Multnomah County has reached an agreement with American Medical Response (AMR) to resolve over two years of slow ambulance response times.
After more than four months of mediation, the two sides agreed to a 12-month staffing plan that will allow some changes while maintaining safety and quality medical care.
“This agreement improves ambulance response times and holds AMR accountable for more ambulances to respond to 911 calls on time. When someone needs an ambulance, every second counts,” said Chair Jessica Vega Pederson. “We’ve included a pilot staffing model that we’ll closely monitor. And for the first time, AMR has agreed to allow response time data to be promptly shared with the public so we can all clearly see what’s working and what’s not. I have high expectations for AMR over the next 12 months, and I believe they can be successful.”
The agreement will test 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. It also permits Multnomah County to report ambulance response times and other compliance metrics to the public. County emergency medical services experts will carefully monitor for impacts to patient safety, response times, and ongoing staffing levels.
"This announcement is a real win for the citizens of Multnomah County," said Rob McDonald, regional director for AMR. "AMR will now be able to invest in putting more ambulances on the road, supporting our goal to provide the right care at the right time. We look forward to working with the County and EMS Office to implement this solution and to continuously evaluating and improving it."
“We are grateful to Multnomah County EMS for working to reach a compromise that respects the voices of frontline workers,” said Austin DePaolo with Teamsters Local 223, the union representing AMR paramedics. “In the face of political pressure, Chair Vega Pederson and Multnomah County chose to get this right by rolling up their sleeves and getting to a responsible compromise. For us this issue has always been about prioritizing the safety and well-being of our residents by preserving the expertise and experience of our paramedics, and we think this agreement does both.”
Background
AMR has been the sole ambulance provider in Multnomah County 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.
After months of disagreement over how to resolve this issue, the two sides entered mediation in March. Talks concluded Wednesday, July 31, with a new agreement signed by Chair Vega Pederson.
Provisions in the 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.
The company will not be invoiced for any additional fines during the pilot. The agreement provides pathways for AMR to reduce the $7.1 million in fines the company has accrued to date since falling out of compliance in 2022 – if AMR can meet the requirements outlined in the agreement.
If AMR meets the response times required under its contract and the minimum ALS and BLS ambulances in the temporary staffing pilot outlined in the agreement, increments of the $7.1 million fines are eligible for waiver each month, up to 60% of the total fines. The remaining 40% of fines can be reduced, month by month, for every Advanced Life Support ambulance with two paramedics AMR places in the field that go beyond the 20 two-paramedic ambulances required in the staffing pilot.
The deal also permits AMR — with approval from the County’s Emergency Medical Services Administrator — to offset accrued fines by investing in staff recruitment and retention, including shift bonuses, stipends, subcontracting, scholarships, or other appropriate investments in AMR’s frontline workers.
The Board of Commissioners will be briefed on the agreement today, Aug. 1. The temporary staffing provisions in the agreement are subject to Board approval under the process outlined in the County’s Ambulance Service Plan. The Board will be asked to consider this action at a future meeting.
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