Multnomah County commissioners received an informational briefing Oct. 31 on American Medical Response’s implementation of ambulance staffing changes agreed in a mediated settlement and scheduled to enter strict compliance Nov. 1.

Health Officer Richard Bruno and EMS Administrator Aaron Monnig summarized the settlement the board approved in August, which set staffing and response-time requirements, established a ramp‑up through Nov. 1 and created pathways for AMR to reduce up to 60% of accrued fines by meeting response-time targets. County staff said AMR had accrued about $7.7 million in fines for prior noncompliance and that the county published a static performance report and an interactive dashboard this month to show response-time compliance by code and geographic zone.

Rob McDonald, AMR regional director, and Andrew Sherry, AMR operations manager, told the board AMR has accelerated hiring and training since August: 65 EMTs onboarded with more to come, 14 new paramedics hired outside scholarship or internal advancement programs, and 16 paramedic graduates from scholarship programs. AMR said it invested in recruiting, a scholarship pipeline, an "earn‑while‑you‑learn" program and two subcontracting pathways (an AMR SOS traveling‑paramedic program and an external vendor) to supplement paramedic capacity. AMR also said it bought 14 additional ambulances to meet deployment goals.

AMR presented early performance graphics showing increased weekly deployments, improved capture rates of low‑acuity calls by BLS ambulances and a steep decline in the time the system spent with no ambulances available (“level 0”): where previously there were many hours per week with no available unit, AMR reported reducing that to minutes per week prior to the Nov. 1 go‑live. Both AMR and county EMS staff described the trends as encouraging and said the county posted an interactive dashboard (maltco.us → EMS) to share adjudicated monthly results; county staff noted that monthly data are finalized after an exemption/adjudication process and typically become public 1–2 months after the reporting month.

Commissioners pressed for additional and different metrics. Several asked that the dashboard display raw, zone‑level adjudicated data, counts of level‑0 events, ambulance utilization and hiring numbers for EMTs and paramedics. County staff said the finalized zone‑by‑zone data underlying the dashboard are available and staff will work with commissioners on the preferred formats. The board pressed AMR and county EMS to track clinical outcomes—timing for recognition and transport of strokes and heart attacks—and to make future reporting of clinical metrics feasible without identifying individual patients; county and AMR staff said small sample sizes will require careful aggregation.

Commissioners also asked about training and workforce quality after an accelerated onboarding effort. AMR said it expedited some training modules but maintained required checklists and field training‑officer sign‑offs; AMR and county medical directors said they were monitoring open operational and clinical investigations and would notify the board if any trends rose to a level that required action. AMR said restoring normal, longer training timelines will be a goal as staffing stabilizes.

Board members asked how quickly the system could be expected to reach contractual compliance targets such as 90% by zone. AMR described the improvements as happening faster than expected and forecasted continued gains in weeks to months; the county recommended quarterly updates so commissioners can review clinical and operational impacts as the system proceeds into strict compliance.

The briefing was informational; the board did not take formal action on the settlement at the meeting. AMR and county EMS offered to return with additional data and commit to iterative dashboard enhancements and to public reporting of adjudicated, zone‑level data.