The Board of Commissioners voted 3-to-2 today to approve a new Ambulance Service Plan, paving the way for a competitive process in 2027 to contract for emergency medical care across all of Multnomah County.

The Board also approved a resolution meant to shape that process by giving preference to any proposals that offer faster ambulance response times for Fairview, Troutdale and Wood Village.

All counties are required to have an ambulance service plan. The plan lays out the structure of the emergency medical system, including ambulance deployment and staffing, response times, medical direction, communications, and the roles of fire agencies.

Multnomah County’s current plan was adopted in 2016. The contract for the County’s current provider under that plan, American Medical Response, ends in August 2028.

The intensive process to build the plan began two years ago with an in-depth study of the County’s existing emergency medical services system. That study, conducted by an external, third-party evaluator, led to the findings and recommendations that the new plan is built on.

The plan codifies a new staffing approach that focuses on using the right resource for the right call, prioritizing teams with specialized skill sets for the emergencies they are most needed on.

Basic Life Support ambulances: For lower-acuity calls; staffed with emergency medical technicians.
Advanced Life Support ambulances: For more serious calls; staffed with at least one paramedic.
Advanced Care Paramedics: Experienced “lead paramedics” who would be deployed on critical calls, potentially via “Quick Response Vehicles” rather than traditional ambulances.

“Modern emergency medical system success is no longer defined strictly by response times, but by high-quality patient care and improved clinical outcomes,” said Multnomah County Health Officer Dr. Richard Bruno, who oversees administration of the County’s emergency medical system. “Our plan corrects systems issues that emerged during the pandemic, codifies recent reforms and provides flexibility to address any new gaps more nimbly than ever.”

Health officials said improvements in the plan reflect a system that has endured significant changes in the past six years. The improvements promote flexibility and innovation while still focusing on high-quality care, strong clinical oversight, and stable, consistent services.

Beyond a modernized staffing approach, the new plan includes improved training requirements, dispatch changes and quality care standards.

“This plan is brand-new, from top to bottom, and will lead to measurable improvements in clinical outcomes and patient care across Multnomah County,” said Emergency Medical Services Administrator Aaron Monnig. “We are working to build a system that ensures that whenever anyone in Multnomah County dials 911, the system has the capacity, the flexibility and the right clinical resources ready to answer the call without fail.”

Aligning with state definitions

The plan includes updated response time standards newly consistent with state definitions for urban, suburban, frontier, and search-and-rescue areas. Each area has an associated benchmark under a state-defined methodology that accounts for geography and population.

The state’s methodology defines the East County cities of Fairview, Troutdale and Wood Village as suburban, reflecting that their populations, geography and associated call volumes differ from those in urban Gresham and Portland. The benchmark for responding to life-threatening emergencies in suburban zones will be 15 minutes or less, compared to eight minutes or less in urban zones.

The Board heard testimony from East County community members and leaders, who expressed concerns about changes to response time standards for suburban areas.

The plan allows for "supplemental performance agreements," arrangements negotiated by a city, fire district or coalition with the contracted ambulance service provider to achieve improved service in a specific area. This could support faster response times or dedicated ambulance staging for cities, if pursued in the future.

Following the vote to approve the Ambulance Service Plan, the Board approved a resolution co-sponsored by Commissioner Meghan Moyer and Commissioner Vince Jones-Dixon that focuses on the future procurement for ambulance services.

The resolution cements the County’s commitment to criteria that would give preference to proposals that can achieve improved response times for Fairview, Troutdale and Wood Village without any additional subsidy from the County. Proposals would not be required to address this enhanced time standard, but would be incentivized to do so.

The Ambulance Service Plan will now be submitted to the Oregon Health Authority. A procurement process to identify the County’s next ambulance services provider is expected to start in 2027. Services under the final new Ambulance Service Plan are expected to start in late 2028.

Source: Multnomah County