December 14, 2023 

Aaron Monnig 

Multnomah County Health Officer Operations Manager and EMS Administrator (Dr. Jonathan Jui and Multnomah County CHair Jessica Vega Pederson copied) 501 SE Hawthorne Blvd. 

Portland, OR 97214 

Re: Proposal to Change Ambulance Staffing Model in Accordance with Multnomah County Ambulance Service Plan 

Dear Aaron, 

Pursuant to the Multnomah County Ambulance Service Plan (MC-ASP), I am writing to you EMS Administrator for Multnomah County with this formal Proposal to Change Emergency Ambulance Staffing from the current model. 

Currently, all ambulances providing 9-1-1 medical call responses are staffed with two Paramedics (the “2P Model”) unless they fall within specific narrow exceptions. My Proposal recommends changing to a one Paramedic and one EMT Basic staffing model (the “1:1 Model”). It is based on the current crisis Multnomah County is facing in regard to excessive ambulance response times, putting the public at risk of serious harm and even death. It is supported by extensive evidence that the proposed model will not cause harm and, in fact, will improve not only ambulance response times, but the health, safety and well being of Multnomah County residents. 

It is my understanding that under the MC-ASP, the EMS Administrator must, in consultation with the EMS-MD (Dr. Jonathan Jui), screen any proposal to determine whether it has sufficient merit to justify more detailed consideration. If so, “the EMS Administrator will charge a group of experts to evaluate the proposal in detail, report their findings, and make a recommendation to the EMS Administrator and EMS-MD regarding approval and other considerations.” 

If a change in staffing is recommended by the group, the EMS-MD must consider whether the change is “appropriate and desirable” based on the recommendation. If so, “the EMSMD will be required to notify the Board of County Commissioners of the proposed change, make a recommendation regarding adoption, and address the following issues:

● The major factors driving the proposed change - e.g., lack of personnel (paramedic) availability, unmanageable changes in call volume/demand, etc. 

● Alternative solutions that have been considered. 

● How quality of care will be maintained, and what quality assurance and improvement processes will be used to ensure quality. 

● Anticipated adverse consequences of the proposed staffing change, and mechanisms to monitor for and respond to adverse consequences.” 

Based on my experience as an emergency physician, consultation with EMS directors in Oregon, and research of standards of care and best practices, I have first recommended, then begged, for the change in staffing model for months, starting when I first met with you and Dr. Jui in April of this year. I researched and prepared an EMS Emergency Response Proposal that I sent to you and the Chair’s office in June and have attached again here for your convenience. My call for change was echoed initially by the Mayor of Gresham, Gresham City Council, and the Gresham Fire Department, then other East County Mayors. Yet no meaningful action has been taken. Certainly no “group of experts” external to the County has evaluated the proposal in detail, reported their findings, or made a recommendation, which could have been done easily and expeditiously any time during the past eight months. 

With this formal Proposal, I hope the process that should have happened will in fact happen, and that it will be expedited. At today’s Board meeting, Chair Vega Pederson stated that it would take nine months to convene such a group and get a recommendation. This is patently absurd. It could be accomplished within days to weeks. The fact that it hasn’t yet been done is unconscionable. 

Assuming that the group of experts recommends a change in staffing model, I would hope that Dr. Jui would expeditiously support the findings and urgently recommend adoption by the Board of County Commissioners. The elements that he would need to address have been highlighted for months. To summarize: 

The major factors driving the proposed change include the perfect storm of a desperate “lack of personnel (paramedic) availability” and the “unmanageable changes in call volume” that have pushed a system already in crisis further over the edge. 

Alternative solutions include the pilots proposed by the EMS-MD with the County Chair’s support and the fine imposed on the ambulance service provider. Both have added insult to injury, and in my view delayed meaningful action and caused additional harm.

Quality of care will be maintained and monitored through direct real-time management of EMS calls and analysis of the extensive data collected and reviewed around these calls. 

Anticipated adverse consequences are projected to be minimal, if any. In fact, improved ambulance response times and decreased times getting patients to definitive emergency care will likely result in better outcomes across the board, ranging from improved customer service and public trust in the system, to getting key therapeutic interventions started sooner and decreasing harm and suffering, to potentially saving lives. The real-time monitoring and management of the system would identify any potentially concerning issues, which could then be urgently addressed. 

I informally made this proposal eight months ago and had hoped for meaningful action and collaborative resolution. But rather than providing any evidence countering my suggestions, I and the public have been met with unsupported and vague statements from Dr. Jui and Chair Vega Pederson; irrelevant or misleading data about ambulance calls and Paramedic needs and response; vague and predictably ineffective interventions; inappropriate and misleading comparisons to other jurisdictions; and deflection of responsibility. 

It is egregious that the County has allowed its emergency medical response system to descend to this point. The issue feels like it’s being treated as a Contracts assignment in law school rather than the matter of life and death that it is. 

I am therefore sending you this formal Proposal to Change Ambulance Staffing under the Ambulance Services Plan. I hope that this leads to prompt and definitive action, starting with the urgent convening of a group of experts to evaluate the proposal and make a recommendation. 

Respectfully submitted, 

Sharon Meieran 

Sharon Meieran, MD, JD 

Multnomah County Commissioner, District 1 


Phone: (503) 988-5220