Board votes to re-evaluate Ambulance Service Plan; expresses concern for slow ambulance response times

February 29, 2024

The Multnomah County Board of Commissioners on Thursday, Feb. 29 voted to re-evaluate the Ambulance Service Plan (ASP) — two years ahead of schedule. Revising the 2016 Plan is needed so that the County’s Emergency Medical Services team can make informed recommendations to the Board of Commissioners on material changes to the system.

Thursday’s vote approved the Health Department’s request for $167,086 from the County’s General Fund contingency to immediately initiate an early review of the Plan. That work includes hiring an expert consultant, analyzing data, and extensive interviews, focus groups  and meetings with stakeholders such as fire departments, first responders and emergency departments. The goal of this process is to ensure that all partners can weigh in, and the public understands the impact of any changes to ambulance services to the emergency medical system, including staffing.

Chair Jessica Vega Pederson acknowledged several fundamental policy issues around the County’s current Ambulance Service Plan — including appropriate staffing, required ambulance response times, the 911 dispatch system and the formal and informal roles of fire agencies — that the Board, jurisdictional partners and other stakeholders want to reevaluate. 

The state requires each county to have an ambulance plan that specifies how emergency medical services are delivered, including the role of fire agencies, ambulance deployment, staffing, response times, medical direction and quality improvement.

Re-evaluating the Plan is one part of Chair Vega Pederson’s four-point plan to address the Ambulance Service crisis that was announced on Feb. 20.

“The appropriate and responsible process to examine these major elements of our emergency medical system is an assessment of our Ambulance Service Plan,” said Chair Vega Pederson. “To do that full picture analysis, the ASP assessment process is the appropriate tool and we should start now, because it is — by nature and by necessity — an in-depth process.”

Reviewing the plan requires both Health Department staff and an external consultant with subject matter expertise in emergency medical service systems. Emergency Medical Services administrator Aaron Monnig explained the assessment will identify the strengths and challenges of the County’s current system, explore possible system wide changes — including potential benefits and tradeoffs — and produce recommendations to build a stronger County EMS system.

Monnig said the assessment is the appropriate process to reexamine major elements of our system. “Typically, we would do this within the contract term of our ambulance service provider, which would be assessed in 2026 to 2028, but it is clear there is urgency to evaluate these big system questions sooner than that,” said Monnig.

Monnig explained the ASP assessment is a consultant-facilitated process that includes stakeholder engagement and data analysis and review. “The ASP assessment is expected to take around nine months, and at the conclusion of the assessment phase, recommendations would come to the Board of County Commissioners for consideration,” said Monnig.

During the Board meeting, four local paramedics and Portland Fire Chief Ryan Gillespie testified in support of a full assessment of the Plan.

“It is time for change. Our EMS professionals deserve better. Our community deserves better,” said Tim Mollwan, a current Multnomah County paramedic who has 25 years of EMS experience. “Allocating these funds is the first step in creating an EMS system that serves the people, not only the profit margin. Today you have the opportunity to take the first steps in positive change for our communities. Reducing the quality of care your neighbor, your friend, or your family receives is a step in the wrong direction.”

Chair Vega Pederson outlined several actions she has asked the County’s ambulance service provider to take to improve their contract compliance with ambulance availability and response times including:

  • Shore up their staffing by subcontracting;
  • Provide hiring and retention incentives to hire and retain staff in Multnomah County;
  • Fully staff Basic Life Support ambulances to take pressure off the system — there is still a lot of room to fully realize the benefits of this program.

“With today’s action, we are one step closer to where we need to be and my hope is that this will pay off in a resolution to this crisis that meets both the needs of our providers and the needs of our community,” said Chair Vega Pederson.

Board comment

All the commissioners said they recognized both the need to take action to fix issues that have afflicted ambulance services in the County for the past three years. However, the Board was split on whether to start addressing the problem by re-evaluating the Ambulance Service Plan, or if the Board should take action to immediately change the ambulance staffing model. Ultimately, the Board chose to re-evaluate the Plan in a 4 to 1 vote.

Commissioner Jesse Beason took a moment in his remarks to recognize, honor and thank the Freedom House Ambulance Service. Commissioner Beason explained that the all Black ambulance team began in the 1960s, which effectively launched the paramedic system and created the model for what we still use today.

“Before their work, emergency medical response was haphazard, slap shot and highly racialized to the detriment and death of mostly Black Americans,” said Beason.

Beason explained that the all Black ambulance team pioneered several medical developments and technologies including introducing medical physicians to ambulance work, allowing medics to transmit EKGs, using air casts to stabilize injured bones and joints and administering Narcan to overdosed patients.

“I am grateful to them for all their work and the countless lives that they saved and our paramedics save every day” said Commissioner Beason.

Commissioner Beason, who voted in favor of the resolution, urged the Board to hold a meaningful public work session involving AMR and all EMS partners to understand the complexities of changing the ambulance staffing model. “When AMR is failing to provide adequate service in neighboring counties and across the country with differing models, I would like better context for why that is,” said Beason.

“What is it that we are solving for? To me, one of the biggest issues is workforce. Why aren’t we talking about how to get more paramedics or more EMTs into the system and incentivize them…You all work in the medical field and you understand treating root causes. I don’t want to look at the symptoms but at the root causes,” said Commissioner Lori Stegmann, who also voted in favor of the resolution. “I am committed to staying at the table and I want everyone else to make that commitment to work in a collaborative spirit — to do the best thing to serve our community members.”

“If we just used our board meetings to have these conversations and real work sessions where we bring people in, I think we can get to the heart of this. $167,000 is a down payment on what will be asked for in our regular budget. I don't think that's the best use of our funds,” said Commissioner Sharon Meieran, who voted against the resolution.

“I am going to support this agenda item and also I think we need to do much more,” said Commissioner Julia Brim-Edwards. “Having a vote just on an assessment of the ambulance service plan is inadequate. I hope this team, in addition to moving ahead with the assessment of the Plan, is also coming back with recommendations of things we could do to make short term improvements in our ambulance response times.”

“Starting now will equip us with the kind of thoughtful, thorough analysis we would need in order to consider any significant changes to major elements of our ambulance service system,” said Chair Vega Pederson, who also voted in favor of the resolution.

The Board will be holding a public work session on ambulance response times with stakeholders in March 2024.