MENTAL HEALTH INITIATIVE AT GRADY EMS, ATLANTA, GA Georgia launched the Grady EMS Upstream Crisis Intervention Group in January, 2013 to provide better services to its mental health patients and take pressure off its traditional 911 system. GEMS had found that 6% of its 911 calls were mental health-related, and that GEMS was losing on average $109 on each of these patients per call and the emergency department was losing $401 per patient per visit. Moreover, many of these patients were frequent users who were repeatedly subjected to restraint, police involvement, and uncoordinated care. Instead of using an ambulance, Grady EMS now responds to mental health dispatches with a team of a paramedic and a licensed clinical social worker, who use telehealth to connect the patient with a mental health professional. As Michael Colman, the Director of EMS Operations explained, “The goal of the program was to replicate the ED process of medical clearance upstream from the ED, at the community level.” Among other things, the team can schedule mental health appointments for the patient or transport him or her to a psychiatric facility. When not responding to emergency calls, the team visits the homes of super-utilizers and helps coordinate care. The program saved an estimated $248,000 and 1,925 bed hours in its first year- the equivalent of emptying a 24-bed ED for over 3 days. It also saved GEMS more than $100,000 in both 2014 and 2015. Frequent mental health user 911 calls have fallen by over 50%. members feel they are providing services that are needed by their patients, and traditional EMS providers are happy that non-emergent calls are being diverted or prevented. Some crisis response team members have turned down promotions to stay on the team. GEMS has allowed EMS providers to specialize in an area of medicine in which they are interested, which helps it retain talent and provide better services. The program is also popular with EMS providers inside and outside the crisis response team. Crisis team
portion of low-acuity EMS patients suffer from unaddressed behavioral health conditions. There may be significant opportunities for EMS to become more engaged with behavioral health crisis teams to fill gaps and improve care coordination for these patients. Service delivery between EMS and mental health services could possibly be integrated creating economies of scale for both. Mental health professionals may not be aware of the significant contact EMS has with their patients nor the potential to work closely with EMS to improve the services these patients receive. Some EMS agencies are experimenting with better ways to care for low-acuity behavioral health complaints that don’t fit into the traditional emergency role of EMS. Perhaps with additional training, researching of new triage protocols, or use of telehealth, EMS could divert patients to facilities other than emergency departments. Many patients may simply need transport to psychiatric facilities or assistance scheduling appointments with mental health professionals. More integrated EMS- behavioral health teams could reduce cost, provide better care, and avoid burnout. Public Health EMS and fire services have embraced their role in fire and injury prevention, from providing carbon monoxide detectors to participating in community education campaigns. In addition, many EMS agencies also conduct CPR classes and other first aid courses for laypersons. While it may not always be viewed as such, these are very much public health initiatives. These efforts could be taken even further and open up a vast array of possibilities for EMS based efforts at promoting the health of the community and preventing injury and illness before they occur. Perhaps EMTs and paramedics could serve as public health educators in their local communities and build stronger relationships with the community outside of emergencies. For example,
Colman, Michael, “Innovations: Upstream Crisis Intervention Unit”. Urgent Matters (blog), (December 19, 2013), http://smhs.gwu.edu/urgentmatters/news/innovations-upstream-crisis-intervention-unit.
Stanaway, Nathan, “Community paramedic program cuts mental health patient call volume”. EMS1. com (blog), (May 23, 2016), https://www.ems1.com/community-paramedicine/articles/93357048- Community-paramedic-program-cuts-mental-health-patient-call-volume/
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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