Aug 31, 2023 - News

Oregon experiments with relaxing emergency responder credentials

Illustration of an ambulance symbol with an exclamation point in the middle of it.

Illustration: Brendan Lynch/Axios

After months of ambulances failing to respond to emergencies as fast as they're supposed to and the industry saying there are too few staff to handle increasing calls, local and state officials are experimenting with dialing back first responder training requirements.

Why it matters: Ambulance response times can be the difference between whether a patient lives or dies.

Driving the news: A pilot program that sends less experienced first responders to less serious calls is underway in Multnomah County, and the Oregon Health Authority is due to soon release a draft proposal that would ease paramedic licensing requirements.

Catch up quick: Between Sept. 1, 2022 and Feb. 28, 2023, ambulances sent on life-threatening calls in Multnomah County met their contractual requirement for quick arrival only 67% of the time.

  • Under pressure to turn things around, Multnomah County Chair Jessica Vega Pederson announced Aug. 9 that the county would begin to fine the ambulance company that holds the sole contract for emergency services — American Medical Response — based on its performance this month.
  • A week later, in a pilot program, AMR began sending ambulances with two emergency medical technicians, but no paramedics — the highest trained ambulance staffers — out on less serious calls.

Separately, an Oregon Health Authority advisory group has drafted a proposal for a new "transitional" paramedic license.

  • It would allow paramedics accredited by a national registry to work in Oregon for up to four years before earning their associate's degree, rather than completing it before they are licensed, which is the current standard in Oregon.

What they're saying: Austin DePaolo of Local Teamsters 223, the union that represents both paramedics and EMTs in Multnomah County, told Axios four years is a "generous" but realistic grace period, since the often-unpredictable work can interfere with class schedules.

Yes, but: The union does not want to do away entirely with Oregon's unusual requirement that paramedics have a two-year college degree.

  • "We don't want to see standards chipped away at or decline and we want to protect those jobs," DePaolo says.

Meanwhile: AMR, the Multnomah County ambulance provider, wants local officials to change the makeup of teams even on "high acuity" calls, dropping from the current requirement of two paramedics to one paramedic plus one EMT as the standard.

  • They are backed by County Commissioner Sharon Meieran, who told Axios dropping the two-paramedic requirement would be "the fastest, best way" to speed up ambulance response times.
  • However, county medical director Jonathan Jui doesn't appear to favor just one paramedic per team, telling Willamette Week in June that two paramedics — or more — are "optimal" for patients needing critical care.

What we're watching: Whether ambulance response times improved enough in August that the county will back off its threat to fine AMR.

  • Fines could reach $10,000 per month, according to the ambulance contract shared by The Oregonian.

What's next: The proposal to license paramedics before they complete two years of college is expected to be published as soon as Thursday, with a public comment period following.


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