AMR pressures Multnomah County over ambulance staffing rules

By Ryan Haas (OPB)
Feb. 14, 2024 7:48 p.m.
A man who was just revived from a near-fatal overdose climbs into the back of an ambulance, Dec. 13, 2023.

A man who was just revived from a near-fatal overdose climbs into the back of an ambulance, Dec. 13, 2023.

Kristyna Wentz-Graff / OPB

American Medical Response sent a letter to Multnomah County on Tuesday, warning of a potential emergency system collapse if the county doesn’t ease its requirements for ambulance staffing.


“If we continue the current path, this system could collapse in a matter of months as the impact of the national paramedic shortage worsens,” the letter, signed by AMR’s Northwest operations manager Rob McDonald, said in its starkest terms.

For roughly a year, AMR and the county have disagreed on how many paramedics are needed to staff an ambulance.

Related: Multnomah County fines ambulance company for slow response times

Multnomah County requires ambulances for high-level calls to have two paramedics. Other jurisdictions in Oregon only require ambulances to have one paramedic and one emergency medical technician — a position that requires less specialized training.


Ambulance response times, meanwhile, have continued to increase. In January, KGW reported that so-called “level-zero events” — times when no ambulances are available to respond to emergencies — are most common on busy weekend evenings.

In its letter this week, AMR said it is short of Multnomah County’s requirements by around 60 paramedics, and that number is rising on a monthly basis as people leave the job. The company estimates it would need around 50 fully staffed ambulances per day to achieve adequate response times, and it is only currently able to provide around 33 — about one-third short of the need.

Related: Multnomah County says it will fine ambulance provider AMR for slow response times

The county and its medical advisors have broadly insisted that having two paramedics staff ambulances leads to better outcomes for patients with life-threatening conditions, such as cardiac arrest.

Through a spokesperson, county chairperson Jessica Vega Pederson declined to comment on AMR’s letter “until she has briefed her colleagues on the Board of Commissioners on next steps.”

Related: Multnomah County ambulance provider appeals fine, causing finger-pointing, search for solutions

Individual members of the commission have remained divided on changing the staffing requirements.

AMR said it has the support of fire departments from Portland, Gresham and Corbett, as well as a variety of east county political leaders, to adopt ambulance staffing with one paramedic and one EMT.

The company estimated that if the change went into effect, it would require around three months before it can provide the full 50 ambulances needed on any given day. During that time, the company said, it would continue to onboard more EMTs and paramedics and pursue training efforts to make sure all ambulances are capable of handling the most severe calls.