The Multnomah County Board of Commissioners received a briefing on April 14 about proposed changes to the county’s ambulance services, as the current contract with American Medical Response is set to expire in 2028. Emergency Medical Services Administrator Aaron Monnig said the county must move away from its current funding model and staffing requirements due to ongoing issues with response times and shifts in the emergency medical landscape.
The review of Multnomah County’s Ambulance Service Plan, last adopted in 2016, comes after a third-party assessment and months of public feedback. The assessment highlighted concerns over funding stability, workforce shortages, and coordination among first responders.
“Our mission remains the delivery of the right care at the right time,” Monnig said. “A county as geographically and socioeconomically diverse as ours requires a system that is not only clinically excellent, but also structurally resilient.”
Monnig outlined five key pillars for reform: establishing an Office of EMS Medical Director within the Health Department; modernizing technical systems for better interoperability among police, fire, and EMS; formalizing fire agencies’ role with clear performance metrics; reserving advanced paramedics for high-acuity incidents; and shifting toward a public utility approach for funding. He described persistent challenges such as paramedic shortages as “a structural reality.”
Instead of requiring two paramedics per ambulance—a standard contributing to recent response-time struggles—the assessment recommends a hybrid staffing model. This would deploy basic life support ambulances staffed by emergency medical technicians alongside lead paramedics who would respond to critical calls using quick response vehicles.
Monnig said that financial pressures are acute because Medicare or Medicaid cover most patients but do not pay enough to meet service costs. “Simply raising rates is no longer a viable option,” he said. “The report recommends addressing the structural deficit by acknowledging the failure of the user-fee model. We must move toward modernizing subsidies and funding the system at large as a public utility or a service district.” Possible options include direct subsidies from local government or creating an EMS Service District.
Next steps involve drafting an updated Ambulance Service Plan that incorporates recommendations from assessments, community input, and commissioner feedback. A draft plan will be presented by June 2026 with approval expected later that year before submission to state authorities. Procurement for new ambulance services will begin in 2027 ahead of implementing changes by late 2028.
