With Emergency Triage, Treatment, and Transportation, the U.S. Centers for Medicare and Medicaid Services pays emergency medical responders to transport patients to an alternative facility, such as: such as a primary care office or a community mental health center. ET3 also covers emergency responders who initiate on-site treatment with a qualified healthcare partner – in the field or through telehealth.
According to Justin Miller, vice president, the ET3 model also encourages local governments and other organizations with jurisdiction over one or more 911 dispatches to promote and establish a medical triage line for calls Low-grade 911 and reduced avoidable transportation to emergency departments and hospitalization. customer success at eVisit, a telemedicine technology and services company.
“Navigators help categorize people who have called 911 and have been involved in the emergency response system by determining in advance if they are eligible for a telehealth or telehealth call,” he said. actual emergency visit or not”. Healthcare IT News last year.
“The dispatcher connects the caller with a nurse who will seek to understand the patient’s concerns and connect them to the right provider before they send the ambulance fleet. The focus is on providing a level of coverage. the right care at the right time,” he said as he traveled across the country to observe health from a distance after the pandemic.
A five-year, federally funded pilot project, ET3 aims to make emergency medical care more accessible. However, CMS has announced the early end of ET3, two years early – effective December 31.
“This decision was made due to lower-than-expected participation rates and lower-than-expected interventions,” CMS recently announced on its ET3 website.
“Emergency medical services remains an area of focus for CMS, and we believe the lessons learned from the ET3 Model can aid the development of potential future initiatives.”
Meanwhile, a campaign in California is lobbying to shift responsibility for certain 911 calls to the healthcare sector, building on the success of public safety coordinators starting to head of clinical triage by nurses in mobile crisis units, according to the following Molly Castle Work article, written for Health News KFF.
Mountains of evidence show that police often do not respond properly to people in a mental health crisis. It can lead to avoidable deaths and criminalize mental illness, especially among people of color.
A poll commissioned by Public Health Advocates, a health policy nonprofit based in Davis, found that more than two-thirds of California voters want behavioral health professionals to be involved in the response. emergency in non-life-threatening situations. Of the seven types of situations that are likely to require an emergency response, voters say law enforcement agencies are least equipped to respond to calls about mental health crises and those who are not. housing, according to a May 24 poll.
“The police response has become a vehicle for oversized bandaging support for something that’s bandages,” said Ryan McClinton, manager of the Public Health Advocates’ First Response Transformation Campaign. Never designed to cover or heal.
His team and like-minded advocates in California are stepping up a campaign to overhaul the state’s 911 system to include more mental health professionals and others with specialized training to handle a variety of emergencies. level, instead of the police.
Law enforcement officials agree that the 911 response deserves a more nuanced approach. But powerful police unions oppose proposals that could reduce their control over 911 operations, as well as the budget and staff that go with them. Police representatives contacted said they favor alternatives that would complement the current system rather than replace it and that would hold 911 shared responsibility with police departments.
“Our 911 dispatchers have done a fantastic job and are the perfect people to handle people in crisis,” said Tim Davis, president of the Sacramento Police Association, an association. “It is imperative that 911 be under the direction of the police department, as the majority of the calls they receive are for police services.”
However, McClinton said emergency response systems are outdated and need to be transformed. In many California counties, change is already underway. Forty-one of the state’s 58 counties have some form of mobile crisis service in which mental health workers go out and address crisis needs in the community, according to a survey conducted by Conducted by the County of California Association of Behavioral Health Directors.
By next year, all California counties will have mobile and operational crisis services, said Michelle Cabrera, executive director of CBHDA.
Founded in 1968, 911 was designed for fire alarms. However, it quickly became a versatile system for routing a wide range of calls to the police.
Californians now make more than 25 million 911 calls annually. Nationwide, up to 15% are spent on behavioral health emergencies, according to a 2021 study in the journal Mental Services.
Andrea Rivera, a health advocate, said today’s 911 centers are flooded with calls that are not necessarily emergencies – a large amount that the system is not built to handle.
“The 911 has become a compelling product,” said Rivera, who works for the California Interethnic Health Network. “While it may be unfair to law enforcement who are incompetent or untrained, it is especially unfair to community members who don’t feel they have anyone. that’s to aim for.”
Alternative methods vary widely across the state. For example, Santa Clara County has five mobile response teams that can respond to 911 calls and can also be deployed by dispatchers at 988, the National Suicide & Crisis Hotline.
Some groups include clinicians and other trained professionals who can provide peer support. Some responded with police, while others in plain clothes arrived in a non-police vehicle.
Sandra Hernandez, director of Behavioral Health Services in Santa Clara County, said the program is in its infancy but has worked so far. One surprising thing she notes is that community members appreciate being able to ask for help without an ambulance arriving at their doorstep and alerting nosy neighbors to a critical time. panic.
Hernandez recalls a letter her team received from a grateful resident: “My neighbors don’t even know. They think I have guests.”
Cities in Oregon, New Mexico, and Colorado have similar programs.
Advocates point to cases like that of Jaime Naranjo, a Sacramento County resident who was fatally shot by police last year at his home. Naranjo’s wife, Elisa Naranjo, said her husband had suicidal thoughts and was experiencing delusions and was carrying a machete when she called 911 for help.
Sacramento has a Mobile Crisis Support Team, but it is not available 24/7 and Elisa called 911 outside of team hours. The Sacramento County Sheriff’s Office said that when police arrived, officers asked Naranjo to put down his weapon, but he did not comply. That’s when Naranjo approached the deputy, who shot him dead, the Sheriff’s Office said.
In California, the proposed measure would make alternative response a statewide requirement. State Senator Aisha Wahab’s SB 402, backed by Public Health Advocates, will require 911 service centers to send professionals who are not armed police officers for calls involving related to mental health or homelessness.
This approach resembles the role 988 was intended to fill, says Wahab, but the low perception of the number 988 has been a barrier to effectiveness.
Wahab introduced an alternative response program three years ago in Hayward, while on City Council, and said its success inspired her to draft legislation. She said the bill, which won’t be decided until next year, is her top priority but acknowledged that it would be complicated to enact statewide changes.
Police union representatives said they supported the idea of an alternative response in principle.
“Our members are not mental health professionals,” said Alexa Pratt, communications director for the Association of Orange County Sheriffs Deputy. “We agree that law enforcement should not be the leader dealing with mental health calls but should be there to support these programs.”
Tom Saggau, a spokesman for the San Jose Police Officers Association, mentioned a pilot program in San Jose that police were skeptical of at first, until they saw sharing the burden of responding to calls. emergency eased their workload. The program has grown sixfold in eight years.
Saggau, who also represents the Los Angeles Police Protection League, a federation, said Los Angeles has compiled a list of 28 types of calls that can be redirected to other initial responders and not require a police presence.
However, police departments still protect their control over 911 and associated staff and funding.
Saggau criticized the 911 restructuring proposals as a natural result of the “undermining the police” movement and expressed disappointment that some advocates argued that supporting an alternative response required disaggregation. redistribute the police budget.
The effort to cut police funding, which gained international momentum following the 2020 killing of George Floyd, refers to reallocating funding from police departments to other government agencies that support support social services.
“It’s not either,” Saggau said. “You can have a strong, well-staffed police department, and you can also have a strong alternative response model.”
Wahab believes it is important to ensure all cities and counties have clinicians and other unarmed emergency responders.
“It’s very simple,” Wahab said. “You save lives by having an appropriate response to a crisis.”
This article was written by Molly Castle Work of KFF Health News and produced by Health News KFFpublish California Health Linean editorially independent service of California Health Care Foundation.
