In a briefing Tuesday before the Board of County Commissioners, AMR Regional Director Rob McDonald said relaxing the two paramedic requirement made it possible for the company to deploy 18 new ambulances in Portland over the last year, which has dramatically improved response times.
AMR is also investing in local scholarship programs to bolster its workforce. So far, 18 paramedics have graduated through an AMR scholarship program and started working or job training in Multnomah County. The company says it’s providing scholarships to 75 more paramedic students across four different Oregon schools with graduation dates into early 2026.
However, McDonald said the ongoing national shortage of paramedics – coupled with Oregon’s unusual requirement that paramedics have at least an associates degree – has made it hard for AMR to recruit new hires.
That led the company to look to Australia. According to McDonald, while the United States is graduating too few paramedics to meet its needs, Australia has the opposite problem, with paramedics fresh out of school struggling to find work.
“These are great clinicians excited to live and work in the US,” he said in a presentation to the Multnomah County board. “We believe this is the first time in Oregon history where an agency will build and maintain a pathway for international paramedics to come to the United States.”
The company is still falling just short of meeting a key target, getting to 90% of high priority calls within eight minutes of being dispatched. That target is used by the county, and many first response systems nationwide, to judge ambulance performance. Research has found that a response time of around eight minutes improves survival rates for cardiac arrest and other medical emergencies.
County staff confirmed that because AMR has fallen short of that metric, it hasn’t started earning a reduction in fines for improved service. Up to 60% of the company’s fine can be reduced if it meets that target.
In March, AMR ambulances reached 88% percent of high priority calls within eight minutes, according to data McDonald presented to the county board. A year ago, AMR was only responding to about 67% of critical calls within that time frame, according to a public dashboard tracking progress under the settlement.
The amount of time the system is at so-called “level zero,” where no ambulances are available to deploy when a call comes in, has fallen too. According to data presented by AMR, the ambulance system is now at “level zero” for just minutes a week, down from more than 30 hours a week last summer.
County Commissioner Julia Brim-Edwards asked the county’s EMS team whether they’ve seen any difference in the quality of care provided to patients on ambulances staffed with a lead paramedic and a less trained EMT.
“I don’t think we could give you a good answer about whether the quality of care has changed between a dual staffed ambulance and a hybrid ambulance,” said Aaron Monnig, health officer operations manager for the county.
County EMS medical director Dr. Jon Jui had previously defended the county’s two paramedic standard, saying it was critical to the quality of out-of-hospital care. The region’s fire chiefs, meanwhile, pointed to the importance of response time and urged him to lower the staffing requirement to get more ambulances on the road.
Last year, OPB uncovered data that showed that EMS patients in cardiac arrest who needed rapid defibrillation were less likely to survive in 2023, as delays were mounting, than the year before.
That survival data isn’t available yet for 2024, according to an AMR spokesperson.
Monnig said there’s little published research that establishes whether there’s a difference in the quality of care based on ambulance staffing. The county is hiring a new EMS medical director who will look at that issue.
If the quality of care isn’t substantially different, Brim-Edwards said, the county should consider ending the two-paramedic requirement permanently.
At present, AMR only has the flexibility to staff its ambulances differently while the settlement is in effect.
The settlement extends through August 2025. At that point, either party can withdraw from the agreement by giving 90 days notice, and the county has the right to begin invoicing AMR for the fines it has accrued.
At the same time, the county is in the process of reviewing its ambulance service contract and considering broader changes.
Multnomah County Chair Jessica Vega Pederson seconded the request for more data, and said the county will hold another hearing on the issue in August.
“We’re trying to make really important policy decisions around the agreement we have and what that might look or our system might look like in the future,” she said.
