More and More Often, No Ambulance Is Available When Portlanders Call 911 for Medical Help

The underlying problem is a nationwide shortage of paramedics, which has forced the county’s beleaguered ambulance contractor to run fewer ambulances.

A nightmare scenario is becoming more common in Multnomah County: Ambulances are so scarce that 911 callers are being forced to wait.

That scenario is known as “level zero,” after the radio code used by dispatchers to warn first responders that there’s a backlog of requests for ambulances.

In January, the county began tracking how often Multnomah County descended to level zero, and in June, WW reported what it had learned: Ambulances were unavailable 5,000 times—approximately 10% of calls.

Now, new data shows, the problem is only getting worse. AMR says it responded to around 10,000 calls for service in October. That month, there were over 1,800 “level-zero incidents,” the highest monthly total recorded so far, according to data provided by the Portland Bureau of Emergency Communications. That’s 18% of calls.

County officials question BOEC’s data. A spokesperson says the county believes the bureau is using level zero “for times other than when no ambulances were available” and, in August, identified a dozen instances of it having done so.

BOEC did not dispute this. It’s spokesperson said that level zero is used “at the direction of the AMR dispatcher,” and that it can be used as a “placeholder” while dispatchers decide where to route ambulances. It’s not clear how often this happens.

“The use and meaning of level zero in the BOEC data does not just mean what it was originally designed for (i.e., there were physically no ambulances available),” county spokeswoman Sarah Dean said.

Still, some are concerned by the data. “Level zero, plain and simple, means Portlanders experiencing a medical emergency can’t get the care or transport they need as quickly as they need it,” City Commissioner Rene Gonzalez tells WW.

The underlying problem is a nationwide shortage of paramedics, which has forced the county’s beleaguered ambulance contractor, American Medical Response, to run fewer ambulances. Its parent company, as WW has previously reported, is perilously in debt (“Junk Ambulances,” July 12). Right now, AMR is running as few as 32 ambulances in Multnomah County each day. Normally, there are 50.

As flu season approaches, calls increase, and when that increase in demand meets plunging ambulance supply, level zero becomes more frequent. The result has been further delays.

Without major changes, the problem could go on for years, says AMR operations manager Robert McDonald. But McDonald and the county don’t agree on what that major solution should be.

AMR says the county’s unique policy of requiring two paramedics in each ambulance is unnecessary. Removing the restriction would allow the company to return all its ambulances to the street within months, McDonald says.

Without those changes, McDonald warned, AMR’s performance will continue to decline. “It’s going to get worse. And it will ultimately collapse.”

But the county isn’t budging. Its emergency medical director, Dr. Jonathan Jui, says the policy saves lives. He points to the county’s survival rate for heart attack victims, which is among the highest in the nation. (AMR says the survival rate is just as high in neighboring Clackamas County, which has a one-paramedic system.)

Instead, the county has fined AMR over $500,000. AMR is appealing the fines. McDonald says financial penalties will only exacerbate the problem as the company tries to invest more in recruiting. “We’re turning over all the stones we can,” he says.

County leadership’s suggested solution: hire a subcontractor to pick up the slack.

The obvious choice is Metro West Ambulance, AMR’s local competitor. AMR recently took over Metro West’s contract in Washington County, which has siphoned AMR paramedics away from Multnomah County, the county says. (AMR denies this.)

Now, Metro West is back, having recently signed contracts with both Washington and Clackamas counties to supplement AMR. And it appears interested in doing the same in Multnomah County. “We have not been approached about an agreement for subcontracting in Multnomah County, but Metro West Ambulance is here to provide care in any capacity requested,” a spokeswoman told WW in a statement.

AMR’s regional director, Randy Lauer, isn’t impressed: “They don’t have enough paramedics, either.”

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