Can Paramedics Safely Screen Patients for Transport to a Mental Health Crisis Center? Evidence from California
Authors: Coffman J. 
Published: August 2020

Research Objective

Historically, ambulances have only transported patients to emergency departments (EDs). By 2017, at least 64 ambulance providers across the United States were transporting patients to facilities other than EDs, including outpatient mental health crisis centers, urgent care centers, and physician offices. In 2020, Medicare’s new Emergency Triage, Treat, and Transport Model will reimburse ambulance providers for transporting patients to alternative destinations. This study analyzed data from four ambulance providers in California to assess whether paramedics can accurately identify patients who can be treated safely in a mental health crisis center without first being transported to an ED for medical clearance.

Study Design

Data regarding transports to mental health crisis centers in the four communities were collected as part of an evaluation of 20 pilot projects in California that are testing multiple concepts for utilizing paramedics outside their traditional roles. All four projects have trained paramedics to implement a screening protocol to determine whether patients with mental health needs could be treated safely in a crisis center. Patients whose vital signs are within the parameters of the protocol and do not have symptoms of injury or physical illness are offered transport to a crisis center instead of an ED.

Pilot projects used a standardized data collection tool to report data regarding the numbers of patients enrolled, the numbers transported to an ED within six hours of admission to a crisis center, reasons for ED transports, and the disposition of patients transported to an ED. Descriptive statistics were tabulated.

Population Studied

911 calls involving people with suspected mental illness.

Principal Findings

The four projects transported 3,087 patients to a mental health crisis center between September 2015 and September 2019. In all four communities, the majority of patients were uninsured or enrolled in Medicaid. Crisis centers accepted almost all patients transported to them, with rare exceptions related to resources (eg, not able to dispense methadone) and patient insurance type. Across all four projects, 65 patients (2%) were transported to an ED within six hours of admission to a crisis center. Patients were transported to an ED for a range of reasons including elevated vital signs, pain, seizure, urinary incontinence, and alcohol withdrawal. Among the 65 patients transported to an ED, 38 were treated in an ED and released, 21 were treated and transferred back to the crisis center or to an inpatient psychiatric facility, and 6 (0.2% of all patients) were admitted to a hospital for inpatient medical care.

Conclusions

The experience of California’s four pilot projects suggests that paramedics can apply a protocol to identify patients with suspected mental illness who can be treated safely in a mental health crisis center instead of an ED. Patients were rarely transported to an ED, and ED visits rarely resulted in an inpatient admission.

Implications for Policy or Practice

Transporting patients experiencing a mental health crisis directly to a crisis center enables them to obtain mental health services more quickly and in a calmer, less costly environment than an ED and can help reduce ED overcrowding. States should consider requiring payers to reimburse ambulance providers for these transports.

Primary Funding Source

California Health Care Foundation.