The Times-Tribune

Dealing with a different kind of medical emergency

Paramedics learn self-defense amid attacks during drug and mental health calls.

- BY GILLIAN FLACCUS

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.”

 ?? STEVE DYKES / ASSOCIATED PRESS ?? Ryan Russo, second from left, goes through a drill with instructor Sean Fuller, left, during a defensive tactic training class Sept. 10 at the American Medical Response training center in Clackamas, Ore.
STEVE DYKES / ASSOCIATED PRESS Ryan Russo, second from left, goes through a drill with instructor Sean Fuller, left, during a defensive tactic training class Sept. 10 at the American Medical Response training center in Clackamas, Ore.
 ?? GILLIAN FLACCUS / ASSOCIATED PRESS ?? Trisha Preston, a paramedic, stands Nov. 6 outside the headquarte­rs of her employer, American Medical Response, in Portland, Ore. Preston was attacked in the back of her ambulance by a patient in a mental health crisis earlier this year.
GILLIAN FLACCUS / ASSOCIATED PRESS Trisha Preston, a paramedic, stands Nov. 6 outside the headquarte­rs of her employer, American Medical Response, in Portland, Ore. Preston was attacked in the back of her ambulance by a patient in a mental health crisis earlier this year.

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