Interesting issue – Many communities have not only done away with dual-paramedic units, but also any paramedics, opting for tiered ALS/BLS deployment models, when quality Emergency Medical Dispatch is used to appropriately triage calls, based on patient condition, since BLS care is appropriate for a large % of EMS requests.

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‘Extremely unsafe’ lack of ambulance service in Multnomah County is unacceptable, Portland fire chief says

Jan. 25, 2024

By Austin De Dios | The Oregonian/OregonLive

https://www.oregonlive.com/crime/2024/01/extremely-unsafe-multnomah-county-ambulance-services-unacceptable-says-portland-fire-chief.html

Interim Portland Fire Chief Ryan Gillespie is the latest official imploring Multnomah County commissioners and health officials to address dangerously slow ambulance response times by changing the staffing model the county imposes on its ambulance provider.

“The shortage of ambulances is putting the community’s lives in jeopardy and it is also putting our firefighters’ lives in danger,” Gillespie wrote to Dr. John Jui, the county’s medical director, and Aaron Monnig, its health office operations manager, in a letter dated Jan. 23.

Gillespie joins Multnomah County Commissioner Sharon Meieran, an emergency room doctor, and Portland Commissioner Rene Gonzalez, who oversees the Fire Bureau, in demanding that county officials pilot a program to staff ambulances with an EMT and a paramedic, instead of two paramedics, as they do now. Meieran submitted a proposal to change the staffing requirement Dec. 14.

Multnomah County has contracted with American Medical Response to send ambulances to emergency medical calls since 1995 but is unique among public agencies in requiring two paramedics per ambulance. AMR officials have said that dropping the requirement would allow them to put more vehicles on the road and respond to more emergencies faster.

County officials recognize the growing problem of slow response times. In November it fined AMR over $500,000 for failing to meet 911 response time requirements spelled out in its contract with the county, which include arriving within eight minutes for emergency calls. But those same officials disagree about whether a shift to EMT staffing would solve the issue.

Multnomah County health officials have insisted ambulances need two paramedics because that has helped the county maintain one of the highest cardiac arrest survival rates in the country, according to a November statement.

Refusing to pilot this model “is irresponsible at best,” Gillespie wrote.

During the snowstorm that pounded the city last week, Gillespie said that a firefighter broke several bones while battling a blaze. But no ambulances were available at the time, so firefighters transported the firefighter themselves, Gillespie wrote. That’s not something they can do for everyone.

In the early morning hours of New Year’s Eve, firefighters responded to a call of someone with chest pain. No ambulance was available to respond, a status known as “Level 0,” and firefighters worked with TriMet staff to take the man to the hospital on a bus, as first reported by KOIN 6. The driver, Joe Wiggins, and other TriMet employees won praise in a TriMet board meeting Wednesday, but the man could have died had the situation been more dire.

The problem requires immediate action, Gillespie said.

“This is extremely unsafe for the patients and for the firefighters providing medical care as these vehicles are not licensed, nor set up to transport critical patients,” Gillespie wrote.

Shane Dixon Kavanaugh contributed to this story.