The Board of County Commissioners today voted unanimously to approve an agreement with American Medical Response to launch a 12-month staffing plan that will allow some changes while maintaining safety and quality medical care.
The agreement was reached July 31 after four months of mediation with AMR, the County’s sole provider of ambulances since 1995. Under its current contract, the company committed to responding to 90% of life-threatening calls within eight minutes in urban areas. AMR has not met that 90% target since March 2022
“Today this board has the opportunity to affirm a responsible approach and approve the staffing change recommended by our Health Department and AMR, and help us move to a stronger, healthier place in Multnomah County,” said Chair Jessica Vega Pederson in introducing the vote.
“This settlement agreement is clear, it is structured, it is accountable, and it is balanced. It gives us a path forward to work in partnership to improve ambulance response times, which is ultimately a goal I know we all share.’’
After more than a year of working with AMR to improve response times — including a formal corrective action plan, an innovative agreement to better manage low-acuity calls, and pushing AMR to pursue subcontracting — Multnomah County ultimately entered mediation with AMR in March.
Talks concluded with a new agreement signed by Chair Vega Pederson that provides flexibility in staffing with sideboards for accountability. The settlement agreement was publicly presented to the Board of County Commissioners on Aug.1, 2024. The negotiated staffing plan will expire July 30, 2025.
The plan calls for a blended, more flexible staffing model that will maintain two paramedics on a minimum of 20 advanced life support (ALS) ambulances, allow one paramedic and one EMT on new “hybrid” ALS ambulances, and maintain basic life support (BLS) ambulances staffed by two EMTs. The plan also permits Multnomah County to share ambulance response times and other compliance metrics with the public, instead of with commissioners and other internal stakeholders only.
County emergency medical services experts will carefully monitor the plan for impacts to patient safety, response times, and ongoing staffing levels.
Before voting to approve the staffing changes, Commissioners Lori Stegmann, Julia Brim-Edwards, Jesse Beason and Sharon Meieran all expressed frustration over the time it took to change staffing levels. They called for more sharing of response time data with the public, more transparency for the Board on subsequent steps around the ambulance services system and more accountability going forward. You can watch the Board’s full remarks today.
Staffing changes in the agreement could begin as soon as today, following the Board’s unanimous vote, with additional staff coming into the system and AMR increasing the number of ambulances on the street.
Background on the approved agreement:
- Requires AMR to have at least 20 Advanced Life Support ambulances staffed by two paramedics. The company currently averages between 34 to 44 total ALS ambulances on the street at any time.
- Requires AMR to deploy enough Basic Life Support Ambulances staffed by two EMTs to respond to 85% of appropriate lower-acuity calls.
- Permits AMR to deploy hybrid ambulances staffed by one paramedic and one EMT supplement these minimums and meet response times.
- Prohibits AMR from entering new contracts with new customers to provide non-911 standby ambulances for professional sporting and other events. (This provision does not affect AMR’s current multi-year contracts.)
- Permits the County to produce monthly public reports or summaries about AMR’s compliance with response times and other contract metrics.
A copy of the settlement agreement is here.
A copy of the Health Department’s recommendation to change the model is here.
Compliance data is here.