When someone has an emergency in Portland, a patchwork of programs responds, including paramedics, firefighters and the dispatch center – which answers 911 calls. Dispatchers job is to ask questions and determine what resources are needed for each call.
However, Multnomah County says its 911 dispatch center’s triage system is not 100% accurate, and they’re still working toward accreditation to become more skilled and efficient.
Portland’s Bureau of Emergency Communications (BOEC) has a stringent quality assurance program and reviews a random sampling of roughly 3 percent of medical calls each month. Of the 316 calls we reviewed in May, the Chief Complaint from a caller, which describes the purpose of their call, and the final code, was correct 93 percent of the time.
This means that AMR is getting an accurate description and priority of the caller’s problem 93 percent of the time.
“There’s a difference in the 911 dispatch environment and the on-scene environment for paramedics. 911 is in a blind environment,” said Jaymee Cuti, with BOEC. “When paramedics get on the scene, they’re in a tactile environment, with more information to access the patient.
BOEC started working toward accreditation in May of 2021 — something Clark County has already completed.
Reaching accreditation is a tall order, requiring highly trained dispatchers that ask the right questions to triage calls as accurately as possible. They also include post-dispatch instructions, which focus on patient care.
Currently, the county says dispatchers are still incorrectly identifying some serious 911 calls as low priority.
“We know that sending a great big fire truck with four people on it is not super-efficient, and I think we need to be efficient to meet people’s medical needs,” said Aaron Monnig of the Multnomah County Health Department. “As the triage gets better, it gives us even more options.”
It could take two to four more years for the 911 dispatchers to reach accreditation, but paramedics are pushing for the 911 call center to reach its accreditation as soon as possible.
“It’s going to need a lot more city resources to actually be invested in getting accredited faster than that time frame,” Monnig said.
As a labor shortage is leading to burnout, paramedics want to implement more healthcare options for less severe calls.
For example, Clark County has a nurse navigation line so that when someone calls 911 and it’s not a serious emergency, they can offer the caller a cab ride to a nearby urgent care facility instead.
Paramedic Tim Mollman says many 911 calls do not require an ambulance or even a trip to the emergency room. While there is a severe labor shortage, the city and county need to focus on making the appropriate investments.
“Everybody doesn’t need an ambulance. Everybody doesn’t need to go to the ER,” Mollman said. “And right now, the system kind of pushes everybody in that direction because that’s pretty much all we have to work with within our ambulance system.”
In order to bring a Nurse Navigation system to Multnomah county, it is contingent on having an accredited dispatch, which again, Multnomah County does not have and Clark County does.
“We have a cab program; Portland Fire & Rescue can request it but AMR has a policy that prevents AMR from calling a cab, in addition there are funding barriers,” said Sarah Dean, a Health Communications Coordinator for Multnomah County. “The City has a city funded cab program and there is a County program where AMR pays for those cabs through the franchise fee.”
While there are some efforts to reduce the use of ambulances when they aren’t necessary, it isn’t as seamless or robust as it could be in order to alleviate the strain on paramedics at this time.
In an effort to improve emergency medical services, Multnomah County has two pilot programs underway.
Locally, patient volume has markedly increased by 10% to 15% in the last couple of years, especially in lower acuity and Basic Life Support (BLS), where people are calling ambulances to get to patient care access. The County has been studying the Basic Life Support system and over the last two to three years, the County has come to the conclusion that it is time for BLS ambulances to be deployed.
The first pilot started in May — and is testing out the efficiency and efficacy of using a basic level ambulance for transporting patients to the hospital.
First, a paramedic has to assess to determine if a patient can safely be transported by an EMT. These 911 basic life services ambulances will be staffed by two EMTs and help free up the ambulances staffed with paramedics for more serious calls.
The second pilot authorizes holding minor 911 calls in a separate queue and monitored by American Medical Response (AMR) paramedics who will periodically contact the caller to check on any change in their condition.
The goal is to optimize response for severely or critically ill and injured patients and reduce the number of ambulances being dispatched to low acuity cases.
However, the timeline for accreditation is unknown. The city points out that less than 10% of the agencies that use these protocols are accredited. The city says BOEC has a robust quality assurance program and is working with partner agencies toward accreditation.