The Multnomah County Board of Commissioners was briefed Tuesday, April 22, on the steps American Medical Response Northwest, Inc (AMR) has taken since it approved a settlement agreement for 12 months to improve slow response times and achieve contract compliance.
The County is charged with ensuring people receive ambulance services in an efficient and effective way. The Health Department oversees the exclusive franchise agreement with AMR, the provider of this critical service.
In August 2024, following four months of mediation, the Board unanimously approved a temporary staffing change, empowering the County to enact the agreement between the County and AMR to address lagging ambulance response times — which by that point had been an issue for more than two years — with the intent of maintaining safety and the quality of medical care.
The 12-month change is testing a blended staffing model that maintains two paramedics on a minimum of 20 advanced life support (ALS) ambulances, allows one paramedic and one EMT on new hybrid ALS ambulances, and maintains basic life support (BLS) ambulances staffed by two EMTs.
The settlement agreement included a provision granting AMR additional time, until Nov. 1, 2024, to comply with the new staffing models. At the conclusion of the “ramp up” period built in to allow AMR time to operationalize the changes, County EMS (Emergency Medical Services) staff and AMR executives provided the Board with information during an Oct. 31, 2024, briefing on AMR’s implementation progress.
Since then, AMR has improved its ambulance response times for all call types, according to County Health Officer Dr. Richard Bruno. However, as the data indicates, AMR is still not meeting the contractual requirement of responding to 90% of immediate, life-threatening calls within eight minutes. AMR’s performance has only reached the contract requirement for non-immediate, non-emergency calls.
“We’re encouraged by the upward trend from AMR,” said Dr. Richard Bruno. “However, AMR hasn't quite yet reached contract response time compliance. So while [the staffing change] is a bridge to meet those response times, it's also a bridge time for AMR to grow their workforce and to get back to the core contract.”
The settlement agreement was intended to be a temporary change to allow AMR sufficient time to hire enough paramedics and Emergency Medical Technicians (EMTs) to adequately staff enough ambulances to meet response times.
The Health Department will continue to work with AMR on implementing changes and improving compliance over the next several months. Staff will return to the Board at the one-year mark of implementation (August 2025) with a recommendation to continue, modify or terminate the settlement agreement.
AMR executives told the Board that since August, they have onboarded 122 EMTs in the Multnomah County system. AMR has also hired 28 new paramedics and graduated 18 paramedics from their scholarship program, with an additional 75 EMT and paramedic students expected to graduate in 2025 and early 2026.
“What AMR Multnomah has achieved in the onboarding of EMTs and paramedics into our system in the last seven months is unprecedented in our organization,” said Rob McDonald, AMR’s regional director. “Near the end of 2024, it was not uncommon for our crews to run as many as 10 to 12 calls in a 12-hour period. Crews are now running a much more manageable five to seven calls in a 12-hour shift.”
Since September 2024, AMR has purchased 18 additional fully equipped ambulances.
“In July 2024, we averaged 43 ambulances a day,” said AMR Operations Manager Andrew Cherry, while “in March 2025, we averaged 66 ambulances a day.”
Cherry told the Board that the most significant improvement over the past eight months has been the reduction in “Level 0” incidents, which refers to calls when no ambulances are available to respond.
“Prior to August, it was common to have as many as 20 to 30 hours a week where no ambulances were available to respond to a 9-1-1 call,” he said. “Working with Multnomah County EMS, we have drastically decreased this occurrence to just minutes a week,” with no such incidents in the last week of March.
One of the provisions in the settlement agreement granted the County specific permission to publicly share de-identified and aggregated monthly reports about AMR’s compliance with response times and other contract metrics, which has historically not been readily available for the public to view.
Those can be found on the County’s Emergency Medical Services webpage under the “Ambulance Response Data Reports” heading. The aggregated monthly incident data, broken down by geographic zone and call response type, can be accessed by clicking on the columns in the chart or by utilizing the download function in the Tableau dashboard. The information will be updated monthly as data is finalized.
Board comments
Commissioner Meghan Moyer asked whether the County has observed any negative health outcomes resulting from not having two paramedics in every response vehicle, which was the required sole staffing model for ALS ambulances before the settlement agreement.
“We’re in the process of hiring an additional EMS medical director who can help analyze the outcome data specifically related to heart attacks, strokes, seizures and other life-threatening outcomes,” said Dr. Bruno. “That data is forthcoming, and we’re happy to report that back.”
Commissioner Shannon Singleton shared that she was “interested to know what the feedback from frontline staff is about this agreement and how the process is working for them.”
“There’s a lot of concern about the care staff get to deliver to the community,” said EMS Administrator Aaron Monnig. “They want to deliver high-level care, so they have concerns. We’ve stepped up our game in evaluating and training people, and ensuring they're prepared to be the lead paramedic. I don't know that they're happy about everything, but I think there's a balance.”
Referring to the $8 million in fines the County has assessed AMR for failure to meet contract compliance, Commissioner Julia Brim-Edwards asked, “Have any fines been actually paid?”
Monnig replied that they have not. “The fines are in abatement, meaning we don't have them. AMR has them. We would not be able to invoice until the end of the settlement agreement. We have not collected any money.”
Commissioner Brim-Edwards followed up, expressing interest in having a conversation in August about whether the County should exit the settlement agreement if compliance rates do not improve, to enable the County to collect fines for noncompliance.
“The City of Gresham and myself have been tracking this issue, this challenge, for the last two-plus years,” said Commissioner Vince Jones-Dixon. “It’s great to know that we are working together to build out a system here…”
“Last year [while serving as a Gresham city councilor], I asked how long it would take to right-size our system, and you said it would take years. To know we're making substantial progress over the last seven months should be commended.”
“For the public and for the importance of ambulance service in our county, our partnership with AMR is a continuous effort as we're all working to keep the community safe and healthy,” said Chair Jessica Vega Pederson. “We'll continue to evaluate and ensure that quality and timely services are delivered. That's part of the charge. It's good to see that response times are trending in the right direction.”
