AMR warns Multnomah County that EMS system could ‘collapse’, urges leaders to change staffing model

PORTLAND, Ore. (KOIN) — The calls to change Multnomah County’s ambulance staffing model are growing louder as the number of ambulances is only getting thinner.

Now, ambulance company American Medical Response (AMR) has sent a letter to county commissioners this week warning of a potential system collapse that could happen “in a matter of months.” They’re short 60 paramedics now but they expect to lose two paramedics a month going forward.

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AMR detailed its action plan to weather this national paramedic shortage. This would involve the company temporarily shifting from a dual paramedic system to staffing half of their ambulances with one paramedic and one emergency medical technician (EMT).

AMR highlighted that they average 10 EMT hires to every one paramedic hire, due to the shortage. In the letter, the company provided a clear timeline for strategic staffing adjustments, hiring and onboarding over the first three months, aiming to achieve full staffing by the deadline.

There is a growing list of stakeholders who are now also speaking up to endorse this idea, including all of the fire departments in Multnomah County, the east county mayors, Representatives Dacia Grayber and Rob Nosse, Commissioner Rene Gonzalez and Portland Emergency Management.

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As KOIN 6 News has previously reported in past coverage of the ambulance shortage crisis, Multnomah County Chair Jessica Vega Pederson and the Multnomah County Emergency Medical Services Director are the ones who have the authority to make this temporary change. So far, they have refused to do so, instead opting for looking at “Long-term solutions.”

The letter from AMR is shown below:

In Multnomah County, the mental health system is fractured, drug abuse is skyrocketing, and the unhoused are facing impossible odds. Ambulance availability and response times are significantly affected in the County by mental health and drug related calls, as well as the nationwide shortage of paramedics. In the quagmire that Multnomah County finds itself in, solutions are hard to find, but with regards to EMS, we are willing and able to offer the County a solution utilized by many other jurisdictions and endorsed by the following stakeholders:

• Portland Fire and Rescue 

• Gresham Fire and Rescue

• Corbett Fire 

• Sauvie Island Fire

• Commissioner Rene Gonzalez 

• Gresham Mayor Travis Stovall

• Troutdale Mayor Randy Lauer 

• Wood Village Mayor John Miner

• Fairview Mayor Keith Kudrna 

• Portland Emergency Management

• Representative Dacia Grayber

• Representative Rob Nosse

Simply, we must change the staffing requirement in Multnomah County to model the national and state standard to deploy a paramedic and an EMT to respond to 911 requests. We have an opportunity to exact real change in short order. Together, we can make an immediate impact to EMS. Once fully deployed with 50 ambulances per day, we anticipate that response times will meet contract specifications. This will avoid further penalties and restore the public’s confidence in EMS under your leadership.

We would like to provide as much information to you as possible regarding our proposal to change the Multnomah County EMS staffing requirement to allow for paramedics and EMTs to work together on front line 911 units until the national paramedic shortage is resolved. This is the only way forward to stability in our system while the paramedic shortage persists. Our fire service and other public safety partners have all endorsed this temporary staffing change, knowing that if we continue the current path, this system could collapse in a matter of months as the impact of the national paramedic shortage worsens. We are now short 60 paramedics, with that number increasing by two per month. We need to deploy 50, 12-hour ambulances per day to achieve response time performance, currently we deploy only 32-34 shifts per day. Not all are deployed at the same time as we are a 24/7 operation.

We present to you a brief proposal, to include definitive timelines for deployment modifications and staff on-boarding. While there are several moving pieces to this work, we hope this high-level report may provide more clarity regarding our intent. Below is an outline of what the next four months would look like following board approval to change the staffing requirements to temporarily allow paramedic/EMT staffing for approximately half of our total deployment. (referred to as 1:1 staffing)

Month 1:

•  Currently staffing all ALS two paramedic deployments with a smattering of BLS units (EMT/EMT)

• First week, we will have an additional 4-6 ALS units staffed with medic/EMT

  • We will migrate some paramedics into lead training to allow them to work with an EMT.

  • We will break up the BLS deployment to pair EMTs with medics on ALS units.

  • We will continue to aggressively on board both EMTs and Paramedics throughout the process.

  • We will reconfigure the deployment to compliment this new influx of front-line ALS units and by the end of the month we will consistently have 5-8 additional ALS units on the road every day than we had the month prior.

Month 2:

• Further migration of paramedics to lead to positions to allow more 1:1 units on the road.

• Further on boarding of new EMTs and paramedics. We average 10 EMT hires to every 1 paramedic hire due to the shortage.

• By month end we should see 10 or more 12-hour shifts on the road daily than currently deployed before the change.

Month 3:

• Staffing improvements will have already been realized in the first two months and improvement in the system will be evident with shorter response times and more resources on the road daily. There is still work to do to get to full staffing.

• Continue our aggressive on boarding of EMTs and Paramedics with further migration of medics to lead training until we have a full staff of leads by the end of the month.

• EMT training from the prior month will give us EMTs we can immediately pair with the newly trained lead paramedics.

• FULLY STAFFED and deployed with 50 daily shifts by month’s end.
  

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