
Meieran, clearly, disagrees. She needs three votes on the board of commissioners to make a change this week. To date, only one commissioner, Julia Brim-Edwards, has supported her ambulance plan.
“Having an emergency response system depends on a basic understanding of the word emergency,” Meieran said in a text message. “You call 9-1-1, and you expect immediate help. I called 9-1-1 on the county’s ambulance system a year and a half ago and the chair is only now picking up the phone. The question for Thursday’s vote is whether she’ll do anything besides put us on hold.”