Urge Multnomah County Chair to pilot an ambulance response model to address paramedic staffing shortages and reduce instances when no ambulances are available to respond to emergencies


WHEREAS, Multnomah County, under ORS 682.062, is mandated to develop Ambulance and Emergency Medical Services (EMS) plans. These plans, subject to approval by the Oregon Health Authority, outline the provision and coordination of ambulance services within county jurisdictions, including staffing provisions. 

WHEREAS, Multnomah County's Ambulance Service Plan (ASP), first implemented in 1994, designated the entire county as a unified ambulance service area. It mandated that all ambulances dispatched for Advanced Life Support (ALS) calls be staffed with two Paramedics and established a policy that ambulances shall reach ALS emergencies within 8 minutes 90% of the time. 

WHEREAS, in 2016, the Multnomah County Board of Commissioners updated County Code Chapter 21, Section 406, granting exclusive authority over ambulance staffing, including any changes, to the EMS Medical Director, with the Multnomah County Chair as the sole individual empowered to demand action from department leadership, including the EMS Medical Director, in her capacity as the County’s Chief Hiring Officer. 

WHEREAS, a drastic rise in medical 9-1-1 calls over recent years has placed a much larger burden on medical first responders in Multnomah County. Major structural flaws in Multnomah County’s emergency medical response system have been revealed, resulting in a critical ambulance shortage leading to unprecedented incidents of Level Zero (no ambulances available to respond to emergencies) and delayed ambulance response times.

WHEREAS, residents throughout Portland and Multnomah County who are experiencing perceived emergency medical conditions are at risk of worsening conditions and even death when they attempt to call for help but emergency medical care is delayed due to an insufficient number of ambulances available to respond.

WHEREAS, a staffing model of one Paramedic and one EMT (the “1:1” model) has become the standard across the nation to respond to virtually all medical emergencies. Multnomah County’s ASP retains a two Paramedic staffing model despite challenges to train, recruit, and staff two Paramedics per ambulance. Most days, there is not an adequate supply of paramedics and ambulances available to respond to the increasing volume of medical calls. 

WHEREAS, the increase in ALS calls and stagnation of any staffing model changes has had a profound negative impact on partner first responder agencies and workforce, particularly Portland Fire & Rescue. 

WHEREAS, a proposal exists from Multnomah County’s ambulance provider American Medical Rescue (AMR) to pilot a response model that would allow one Paramedic and one EMT (the “1:1” model) to operate together on a transport ambulance. 

WHEREAS, Portland Fire & Rescue implores Multnomah County EMS to pilot this 1:1 staffing model. The status of transport ambulances in the City of Portland is critically insufficient, and a one EMT and one Paramedic model will make a difference in the number of ambulances available to serve Portlanders.

NOW, THEREFORE, BE IT RESOLVED that the Portland City Council calls on the County Chair to exercise her authority to direct the EMS Medical Director to order a change in ambulance staffing to allow for this 1:1 staffing model pilot to combat the critical lack of ambulances available to respond to emergencies in the City of Portland. 

Impact Statement

Purpose of Proposed Legislation and Background Information

The rapidly increasing volume of medical calls within Multnomah County and the City of Portland coupled with paramedic shortages has led to inadequate ambulance response times and availability throughout the community. Many days, Multnomah County EMS will reach "Level Zero" meaning there are no ambulances available in the community to respond to life-threatening emergencies.

Supplemental medical responders to Multnomah County EMS such as Portland Fire & Rescue have experienced a skyrocketing and unsustainable workload responding to far more medical calls. American Medical Rescue (AMR), Multnomah County's ambulance provider, and the City of Gresham have urged the County to pilot a one-paramedic, one-EMT staffing model which would have an immediate and positive effect, with more ambulances available to serve Portlanders during life-threatening emergencies.

Financial and Budgetary Impacts


Community Impacts and Community Involvement

Switching from a two-paramedic, to a one-paramedic, one-EMT staffing model would provide much needed relief to the community, minimizing ambulance response times by increasing the number of crews available to respond to emergency medical calls.

100% Renewable Goal


Agenda Items

178 Regular Agenda in February 21, 2024 Council Agenda


  • Commissioner Carmen Rubio Absent
  • Commissioner Dan Ryan Absent
  • Commissioner Rene Gonzalez Yea
  • Commissioner Mingus Mapps Yea
  • Mayor Ted Wheeler Yea


Nick Coffey

Commissioner's Staff Representative

Shah Smith

Chief of Staff to Commissioner Gonzalez

Requested Agenda Type


Date and Time Information

Requested Council Date
Time Requested
20 minutes