Dear Friends and Neighbors,
Strap in, cause this is gonna be a wonky one!
Before we take this topic on, I want to take this last day of Black History & Futures Month to recognize, honor and thank the Freedom House Ambulance Service. Beginning in the 1960s, this all-Black team effectively launched the paramedics profession itself and created the model for local ambulance response systems that we still use today. Before their work, emergency medical response was haphazard, slapshot and highly racialized—to the detriment and death of mostly Black Americans. I am grateful to them for that work and the countless lives they’ve saved.
It also seemed fitting to recognize them because in recent weeks, ambulance policy has been a topic of public discourse locally. Specifically, the staffing model and expected service delivery of American Medical Response (AMR), the private company contracted to operate ambulances in Multnomah County’s Emergency Medical System (EMS).
Put simply, AMR does not have enough paramedics to meet the standards they agreed to when their 5-year contract with the County was renewed in January 2023. As a result, lives are at risk and costs to Fire Departments are up (Currently, the data suggests that no lost lives are attributed to ambulance delays, but there’s no doubt that people suffer from longer wait times).
Since taking on this role—and more urgently as Commissioner Meieran has raised the heat on this issue for good reasons—both my staff and I have endeavored to meet with many stakeholders in the EMS system. As a result, I have gained deeper insight into some of the many perspectives. I still feel there’s more for me to learn.
We all agree our current situation is untenable, unacceptable and dangerous. We all agree that there is a nationwide workforce shortage of paramedics and Emergency Medical Technicians (EMTs). Where opinions diverge is what we ought to do about it, what we can legally do, and at what costs to the County, our EMS system partners and public health.
And opinions don’t just diverge among elected officials in multiple jurisdictions. They differ among medical experts, EMS professionals and Fire Departments. People with deep expertise are of differing minds.
In short, I’ve come to believe this issue is far more complex than any press conference or news article I’ve seen about it. But generally the conversation is centered on AMR proposing that instead of sending two paramedics in an ambulance to all calls, they want to send one paramedic and one Emergency Medical Technician (EMT) in an ambulance—often called the 1:1 model (EMTs require less medical training, are faster to hire, and are paid less). Then, on certain life-threatening calls, we would rely on a second paramedic from a local Fire Department to come as well (Currently Fire Departments choose, but are not obligated to the County or AMR, to send what often ends up being a third paramedic to 911 calls).
There’s a lot to dig in on this, but here are the things that stand out to me:
First, according to my conversations and those of my staff, generally EMS partners agree that two paramedics showing up on life threatening calls is the best practice and one we want to continue. But we do not have agreement on what calls are life threatening, nor do we yet have agreement that if we shifted to the 1:1 model that Fire Departments would obligate themselves by contract to send a second paramedic. I hope whatever path we take to solve this issue addresses these disagreements head on.
Second, according to their union, the paramedics and EMTs most affected by this change—who’s job satisfaction, effectiveness and wellbeing is critical to saving lives—have been left out of this conversation and, perhaps even worse, been bullied for questioning AMR’s insistence about that change. I don’t welcome a change this significant without workers closest to the problem being part of the conversation.
Third, regardless of the model being used—1:1 or two paramedics— AMR does not seem to be meeting contractual obligations across the country, and right here in our own backyard. I think it’s right for the County to be pressing AMR to do more to deliver on the promises they made in their very recent contract. I would like better context for why they aren’t. What is a product of the larger stresses across all EMS systems nationally—and what is the product of business decisions? I would hope to understand this more before making big decisions.
Fourth, we have more data work to do in correctly understanding Level Zero—when no ambulances are available for someone that needs one—and triaging calls through the Bureau of Emergency Communications to make sure we are making the best use out of a limited resource in whatever ambulance model we have.
With all this in mind, today I joined the majority of my Commissioners in supporting Chair Vega-Pederson’s proposal to initiate the assessment of our Ambulance Service Plan two years ahead of schedule. It’s an action I believe Multnomah County should have taken earlier. It sets up a process for us to retool our system to address the many challenges.
Whether there is a more immediate change we can make or pilot in the staffing model to address this more urgently, we need to move beyond PR efforts to a broader understanding of the upsides, downsides, and complexity of making this change. We’ve had no meaningful public work session involving AMR—and all EMS partners. I think that’s a missed opportunity for better policymaking. I would urge us to do that in the coming weeks and said as much at today’s board meeting.
If you’ve made it this far, thank you! And thank you for the chance to represent you these past months. It is fascinating, rewarding and a privilege to do so.
Sincerely,
Jesse
