Beyond the Lights and Sirens: The Challenges Reported by Paramedics about Responding to 911 Behavioral Health Emergencies Open Access

Klaus, Jacob (Spring 2021)

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Background: Behavioral health (BH) emergencies are one of the most common 911 complaints addressed by EMTs and paramedics in the United States. The structure of the mental healthcare system and socioeconomic barriers often result in underlying psychiatric needs going unmet. With limited access to formal healthcare, many in this patient population rely on 911 and Emergency Medical Services (EMS) as their entry point into the healthcare system. Yet, this trend has garnered minimal attention in the academic literature.

Objective: This exploratory study investigates the perspectives of EMTs and paramedics about their experiences responding to 911 BH emergencies.

Methods: A total of twelve (N=12) semi-structured interviews were conducted with Atlanta-area EMTs and paramedics between October 2020 and January 2021. Responses were analyzed using Grounded Theory and these data were examined for emerging themes.

Results: Participant interviews revealed that (1) BH emergencies are routinely encountered in EMS, (2) EMTs and paramedics view BH emergencies as often challenging and frustrating, (3) the EMS industry provides inadequate mental health training despite the high frequency of BH calls, (3) BH emergencies are challenging for EMS providers, (4) participants do not view the frequent use of ambulances as necessary or efficient for the majority of BH emergencies, (5) medically unwarranted use of chemical sedations for BH patients appears to be pervasive in EMS, and (6) EMS providers overwhelmingly support the presence of law enforcement on BH calls.

Discussion and Conclusion: EMTs and paramedics viewed the high reliance on EMS to manage BH emergencies as an inefficient use of pre-hospital resources and not in patients’ best medical interests. Additional findings including the perceived over-use of chemical sedation for BH patients and inadequate mental health training suggests the need for additional attention to the aspect of the public health sector. The perspectives of EMS providers who have first-hand experience with these situations should be considered as the public and various legislative bodies favor reimagining public safety’s approach to responding to BH emergencies. 

Table of Contents

Table of Contents

Introduction   9

Emergency Medical Services (EMS) in the United States      9

Deinstitutionalization of U.S. Mental Healthcare     11

Trends in Emergency Department Usage by Behavioral Health Patients     13

Hospital Emergency Department Over-usage           14

Ambulance Utilization Among Behavioral Health Patients   15

Methods        17

Results 19

Theme I: BH calls frequently encountered by EMTs and Paramedics          19

Theme II: Frustrations Accompany BH Emergencies 20

Theme III: EMTs and Paramedics are Undertrained for BH Emergencies     23

Theme IV: The Current Reliance on EMS to Manage BH Emergencies is Inefficient 26

Theme V: Misuse of Chemical Sedation        31

Theme VI: Law Enforcement Integral to EMS Encounters with BH Patients 33

Limitations     39

Discussion      40

Conclusion     46

Appendix A: Semi-structured interview outline        48

Appendix B: Codebook          52

References     58

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