A Descriptive Assessment of EMS Encounters for Patients Experiencing Behavioral Health Emergencies

Introduction: Behavioral health emergencies (BHE) comprise a considerable proportion of patients receiving care by emergency medical services (EMS). However, only limited data describe the characteristics and outcomes of this population. 

Objective: To describe characteristics of EMS patients experiencing BHE.

Method: This retrospective observational study of patients experiencing BHE was conducted using a large national EMS research data set maintained by ESO. A subset of encounters in this database participate in the ESO health data exchange, linking hospital outcome data to the prehospital record. The study period spanned January 1 through December 31, 2018. Inclusion criteria consisted of 9-1-1 responses for adult patients (older than 18 years) with a documented EMS provider primary or secondary impression of a behavioral or psychiatric etiology transported to the ED. Substance abuse and overdose were specifically excluded. We analyzed the data using descriptive statistics.

Results: The data set included 7,574,879 responses from 1,289 EMS agencies, of which 5,970,280 (79%) were 9-1-1 responses. BHE was present in 213,410 (4%). We excluded 21,901 (10%) with patient age less than 18. Of the remaining 191,509 encounters, there were 146,124 (76%) transports by EMS. Median age was 41 (IQR 29–56), 51% were male, 69% were white (non-Hispanic) and 25% were black (non-Hispanic). Hospital outcome data was available for 15,500 encounters (11%). Of these, 51% (7,948) were discharged home in 24 hours or less.

Conclusion: The majority of adult patients with a BHE encountered by EMS were transported to the hospital. More than half of patients transported to the ED for BHE were discharged home within 24 hours. Further study may identify opportunities for the alternative care of BHE patients. Limitations to this study include a lack of universal definition for BHE and the inability to track the same patient over separate EMS encounters.