Multnomah County says AMR staffing changes have improved response times but full contract compliance not yet met

Multnomah County officials and American Medical Response (AMR) told the county Board of Commissioners that temporary staffing changes under a settlement agreement have increased ambulance deployment and reduced periods when no ambulances were available, but monthly contract response‑time compliance has not yet been met.

Dr. Bruno, the county’s health officer and interim medical director for Corrections Health, and Aaron Monning, health officer operations manager and EMS administrator, briefed the board on the settlement terms, public response‑time dashboard data and an ongoing system assessment. Rob McDonald, AMR’s regional director for Oregon, and Andrew Cherry, AMR Multnomah County operations manager, described AMR’s recruiting, training and capital investments.

The settlement agreement, signed by the chair and AMR last summer and memorialized in a county resolution, temporarily allowed AMR more flexibility in staffing to increase the number of ambulances available while it hired and trained clinicians. Under the agreement AMR must ensure that 85% of daily, lower‑acuity calls triaged by BOAC are handled by basic life support (BLS) ambulances and maintain a minimum daily average of 20 dual‑paramedic advanced life support (ALS) ambulances. The agreement also set a ramp‑up period and put previously accrued contract penalties in abeyance pending performance.

County and AMR officials said the measures have produced measurable changes but not full compliance with the contract response‑time targets. The county’s public dashboard — updated monthly — shows improvement in urban life‑threatening (code‑3) response time percentages, which AMR representatives said are in the high‑80s (short of the 90% contractual threshold). Non‑life‑threatening responses exceeded the 90% target. Rural responses are reported in six‑month increments, officials said.

AMR reported hiring and training gains: 28 paramedics recruited outside scholarship programs since August 2024; 18 paramedic graduates from AMR scholarship programs now working in the system; roughly 75 paramedic students in partner programs who commit to Multnomah County for at least two years; and a growing “earn while you learn” EMT pipeline. AMR also said it added 18 fully equipped ambulances to local deployment since September 2024 and increased average daily deployed ambulances from about 43 in July 2024 to about 66 in March 2025.

“Crews are now running a much more manageable five to seven calls in the same 12‑hour shift,” Rob McDonald said, adding that the change has mitigated fatigue and burnout. AMR also credited training expansions — including more training officers and field time — and diversity scholarship programs intended to increase recruitment from BIPOC communities.

The county said AMR has accrued $8,046,825 in penalties for noncompliance between April 2022 and November 2024; those fines are being held under the settlement and would be eligible to be waived only if AMR meets contractual response‑time performance. Aaron Monning said no fines have been waived because AMR has not yet achieved the required monthly compliance.

Commissioners asked for additional information and follow‑up. Commissioner Moyer asked whether the staffing changes have affected clinical outcomes for life‑threatening calls such as heart attack, stroke and seizure. Aaron Monning said the county is hiring an EMS medical director to lead an outcomes analysis and that preliminary analyses are under way. “That is forthcoming,” Monning said.

Commissioners also pressed for zone‑level, priority‑level breakdowns of compliance data (for example, life‑threatening calls in the East zone), frontline staff feedback, and details about AMR’s international recruitment and temporary staffing arrangements. AMR said a previously used national contracting agency that provided temporary paramedics ended its work in March because local staffing began to improve; AMR also described a developing pathway for licensed paramedics from Australia who would work under U.S. visas for an initial minimum two‑year commitment.

Board members requested that AMR and county EMS return with more disaggregated outcome and zone‑level data, direct frontline‑staff feedback at a future briefing, and details on the scholarship and diversity recruitment programs. Dr. Bruno said the county will conduct a one‑year evaluation of the settlement agreement’s implementation and return to the board with a recommendation to continue, modify or terminate the agreement.

County and AMR officials emphasized that the settlement was designed as a temporary “bridge” to increase ambulance availability while AMR rebuilt staffing to the core contract model.