Paramedic Paradox: Unraveling Multnomah County’s response time dilemma
PORTLAND, Ore. (KOIN) – Imagine: You call 911 for an emergency for a loved one and there are zero ambulances available to come help you.
This is the current reality in Multnomah County while AMR is down 58 paramedics, and that number is only expected to rise in the new year. Further, a local ambulance industry expert says the county’s response times are about to get even worse.
Data from November 2023 show Multnomah County continues to regularly run out of ambulances to send to emergencies – only getting to patients within eight minutes, 60% of the time. The half a million dollar fine the county issued against AMR in November has had virtually no impact on speeding up response times, compliance data show.
“Multnomah County has one of the highest cardiac arrest survival rates in the country under this system,” one health department spokesperson told KOIN 6. “Changing the model will not fix response times.”
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According to Dr. Stephen Dean, who worked in emergency medical services both in Portland and across the country for more than five decades and specialized in improving EMS systems,
“people are going to get hurt if we don’t fix the response time problem.”
Now retired in the Portland area, Dean said he can’t help but see the impending catastrophe in Multnomah County.
“A concern you might have is, ‘What is the plan to fix the response times?’ And right now there is no plan. And we’re getting ready to go into the flu season when it’s going to make a difference,” Dean said.
Flu season typically lasts from October to April. Year after year, Oregon Health Authority data documents huge spikes in illness during this timeframe. This year’s data show the spread is starting to rise.
Dean said the number of 911 calls typically correlate with this increase in illness.
“When the flu hits, it raises the whole system’s call volume up, so you get more heart attacks, more respiratory problems, more of everything,” he said.
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Dean warns of the chain of events to come: Emergency room overcrowding would lead to slow patient turnover at hospitals and limit available ambulances for emergency calls. Paramedics who call out sick would also result in higher caseloads and increased burnout.
“My top concern is that the response times will get longer, and response times matter in an EMS system. If they didn’t matter, the county wouldn’t have this eight-minute, 90% compliance,” he said. “As the response times get longer, the county must take action to help the system or help the patients, because it’s the patients who are getting the longer response times.”
Dean urges the county to change their two-paramedic requirement, adding that one paramedic and one EMT “can handle more than 98% of the calls that are received in the system.”
KOIN 6 has repeatedly asked top county health leaders for a year if they’d consider changing Multnomah County’s two-paramedic requirement to the national standard of one paramedic and one EMT, even temporarily. The answer has consistently been, ‘No.’
Multnomah County Commissioner Dr. Sharon Meieran also happens to be an emergency physician, and she said the county needs to “change [its] staffing model, period.” In fact, she recently filed a written formal proposal to change the ambulance staffing model after what she claims were months of verbal requests.
“I am an avid supporter of the one paramedic/one EMT staffing model for a variety of reasons,” Meieran said. “The evidence points to it. It is safe. It is effective, and it is the right combination of providers to provide the best care and the fastest way possible.”
In her proposal, she points to extensive research done within recent years that show the two-paramedic model is an outlier.
“It can be done in very, very unique circumstances. We don’t have any of the circumstances here. And so what we’re doing isn’t done anywhere else in the state,” Meieran said. “The most important thing is getting to the scene fast, starting whatever treatment you can start, and then getting someone to the ER. That’s what we need to be doing.”
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She’s pushing for the Multnomah County chair and health leaders to reconsider their stance for the sake of patients, but both have long publicly supported keeping two paramedics per ambulance – citing studies from abroad that show better cardiac arrest outcomes.
“I mean, I’m glad that Korea is doing whatever it is they’re doing,” Meieran said. “They’re not applicable.”
In a press release from November, the chair and health department director underscored that the dual paramedic “staffing requirement has helped ensure the county’s system has one of the highest cardiac arrest survival rates in the country.”
However, according to state records within the last five years, Clackamas County has a higher cardiac arrest survival rate than Multnomah County. Clackamas County operates with a one paramedic and one EMT model.
MULTNOMAH:
2018: 18.3%
2019: 14.6%
2020: 10.8%
2021: 11.8%
2022: 15.8%
CLACKAMAS:
2018: 19.8%
2019: 17.3%
2020: 13.4%
2021: 17.7%
2022: 18.6%
“The idea that we would wait for two paramedics to do something like that rather than get one paramedic and one EMT to a scene faster is ludicrous,” Meieran said.
KOIN 6 obtained the number of cardiac arrest incidents in Multnomah County within the last five years and found that, of the roughly 120,000 emergency calls they receive per year, about 700 are for cardiac arrest.
That means that cardiac arrest cases in Multnomah County account for 1% of the patients that AMR serves. An internal audit in 2023 showed that nearly all – 99.9% of the 1% – of patients experiencing cardiac arrest in the county received a response of one paramedic from Portland Fire & Rescue as well as two paramedics from AMR.
“So there actually is another paramedic there anyway, this is shocking to me that we haven’t done this already,” Meieran said.
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Meieran initiated a formal process to convene experts on this topic, which she said could offer a solution within weeks. However, Multnomah County Chair Jessica Vega Pederson is on record at a recent board meeting saying otherwise.
“In and of itself, looking at the question of whether a two-paramedic model is still the viable model is a nine month process,” she said. “So the recommendation backed from our team was that if we’re going to be looking at the two-paramedic question, we might as well look at the entire ambulance service plan.”
Sharon Meieran said it should be done with more urgency, adding that “this is not something that needs to be nine months, and whoever is saying that is being inaccurate and misleading.”
A week after this meeting, KOIN 6 obtained a letter that Vega Pederson sent to the mayors of East County, who have begged her to change to the one paramedic and one EMT model.
“Our MCEMS team is undertaking a formal examination of the two-paramedic model to potentially change the staffing requirement, but that process will not yield a quick fix,” she wrote in the letter.
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Meanwhile, AMR said that if Multnomah County moved to a one paramedic and one EMT system, they would immediately have half a dozen more ambulances out in the field and could be could fill the nearly 60 paramedic vacancies with EMTs within a few months.
“It’s literally life or death every single day, every hour,” Meieran said. “And the failure to act, in my view, is a moral outrage.”
This equally outrages residents like Dean, who said he dreads the day he or his family needs an ambulance in this part of Oregon.
“These are very life threatening conditions,” he said. “These are the conditions where seconds and minutes really do matter.”
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