Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills A
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Introduction When an individual calls 911 because of a behavioral health emergency, paramedics may be the first health care professional on scene to address that crisis. Traditionally, the paramedic profession has been educated to respond to life-threatening medical emergencies.1 Paramedics are increasingly expected to respond to behavioral health crises but may not be adequately prepared to do so. 1 There has been limited research regarding paramedics’ experiences, attitudes, and perceptions about responding to behavioral health crises, with a particular dearth of literature on this subject from the USA. 1–5 As the first point of contact, paramedics may influence the quality of care individuals experiencing behavioral health emergencies receive, rendering this gap in knowledge Address correspondence to Bronwyn Keefe, MSW, MPH, PhD, School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215, USA. Kelsi Carolan, MSW, School of Social Work, Boston University, Boston, MA, USA. Amy J. Wint, MSc, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA. Lisa I. Iezzoni, MD, MSc, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA. Matthew Goudreau, BS, NRP, EasCare Ambulance Company LLC, Dorchester, MA, USA. W. Scott Cluett IIINRP, EasCare Ambulance Company LLC, Dorchester, MA, USA. Lisa I. Iezzoni, MD, MSc, Department of Medicine, Harvard Medical School, Boston, MA, USA. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Journal of Behavioral Health Services & Research, 2020. 1–11. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09687-4
Behavioral Health Emergencies Encountered by Community Paramedics
KEEFE ET AL.
concerning. 1,4 Paramedics encounter a range of behavioral health crises, from individuals who have self-harmed, substance use, to older adults experiencing social isolation. 6,7 This study aimed to answer the following questions: Do paramedics feel well prepared to respond to behavioral health crises? How do paramedics describe the challenges and facilitators involved in responding to these situations? What are the skills they use to respond to these situations? The present study examined paramedics’ experiences and perceptions regarding behavioral health emergencies, aiming to address a significant gap in the literature on paramedics’ ability to respond to the needs of individuals experiencing behavioral health crises.
Background Limited research based in the UK, Europe, and Australia has examined the extent to which paramedics feel equipped by their training to respond to situations of a behavioral health nature, with a marked lack of USA-based research in this area. In a survey of members of the College of Paramedics (UK), 98% of the 623 respondents endorsed the need for increased mental health education and training. 2 Paramedic training curriculums in the UK have evolved to incorporate more of an emphasis on be
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