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Mental Health Patients Strain Texas EMS Resources

JEMS.com Editor s Note: Frequent fliers and mental health patients are often one in the same. For another story on EMS transports of mental health patients in Minnesota, click here.

AUSTIN, Texas -- The man with a history of mental health problems once called 911 for medical help three times in one day: in the morning for an injury, in the afternoon for ingesting poison and for unknown reasons that night.

Paramedics responded each time and took him to a hospital. Two days later, the man called them back -- twice -- and went to a hospital in both instances.

All told, paramedics went to the man's house 290 times in two years.

As emergency rooms continue to be crowded by mental health patients who can't get beds elsewhere, Austin-Travis County Emergency Medical Services officials have begun trying to figure out how they can better serve such patients, perhaps without loading them into a hospital-bound ambulance.

To figure out the scope of the problem, they recently created a database to identify patients who most frequently summon paramedics and are studying the nature of their complaints.

Among their findings:

  • Ten patients made up more than 1 percent of the system's 130,000 contacts with patients in two years. Their most common complaints were stomach or chest pain, injuries or respiratory problems. Paramedics also responded to calls when the patients exhibited behavioral problems.
  • Nearly all of the patients went to a hospital emergency room each time, sometimes crowding into already overflowing facilities.
  • The patient who was seen 290 times in the two-year period was evaluated by paramedics twice on 36 days and nine times in a separate seven-day period.

Officials would not disclose the names of the patients, citing medical law that protects patient identities.

"We are seeing a small segment of the population we are spending a lot of time with," said EMS Division Commander David Andersen, who has compiled the database. "What we are doing now just isn't working. Taking these patients to the hospital over and over and over just isn't meeting their needs."

EMS officials said such calls also can tie up ambulances and crews for several hours, requiring paramedics from other parts of the city or county to respond to medical calls during that time.

The average call and visit takes more than an hour and $300 in EMS labor, gas and medical equipment.

EMS Acting Director Ernie Rodriguez said officials began trying to grasp the significance of the problem several months ago. In part, they tried to evaluate whether the types of complaints 911 operators listed on dispatch forms matched the actual illness when paramedics arrived.

But Rodriguez said officials also wanted to look at their role in treating mental health patients, particularly since last fall, when Austin's mental health authority cut the number of patients it sends to the Austin State Hospital, a facility for people with mental illness.

The Austin Travis County Mental Health Mental Retardation Center began reducing the number of people it sends to the state hospital by 43 percent last fall, after it exceeded its quota and got word from the state to either stop or pay millions to care for those extra patients.

Emergency rooms have since served as a safety net for those people, even though officials said they don't have proper mental health treatment programs or wards designed for such patients.

That arrangement has left some patients in emergency room beds for days or weeks at some hospitals, where they can be monitored by police or security guards until they no longer pose a danger to themselves or others, said Dr. Corey Jones , chief of emergency medicine at St. David's Medical Center.

"The ERs are jampacked, and we lose a significant capacity of our rooms" with those patients, Jones said.

In those instances, patients may also suffer from not having a physician who knows their medical histories or what medicines they should be taking, said Dr. Ed Racht , the EMS medical director.

Medical officials, including Jones and Racht, said EMS' effort to better triage mental health patients would probably ease emergency room crowding.

Rodriguez said EMS officials are exploring several options and are looking to a couple of other EMS systems across the United States for help.

"We have to come to a real understanding of what their needs are and come up with innovative ways to meet them," he said.

One possibility, he said, is that the system might hire a nurse who would be stationed in the 911 dispatch center and could talk to mental health patients about their concerns before sending an ambulance.

The agency also could create a "community health paramedic," who could respond to calls and who could regularly check up on patients to make sure they are taking medications and going to doctor's appointments.

EMS officials said they have indications such efforts could work: Last year, they temporarily reduced the call volume for one patient by meeting with her and her mother to discuss other ways they could help her, primarily by sending her to social services.

Racht, who was part of the meeting, said the effort worked until the woman was arrested, and then her frequent calls resumed.

Rodriguez said he's hopeful the agency will come up with more specific plans in coming months.

"I think it would revolutionize how we currently deal with a large part of our population," he said.

tplohetski@statesman.com

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