Amid the news of the Black Lives Matter protests last week, I was chatting with my friend Anne Jensen, a paramedic with San Diego Fire-Rescue. Anne is a valued member of the EMS World editorial advisory board, and I often rely on her for expertise, especially in regards to mobile integrated healthcare and community paramedicine (MIH/CP). She is the special projects manager for SDFR and has led her team to impressive success treating underserved populations and superutilizers in San Diego.
Anne remarked to me that the shocking sentiment to defund the police sparks an interesting conversation on systems of care. Do public safety and public health have the skills necessary to address the complex situations we face?
In this debate about the role of law enforcement, perhaps it is indeed instructive to consider the parallels to EMS’s own progress as an industry.
In fact, I bet police officers who believe in “community policing” are a lot like those EMS leaders who believe in the MIH/CP model: Both recognize that the current system and response model is somewhat broken and outdated, and that being proactive, rather than reactive, goes a long way in appropriately assisting citizens and treating patients.
Every EMS provider can tell story after story of calls where law enforcement was present. Not all these interactions went smoothly; sometimes EMS doesn’t respond appropriately to patients, sometimes police officers may not be trained to deescalate a tense situation. Complicating everything is that not all situations are predictable.
Many of these stories involve patients who struggle with mental illness and whose lives are affected by the social determinants of health (SDOH). To quote a recent article in EMS World, “Social determinants include factors that influence health, such as poverty, housing, food security, education and job training, transportation, public safety, social support, social norms and attitudes, exposure to crime or violence, racism/discrimination, literacy, access to communications, and culture.”
In such situations EMS providers often know taking these patients to the emergency department is potentially the wrong solution and may actually harm those patients. I’m certain many of our colleagues in law enforcement feel the same frustration when they arrest citizens and take them to jail.
I once responded to a call where an elderly man had grown so frustrated with his demented wife that he called 9-1-1 and claimed she was trying to hurt herself. In reality she was just refusing to take her medicine. This poor man was at his wit’s end, full of compassion for his wife but with seemingly nowhere else to turn. When we arrived the police officer said to me, “What, am I supposed to place her in custody for having suicidal thoughts?” Of course we all knew that was not the right answer, and with some coaching and empathy, we worked together to help the husband access the resources he needed.
Now more than ever, with the pandemic, unemployment, racial strife, and an uncertain future, we in public safety and public health should be pivoting to emulate the cities and agencies that have found successful solutions.
As opioids continues to wreak havoc on those with substance use disorder (SUD), community health workers, social workers, and departments of health have come together to implement successful harm reduction programs, community treatment facilities, and quick response teams (QRTs). The state of West Virginia now boasts 22 QRTs comprised of members from law enforcement, fire and EMS, local pharmacies, and peer recovery teams. This is where public safety and public health intersect to maximize their expertise to serve the public: In one county, overdose calls decreased by 40%.
“Look at what has happened in this state,” a West Virginia county health officer said. “You can’t arrest or legislate your way out. This is a disease.”
So many of our patients have mental illness, and while sometimes these patients can cause harm to themselves or others, the vast majority do not benefit from being arrested or put in jail. In Eugene, Ore., the Crisis Assistance Helping Out On The Streets (CAHOOTS) program provides medical and behavioral health services in partnership with EMS and law enforcement. When an investigation by the Oregonian found 52% of all arrests in the city were of homeless people for low-level crimes, the need was revealed. Now the CAHOOTS program boasts better care for the community, a huge cost savings, and a model many other cities would like to mimic.
Hundreds more progressive leaders throughout the country have brought together formerly siloed departments to solve problems. From West Palm Beach, Fla. to Colorado Springs, Colo. to Minneapolis, Minn., leaders have moved to proactive from reactive. It is possible that in these places, persons with mental health problems may actually avoid encounters that could be dangerous for them, their providers, and the police.
When I was logging clinical hours to obtain a certification in MIH/CP, I visited the Arlington (Va.) Fire Department to observe its alternative destination program. At the firehouse between calls, a veteran firefighter wanted to hear more about MIH/CP. After some contemplation he said, “Sounds a lot like what the fire department did 30 years ago to put itself out of business: smoke alarms, building codes, sprinklers…” He chuckled and told me to keep up the good work because it was the right thing to do.
We all want to do the right thing, whether we are EMS providers, law enforcement, or firefighters. Let’s do the work to innovate together.
Hilary Gates, MAEd, NRP, is the senior editorial and program director for EMS World.