“Real Emergencies and System Abusers”: The role of EMS in Mental Health Care

Little is known about the nature and content of Emergency Medical Services (EMS) work, a system that is responsible for approximately 16 million transports to American Emergency Departments each year (Warden 2007). Importantly we have found no studies examining the role of EMS in mental health care. In fact, in a 2007 IOM Report “Emergency Medical Services at the Crossroads” there is no mention of the role of EMS in the care and transport of people experiencing psychiatric crisis.

In this paper we report on a qualitative study conducted in a Northeast City examining the nature of EMS work, occupational experience, and how EMS providers perceive the work that they do.Observations were conducted, with one of the authors spending four twelve-hour shifts (night, day, weekend, weekday) with ambulance crews. Interviews were conducted with twenty of the agency's field providers. These explored the nature of the EMS work environment, provider interactions with patients and other healthcare providers.

Preliminary analysis suggest that EMS providers share understandings of appropriate use of services, and these understandings often are in contrast to understandings of appropriate use of EMS held by service users and others in the healthcare system. EMS providers' understanding of their role in the care and transport of patients with psychiatric illness will be explored. Despite the large number of EMS calls that involve psychiatric and substance abuse issues, EMS providers in this study rarely see psychiatric issues as “real emergencies”. This has several important consequences for providers, patients and the community.