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Advancing Emergency Medical Services' (EMS) Response Capability for Behavioral Health Emergencies: Los Angeles
Erick H Cheung1,2, Denise A Whitfield3,4,5,6, Adam Kipust7
1David Geffen School of Medicine, Department of Psychiatry, University of California Los Angeles (UCLA), Los Angeles, California.
Prehospital Emergency Care
|March 25, 2024
Summary
Emergency medical services (EMS) and law enforcement (LE) response to behavioral health emergencies (BHEs) needs improvement. This initiative aimed to optimize BHE response by enhancing EMS protocols and reducing LE
Area of Science:
- Emergency medical services
- Public health
- Law enforcement response
Background:
- Behavioral health emergencies (BHEs) present frequent challenges for emergency medical services (EMS) clinicians and law enforcement (LE) officers.
- Existing best practices for managing BHEs are limited, necessitating a comprehensive review and improvement of current response systems.
- The Los Angeles County EMS Agency (LAC-EMSA) initiated a detailed evaluation of 9-1-1 responses to BHEs in 2016 to enhance patient and first responder safety.
Purpose of the Study:
- To map the 9-1-1 response process for BHEs from initial call to patient disposition.
- To identify and characterize responding agencies and critical decision points in prehospital BHE management.
- To recommend interventions for improving the quality and safety of BHE response systems.
Main Methods:
- A multidisciplinary committee (EMS, LE, health agencies, public) was formed to analyze the BHE response system.
- Process mapping of prehospital BHE response, including agency roles and decision-making.
- Data acquisition to quantitatively and qualitatively assess available services and identify system weaknesses.
Main Results:
- 9-1-1 dispatch criteria for BHEs are inconsistent, often defaulting to LE, which can inadvertently criminalize individuals in crisis.
- EMS protocols for BHEs, particularly for managing agitation, are limited, and substance use disorder treatment lacks integration.
- Destination options and receiving facility capabilities for BHE patients vary significantly between transporting agencies.
Conclusions:
- Standardizing dispatch protocols and shifting primary response from LE to EMS when appropriate is recommended.
- Augmenting EMS treatment protocols for BHEs and agitation, alongside developing alternative transport destinations, can improve care.
- This initiative highlights the need for a comprehensive performance improvement strategy to optimize 9-1-1 responses to BHEs.
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