Multnomah County paramedics facing 20% increase in calls

An experienced paramedic in Multnomah County says he and his colleagues are being stretched thin amid a surge in 911 calls.
Published: Oct. 3, 2023 at 7:45 AM PDT
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PORTLAND, Ore. (KPTV) - An experienced paramedic in Multnomah County says he and his colleagues are being stretched thin amid a surge in 911 calls.

This comes after Portland and Multnomah County emergency management officials briefed county commissioners last month about the long response times of American Medical Response (AMR), the ambulance company contracted by Multnomah County and other local governments for emergency response.

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Multnomah County AMR paramedic, Matthew O’Neill, has worked for AMR in the Portland area for over 15 years. He says he loves the work he does, but the current climate for paramedics and EMTs on city streets is getting to the point where it is not sustainable.

“It’s hard to do an average, but it’s not untoward for myself to run 10-plus calls,” said O’Neill “I work a 10-hour shift, and very frequently my day is filled up with calls.”

O’Neill explains this is not normal.

“Roughly 40% of my day should be allocated to calls and the rest should be charting time, down time, break time, rest time, other duty time besides running calls.”

Multnomah County recently reported that in 2022, AMR responded to 120,478 911 calls, a 20% increase since 2018, when AMR ambulances responded to 100,369 calls. O’Neill says he started noticing issues post COVID-19, when first responders started witnessing high amounts of meth use, and an explosion of fentanyl on the streets.

“Currently, we do have a narcotic epidemic,” said O’Neill “There is an influx of narcotic overdoses, which seems to be a taking of a larger part of our day.”

O’Neill adds, often he and other paramedics are dispatched to the same people experiencing overdoses or other issues.

“It’s not uncommon for us to have multiple contacts with the same people,” he said. “The EMS system and the emergency departments are some people’s first and only real contact for any type of health care. There are resources out for them to navigate the system, but for some reason or another they are unable to partake or unwilling to partake and just can’t get past utilizing really the easiest resource.”

According to county officials, the contract between Multnomah County and AMR states that life-threatening emergencies are expected to receive an ambulance in eight minutes or less at least 90% of the time in an urban setting. Last month, when local EMS managers and health officials sounded the alarm in front of Multnomah County commissioners in a briefing, data was shared showing that AMR has not been meeting these contractual obligations for over a year.

“There’s not enough paramedics or EMTs available to staff enough ambulances for our county,” said Dr. Paul Lewis, former health officer for Multnomah County.

The problem has pushed county officials to potentially fine AMR for thousands of dollars, just for the month of August alone.

“The preliminary ballpark of that fine for the month is about $500,000,” said Multnomah County EMS administrator, Aaron Monnig, to the board of commissioners. “That’s a significant amount of money, and I think once we get the final report, we’ll be discussing how we’re assessing that fine.”

Monnig added that the money from that fine would be used to increase first responder staffing, but nor he or the commissioners were clear on how that would be done.

In response to the county’s move, AMR has issued a statement on the potential fines which reads in part:

“American Medical Response takes the responsibility of staffing its Multnomah operation and meeting obligations very seriously. We have made extensive efforts to communicate the severity and external causes of paramedic staffing shortages nationwide to the county. However, we disagree with the county’s current stance.

AMR wants to assure members of the community that we are doing everything within our power to fulfill our responsibilities and address the staffing shortages. We remain open to working collaboratively with the county to find a resolution.”

County officials launched a pilot program in May of this year to dispatch ambulances staffed with only emergency medical technicians, or EMTs, as opposed to the standard two paramedics, to lower level 911 calls. The goal of this move is to make the more qualified paramedics available for life threatening situations such as calls involving people going into cardiac arrest, having difficulty breathing, unconsciousness, or people who are unresponsive.

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O’Neill says, this could free up resources.

“They’re looking at pulling out as many of those lower acuity calls as possible so that folks that need a dual medic response at this time will receive one.”

But O’Neill says that both paramedic and EMT staffing remain an issue. EMS officials told Multnomah County commissioners last month that there still needs to be about 40 EMTs hired in the county to ease the stress on the system so paramedics won’t be tied up with lower acuity 911 calls.

O’Neill also says, while it is difficult to point to one group of people for the dramatic increase in 911 calls in recent years, the crisis of drugs, mental health issues, and homelessness in Portland and Multnomah County is significant.

“There is a strong correlation between homelessness and addiction or mental health issues, there’s a strong group,” he said. “That group do utilize the system frequently, but we also have other systems that you would be surprised. We have things like a large amount of care homes that call. We have a large amount of inter-facility hospital usage that gets used.”

Regardless of who is calling, O’Neill feels the system that has been in place cannot keep up.

“Now we’re at the point where the amount of people who are doing the same thing is crushing the system.”