PORTLAND, Ore. — Multnomah County's ambulance response 'crisis' means Portland firefighters are being forced to find creative ways to transport patients to the hospital.
The latest incident culminated in a New Year's Eve morning transport on a TriMet bus for a man who was experiencing chest pains and at risk for a heart attack, according to Portland Fire & Rescue.
"Proactively, we have to have a Plan B. There's no stop and scratch your head; we have to be able to think on our feet," said Portland Fire Captain Dennis Bell, one of two firefighters who responded to the 911 call around 2 a.m. on Dec. 31. Bell also stayed with the patient on the bus transport.
Bell, fearing a heart attack, said he knew the man needed to get to a hospital quickly.
AMR, Multnomah County's ambulance provider, was at 'Level Zero' with no ambulances available to transport, according to Bell. After 20 minutes, and without any room in the fire rescue vehicle, Bell said it was time to get creative.
"We had a wide open, vacant bus at 2:30 in the morning," Bell said. "It just dawned on me that [bus transport] was really the only option that we had."
The TriMet bus driver, Joseph Wiggins, said it wasn't the first medical emergency he's experienced on his bus, but it was probably the most dramatic. When approached with the idea, Wiggins asked for permission from his superiors, but said he was itching to get the man to treatment.
“I just wanted to get him to the hospital and get help for him; it reminded me of taking my father to the hospital for the same reason," Wiggins said, recounting the emotional moment.
PF&R reported at least 22 ‘non-traditional’ transports in 2023 — situations where firefighters found other ways to get patients to the hospital because of a lack of ambulances.
In the early fall of 2023, Portland Fire added a function that lets firefighters report a non-traditional transport in its internal system, according to spokesperson Rick Graves.
Graves said the new reporting ability will hopefully allow the bureau to more accurately track the number of times firefighters are forced to 'get creative' in transporting patients. He said he suspects there were more than about two dozen transports in 2023.
In this case, while the unique hospital transport via bus worked, Bell said if the man would've had a heart attack on the bus, it could've been trouble.
"If you're going to bake cookies, you want to be in the kitchen. If you're going to transport a patient, I'd just as soon be in an ambulance, not a TriMet bus," Bell said. "You have to not only prepare for what's happening right now, but what could happen, and a TriMet bus just wouldn't be set up for that."
Fire trucks and rescue vehicles aren’t set up for transport, as water tanks and other equipment frequently take up room. Bell, who's also a paramedic, said he knows when minutes matter.
"It's crucial for the patient outcome. I mean, cardiac muscle dies overtime, so they have to get more definitive care than what we can do in the field," he said. "This is not a solution; the proper staffing [of ambulances] has to be accomplished — and how AMR does that I'm not sure, I don't envy the position they're in."
AMR, for its part, has said its hands are tied by Multnomah County’s two-paramedic requirement for ambulances. The company says it can’t hire and retain enough paramedics to run a full staff, so its response times have fallen off — with company leaders calling the current situation a ‘crisis.’
County health leaders have said two paramedics provide better patient care. County commissioners fined AMR $513k for late responses in November.
“This is a hot topic, and I'm sure it's one that's gaining and demanding a lot of attention," Bell said, "so there are a lot of people working on it and something does need to change."