Multnomah County staff have proposed continuing an agreement that allows the ambulance provider AMR to staff some of its vehicles with one paramedic and one emergency medical technician, but they are not calling the experiment a success.

That’s according to documents filed in advance of a Tuesday briefing for the Multnomah County Board of Commissioners.

AMR and the Multnomah County emergency management service team have clashed in the past over how to handle strain on the ambulances caused by a rising number of overall calls, many of them for minor needs, and a shortage of paramedics.

After a years-long dispute over who was to blame for slow ambulance service and incidents when no ambulances were available for life-threatening emergencies, the county agreed last August to depart from its longstanding requirement that all ambulances be staffed with two paramedics.

Under the settlement, AMR has to provide a minimum of 20 ambulances staffed by two paramedics and some ambulances staffed with two EMTs to respond to low-level calls. If it meets those targets, the remaining ambulances can be staffed by one paramedic and one EMT, the company’s preferred model for its teams.

AMR and the Multnomah County emergency medical services staff are briefing the county board Tuesday on how the settlement has played out.

AMR and county staff have filed dueling slide presentations for the briefing with what appear in some instances to be conflicting facts.

For example, on one slide, AMR reports it has hired 15 new paramedics, for a total of 171 paramedics in the county. The ambulance provider said it is preparing to bring on seven more in September. The county team’s presentation, meanwhile, appears to cast doubt on that, saying data the company has shared shows it has hired 14 new paramedics, while losing 23 part-time paramedics, equating to a net loss.

The county staff slides also state that the county EMS medical director has observed an increase in “serious safety events” during the settlement agreement.

AMR accrued more than $8 million in fines due to late service in 2023 and 2024. Per the county presentation, AMR has not reached the county’s response time goals for any month, even after the changes to staffing.

Neither presentation appears to include any assessment of patient survival in Multnomah County when ambulance response times were at their worst in 2023 and 2024.

OPB requested, and received, some of that data from AMR. The company and the state of Oregon participate in a national registry called CARES. That registry tracks the outcomes of cardiac arrests that are attended to by first responders.

Cardiac arrest is when a person’s heart is no longer beating, or is no longer beating in an effective rhythm. It can happen when a person has a heart attack, drug overdose or respiratory problem, or suffers physical trauma or drowning.

The CARES registry follows the outcomes of patients with non-traumatic cardiac arrests as a way of understanding how well interventions like CPR training are working.

In Multnomah County, 12.2% of patients in the cardiac arrest registry survived to hospital discharge last year, slightly above the national average of 10.5%.

But people whose hearts stopped in Multnomah County were less likely to survive a cardiac arrest than their peers in Clackamas, Clark or Washington counties.

Clark County had the highest survival rate in the region at 19%.

That doesn’t necessarily mean Multnomah County’s emergency medical services system was performing poorly.

Survival rates for cardiac arrest can vary widely and are influenced by factors like age and the health of a community.

To reduce the number of confounding variables and make it easier for EMS systems to get a true read on their performance compared to their peers, the CARES registry tracks a subset of cardiac arrests, known as the “Utstein subgroup.”

The Utstein subgroup includes only patients who are most likely to survive: those whose cardiac arrest was witnessed by their family or a bystander, and who had a shockable heart rhythm.

Looking at the survival rates for the patients with the most favorable circumstances allows for truer comparisons between different emergency systems, according to the registry managers.

In 2023, at the peak of Multnomah County’s ambulance response time crisis, a third of the most treatable “Utstein” patients survived.

Last year, that same group of patients had a survival rate of 42.7%.

The 2024 Utstein survival rate, while an improvement over the year before, still places Multnomah County last in the region for cardiac arrest survival, behind Clark (54.3 %), Washington (52.9%) and Clackamas (48.5%) counties, according to data AMR shared with OPB.

Multnomah County’s survival rates still beat the state and national average reported by CARES.

AMR, which provided the county-by-county data to OPB, cautioned against drawing firm conclusions from it.

The company noted that communities that have larger populations experiencing poverty and chronic disease at higher rates may have lower survival odds.

The 2024 CARES report also includes a detailed analysis of how EMS response times affect patient survival. It found that response times matter a great deal for survival for patients with a witnessed, shockable cardiac arrest.

News Source : https://www.opb.org/article/2025/09/08/multnomah-county-ambulance-amr-emt-paramedics-emergency-response/