Dealing with a different kind of medical emergency
Paramedics learn self-defense amid attacks during drug and mental health calls.
A rash of attacks in recent months has put paramedics in Oregon on high alert as they respond to a growing number of 911 calls for patients in mental health or drug-related crises. See how first responders are dealing with the uptick in violence.
PORTLAND, Ore. — Trisha Preston was transporting a patient in a mental health crisis in the back of her ambulance when suddenly the woman undid her seat belt, jumped off the gurney and attacked the veteran paramedic, punching her and pulling her hair. By the time Preston’s partner wrestled the woman to the floor, Preston had a concussion and bite marks on her arms.
“It took me a good couple of months to get it out of my head. I was constantly thinking about it,” Preston said. “We’re all on high alert these days.”
Her experience is part of a rash of attacks in recent months on paramedics in this Pacific Northwest city as they respond to a growing number of 911 calls for patients in mental health or drug-related crises. The uptick in violence is so severe that the private ambulance company that holds Portland’s 911 contract is training more than 500 of its employees in defensive tactics. The company is trying to better understand what’s happening in the field.
“The frequency appears to be increasing. The severity appears to be increasing,” said Robert Mcdonald, an operations manager with American Medical Response. “This has gone unreported in so many ways that it’s difficult for us to get our arms around.”
The increase in assaults dovetails with a new policy for the transport of patients in a mental health crisis that grew out of a 2012 federal investigation that found police used excessive force against those with mental illness.
Now, paramedics — not law enforcement — routinely take patients on mental health holds to the hospital, most often to a new psychiatric emergency room created specifically to stabilize those in the throes of a psychiatric crisis. In the past, police transported these patients in the backs of patrol cars, in handcuffs, to traditional emergency rooms less equipped to help them.
The policy puts the city at the forefront of a growing national movement to decriminalize mental health by treating a psychiatric crisis as a medical emergency similar to a heart attack — not as a crime.
Portland drew key parts of its new approach from Alameda County, California, where paramedic transports and a psychiatric emergency room model have reduced hospitalization rates for mental health emergencies by 85%, said Scott Zeller, vice president for acute psychiatry for Vituity, a multistate medical consultancy group.
“If an ambulance comes to your house and takes you somewhere versus if the police come and take you away, that’s a whole different thing,” Zeller said. “These are medical issues ... and when you have an exacerbation, you need the same type of emergency help that you would get if you fell down the stairs.”