Prener C, Lincoln AK. Emergency medical services and “psych calls”: Examining the work of urban EMS providers. Am J Orthopsychiatry. July 20, 2015. [Epub ahead of print.]
Although this column often reviews quantitative medical research, qualitative research is also important and can offer in-depth insight into a topic that might not otherwise come out in numbers.
Methods: The authors of this study interviewed EMTs and paramedics to learn more about their attitudes, experiences and beliefs with so-called “psych calls,” which was classified as cases with mental illness and substance abuse. Some readers may find the themes in the interviews offensive or not representative of their beliefs, but this research clearly exposes the ugly underbelly of some of our beliefs systems.
The primary author, Christopher Prener–a former EMT himself–rode along as an observer during four 12-hour ambulance shifts in a busy urban EMS system. After performing this observation, he conducted 20 interviews with four EMTs and 16 paramedics.
The interviews were recorded, transcribed and then rigorously analyzed. Common themes were cataloged, consolidated and sometimes prioritized in an agreed-upon scientific process.
What we know: One-third of patients admitted to EDs are diagnosed with a psychiatric condition. EMS responds to many traumatically injured and medically ill patients whose illness may have been caused, or complicated, by a behavioral emergency.
What this study adds: EMS providers experience significant role strain with behavioral health cases. Initial training in behavioral healthcare is brief, and there’s a mistaken perception that the provider’s role is to respond to exciting, life-threatening cases involving lifesaving procedures.
Results: The good news is that the results show commonalities and agreement in the interviewees, allowing for identification of common themes that can lead to future interventions to address them.
The bad news is that the common beliefs of these EMS professionals are somewhat concerning: Providers believe that so-called “psych calls” are a burden on the EMS system, questioning the value of EMS response to calls that aren’t “real emergencies.”
Interviewees disliked trying to convince a patient to voluntarily go to the hospital, especially when the police didn’t want to involuntarily commit someone with mental illness. Other major themes included frequent contact with substance-abusing or intoxicated patients, and homeless patients they classified as “psych calls” even though no mental illness was present.
Another common theme was dislike of interfacility transfers for psychiatric patients that often require little skill and may involve a high risk of violence, noting that these calls often occur overnight and interrupt the provider’s sleep during a 24-hour shift.
A common perception was that mentally ill patients, particularly the homeless, abuse the EMS system by taking resources away from patients with “more genuine medical needs,” and manipulate the system when the complaint is minor. Although the authors stop short of reporting poor treatment, they acknowledge provider frustrations that “could lead to change the way they interact with these patients.”
Qualitative research: A method of study that focuses on human behavior, examining in-depth the how and why of a topic. It’s popular among social scientists and educators, and can involve participant observation in the field and structured interviews.
Discussion: Although the public often cites law enforcement as having a role in the care of mentally ill patients, it’s in fact EMS who often transports them. We’re in a unique position to help these patients, especially because of gaps in the healthcare system and stereotypical bias that objectifies behavioral health patients.
The results of this study may sound disturbing to some, but anyone involved in EMS has heard these beliefs before. This study helps shed light on the complexities of this belief system. In fact, every case we respond to involves an element of crisis intervention, de-escalation and mental health assessment. Understanding the value of simple interventions, such as suicide assessments and therapeutic communication, could help EMS providers feel a better sense of their worth.
We should all be reminded of the value of good assessment and referral for appropriate care by a healthcare provider who simply cares enough to listen. For those who might want to have law enforcement care for patients with altered mentation, please reconsider. EMS is specially trained and equipped to assess and care for these patients. We ensure that another treatable and potentially life-threatening underlying condition, such as hypoglycemia or drug overdose, is detected and reversed if possible.
Let’s make sure EMS providers are appropriately trained to work with behavioral health patients so the role strain described in this study can be converted to job satisfaction for having helped those in psychological pain.