Every seven minutes, 365 days a year, a fire crew—often four firefighters in a very expensive fire truck—and a two-person ambulance crew both respond to a medical call.
That usually means a minimum of six highly trained, well-compensated first responders racing to incidents with sirens howling and lights flashing.
Sometimes it's necessary: Car crashes, heart attacks and other life-threatening incidents require an emergency response. But nearly a third of the 90,000 annual calls for medical service, according to Multnomah County, are not emergencies and do not require a response by firefighters.
Doctors in the county health department want to address this puzzling and expensive anomaly.
The battleground? The ambulance contract Multnomah County administers. That contract, which expires in August 2018 and is currently held by American Medical Response, serves all county residents. The contract is also very large: It will pay the winning bidder around $750 million over the next decade.
In return, county officials are seeking a big change in the status quo. They want the winning bidder to build a private, independent 911 call center that would more precisely evaluate what medical services callers truly need and dispatch first responders more efficiently.
The likely result, if the contract moves forward as the county proposes, is a substantial reduction in the role of firefighters in the response to medical calls—and a potential threat to the city's Bureau of Emergency Communications.
City Commissioner Dan Saltzman oversees the fire bureau and has long wanted to reduce the number of firefighters deployed to routine medical calls. He applauds the county's idea.
"It's an innovative approach the county is envisioning," Saltzman says. "It's been tried elsewhere, and it's worked."
The county issued a document formally requesting bids Aug. 7. Since then, county officials have instead been fielding expressions of outrage from parties invested in keeping the system from changing.
The firefighters' unions in Portland and Gresham have both filed protests, calling the county's proposal, in a Sept. 7 letter, "deeply flawed."
Most of the people involved in the battle don't want to talk: Multnomah County officials, the fire chiefs of Portland and Gresham, and the acting director of Portland's Bureau of Emergency Communications all declined to be interviewed for this story.
But documents fill in some of the blanks.
To support its course change, the county is drawing on a 2016 study published in the journal Annals of Emergency Dispatch & Response. That study, based on eight years of data in six large EMS districts, undercuts the rationale for firefighters responding to nearly every call.
Today, firefighters respond first because they can. There are more of them deployed in more places around the county than there are ambulances. But researchers found there's often scant benefit in that rapid response.
"With the exception of the relatively few cases of sudden cardiac (or respiratory) arrest, there exists very little evidence that incrementally shorter EMS response times actually improve patient outcomes," the study concluded.
"Many calls require neither two sets of responders nor a high-speed response," says county spokeswoman Julie Sullivan-Springhetti. "Such unnecessary responses reduce the capacity of the system to quickly respond to true time-sensitive life-threatening emergencies."
But fire officials have told the county in writing that creating a new 911 system could slow response times and put citizens' lives at risk.
"The duplication of a call center in a private setting is not an efficient or effective use of taxpayers' money and may result in the delay of first responder dispatching," Portland Fire Chief Mike Myers wrote to county officials Sept 8. In his Sept. 7 letter, Gresham Fire Chief Greg Matthews warned the changes could result in "dire consequences to our citizens."
For years, Portland Fire & Rescue has resisted large-scale changes to how it operates. The clannish bureau is popular with the public and protected by savvy union leadership.
"The stranglehold fire unions have over local governments is very strong," Saltzman says.
In 2012, a consultant concluded Portland Fire was unique in the nation in responding to every medical call with a four-member fire crew and was "responding to exponentially growing numbers of non-emergency medical calls…creating inefficiencies and costing the City of Portland significant dollars."
Since then, the bureau has added two-person "rapid response vehicles," which are dispatched to about 5,000 less-serious medical calls annually. That's still a small percentage of the bureau's calls, and fire officials have regularly tried to scrap the RRVs at budget time.
Last year, ambulances in Multnomah County responded to 90,000 calls. In about 79,000 cases, firefighters responded to the same call.
The county's emergency medical staff doesn't think that's necessary. In fact, documents show they think changing the way operators respond could cut the number of incidents to which firefighters respond by nearly a third—almost 25,000 calls.
Long term, such a reduction could threaten firefighters' paychecks and job security.
Alan Ferschweiler, president of the Portland Firefighters Association, says he fears a private 911 system would be duplicative and slow. He also notes that medical calls have nearly doubled in the past 15 years with little staffing increase.
Ferschweiler says firefighters would welcome giving up non-emergency calls. But he worries if that happens, city commissioners would try to cut jobs. "If call volume goes down 20 percent, then City Council will want to cut our staffing 20 percent," he says.
It's also threatening to Portland's Bureau of Emergency Communications, the troubled agency that currently holds a monopoly on fielding 911 calls.
The union that represents BOEC workers says having a contractor build a parallel 911 system makes no sense. "It just seems to make the system more complicated without making it better," says Rob Wheaton of American Federation of State, County and Municipal Employees Local 88, which represents 70 BOEC employees. "We oppose it."
But an onslaught of criticism from inside and out has left BOEC reeling.
Last year, WW reported that the bureau's staffing had fallen sharply even as call volume soared, leading to employee exhaustion and a worrisome growth in wait times. A city ombudsman's report released in June blasted the agency for losing tens of thousands of calls and reporting false response times. The report found the agency was performing "well below accepted standards."
Multnomah County plans to award the ambulance contract in December. Ferschweiler worries the county is headed down the wrong path.
"What they're proposing won't work," he says. "It's a slap in the face of the citizens of this county."