PORTLAND, Ore. — As a paramedic in Multnomah County, Eli Kilstrom tries to be prepared for anything.
"In this job you try your best to understand your capabilities," he said. "We can't un-shoot somebody, we can't un-smoke a pack a day for 30 years, and I can't make there be more ambulances."
AMR, the county's ambulance provider, is severely understaffed, with response times far below county standards and getting worse. AMR Vice President Randy Lauer told KGW that AMR can only staff about 32 of the 50 shifts it needs to adequately fill a day.
"In October we were down 50 paramedics (in Multnomah County), now we're down about 59 or 60," Lauer told KGW. "So it's still going the wrong way."
It’s a dangerous situation for anyone who needs emergency treatment and transport, with paramedics picking up extra shifts in a tough job.
“You could go from a shooting to a birth to, 'It's too cold to live outside,'" Kilstrom told KGW.
Kilstrom said paramedic burnout is now a big problem.
"There are not enough paramedics, everybody is tired, but we're dealing with it the best we can," he said.
When asked what he's heard from people who have left AMR Multnomah County, Kilstrom said their reasonings have been understandable.
"They just can't do it anymore — that they're exhausted, they're not able to spend time with their family," he said.
Lauer, a longtime paramedic turned boss, admitted that the current "crisis" elicits a different kind of pressure.
"I couldn't imagine being a paramedic in the system now," he said. "Of course, they're a lot younger than I am, but I don't think I could handle the workload and the stress of this system the way it is now."
AMR is offering hiring incentives and scholarships to attract more paramedics, but it’s not working.
KGW acquired AMR staffing data from 2023. It shows paramedic turnover outpaced hiring: AMR brought in 32 paramedics last year. It lost 44.
Lauer said some of the departures moved to fire department jobs or other agencies, while others left the field altogether.
“I fear we’re going to see more of this until something changes … just because the staffing is still going the wrong way, we’re able to deploy fewer ambulances than we were six months ago," Lauer said. "That’s likely to continue for a while, we don’t see it shifting. I think I’ve said it before: We’re in crisis heading to catastrophe."
Kilstrom is one of the paramedics left to pick up the slack, as shifts can frequently stretch to 14 hours or longer.
"It's very easy to see why people would be looking for a different place to work," he said, adding that he enjoys his job and the ability to help people.
Meanwhile, Kilstrom said he recognizes that people all over Multnomah County are waiting for an ambulance to arrive in their most critical moments, and he feels sorry for that, even if he can’t change it.
"There are a lot of things that are outside of our control, including how many calls there are and the severity of those calls," Kilstrom said. "We are doing our best. We very, very much appreciate your patience and we're very sorry that we aren't able to serve you in a more timely manner."
AMR blames the county's requirement of two highly trained paramedics for its staffing struggles, saying that the company would be able to improve response times amid the national shortage of paramedics if the county allowed a temporary change to one-paramedic and one-EMT model that's used by neighboring counties.
Commissioner Sharon Meieran and Portland Fire Chief Ryan Gillespie have called for this change. However, county health leaders have refused to budge on its requirement — a contractual obligation for AMR under the agreement they inked with the county — saying that two paramedics provide better patient care.
On January 25, more than a month after Meieran called for a change, Multnomah County EMS director Dr. Jon Jui replied to Meieran, saying a "systemwide review is warranted." Chair Jessica Vega Pederson said in a December meeting that a review could take nine months.
Importantly, the union that represents AMR Multnomah County paramedics — Teamsters 223 — supports the county's two paramedic rule. The union released a statement on December 23 saying: "We firmly believe that preserving the two-paramedic rule is crucial for the safety and well-being of our community."
AMR staffing data shows that the company added a net 43 EMTs in 2023, illustrating that is is easier for the company to hire the lesser-qualified first responders, many of whom look to gain paramedic licensure after receiving on-the-job training.
EMTs are not licensed to perform as many medical procedures as paramedics, a potential limiting factor in emergency response.
The shortage of paramedics meant dispatchers in Portland answered nearly 15,000 emergency calls in 2023 and didn't have any available ambulance crew to send.
"We are just as frustrated as you are in terms of the challenges that we are facing that we don't currently have the tools to solve," Kilstrom said.