Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Tuesday, January 30, 2018

Seattle Times article on the need for changes to 911 services and emergency response

Spurred by problems within DC and the metropolitan area, I've written quite a bit over the years about emergency responses to crime, fires, and medical emergencies, and mental health incidents -- partly because of deaths at the hands of EMS, killings by police officers of people with mental health issues, how EMS resources are used, etc.

-- "DC EMS Medical Director/Assistant Fire Chief resigns with blistering resignation letter," 2016
-- "Police response to mental health matters," 2016
-- "Who identifies problems and addresses them at the metropolitan scale? No one, at least when it comes to mental health-related police shootings," 2016

-- "DC's fire department is in the same situation as WMATA in terms of the necessity of a redesign of culture and behavior through a human factors approach," 2015
-- "The "recent" failures of the DC Fire Department are indicative of much deeper systems failures than people realize," 2006
-- "Rationalizing fire and emergency services," 2011
-- "Fire and emergency services (in DC)," 2013
-- "DC "fire" department continued," 2013
-- "Fire department issues in municipalities," 2014

The Seattle Times has an enterprise reporting initiative, called "Project Homeless," about issues surrounding the homeless problem in Seattle, which has one of the largest urban homeless populations.

(c. 2002-2004, I was very much influenced by an article in the ST about single sales of alcoholic beverages and the city's aim to restrict sales in certain areas because they discovered that a select number of homeless people "consumed" disproportionate amounts of emergency services, to the tune of $1 million or more per year. That led me to take up "single sales" as an issue for awhile, I was even featured in a 2003 Washington Post story on the subject.)

The latest article, "Puget Sound's homeless crisis pushes 911 beyond its design," is about the 911 emergency response program, and how it is set up to do three things well:

- get police to respond to crimes and incidents
- send fire departments to respond to fires and other emergencies
- send EMS to respond to medical emergencies

But it doesn't work so well in dealing with the homeless (or incidents with a mental health dimension).

The article raises issues that are more fundamental, about the nature of emergency response and how it can be better crafted to be more successful and less problematic.

The article discusses the difference between 911, for immediate emergencies, and other services (311 or 211) for nonemergencies.  Part of the problem is that most people don't use the non-911 service, even though it has plenty of access to resources.  The need for shelter isn't considered a 911 matter.

From the article:
Even as the homeless crisis has reshaped politics of the city and region, 911 — the front door for emergency medical services — has not evolved to cope with the scale of the problem, city leaders say. That leaves callers like Murphy confused about where to turn when they see someone in need of help, especially if it involves a mental-health or substance-abuse crisis.

“You see people all the time — especially working in downtown Seattle — in behavioral-health crisis and nobody knows what to do,” said Jim Vollendroff, who oversees King County’s substance-abuse treatment and mental-health services. “So they just walk right on by them, typically.”

The consequences of inaction can be bleak, especially in the winter. People without homes are eight times more likely to die of hypothermia than those with homes in King County, according to Dr. Richard Harruff, the medical examiner.
In Seattle, City Councilmember Sally Bagshaw is pushing the 911 system to "evolve," and to integrate the ability to respond to calls about homelessness and the need for shelter. According to Councilmember Bagshaw, more than one dozen city and county agencies address homelessness issues, and they aren't well coordinated.

For example, Seattle also offers a "sober van" service (King County Emergency Services Patrol) to deal with drunkenness and "sleeping it off," and the Fire Department has created the capacity for differentiated responses. From the article:
If an ambulance isn’t required, but the person does need medical help, the Fire Department will send a truck or an “aid car” staffed with firefighter EMTs to the scene. If the person is intoxicated but doesn’t require emergency medical assistance, medics can call yet another agency: King County’s Emergency Services Patrol, also called the “sober van.>

While 911 services are wary of expanding what they deal with, it is expensive for "nonemergency" services to set up and staff call center operations. From the article:

One answer could be hiring a 911 dispatcher with medical credentials who would be responsible for coordinating the sober vans and other services for homeless people in crisis. Another idea is to spread that knowledge across all 911 dispatchers.

It’s possible, Vollendroff says, that the answer is not 911 but creating a new dispatch line specific to behavioral-health issues. Scoggins agrees but thinks it could be hard to “wean people off that 911 number.”

The Fire Department has experimented with one alternative: A nurse line that shelter workers can call for advice before calling 911. That line has only been tested at a few shelters, but Scoggins says it has reduced emergency responses to those shelters.

The answer might be more of everything, said Jeff Lilley, president of Union Gospel Mission, whose “Search and Rescue” vans offer wool blankets, food, water and rides to shelter.
A few cities have special mental health response units, that are dispatched via 911, but usually such as in San Antonio, these are still small units, and the demand for service isn't able to met.

The Seattle initiative to rethink 911 spurred by Councilmember Bagshaw seems like a good idea, and the effort to rethink emergency response, not just "911 services" needs to be deeper, and taken up by more jurisdictions, especially as it relates to response to emergencies involving homelessness and mental health matters.

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At 11:51 AM, Anonymous charlie said...

We tangled a few weeks ago on Philly and overdose rates..If I read the tables correctly both DC and Philly have similar rates for 2017.

Also a great example of wonks. Nice to have the data, doesn't solve the issue that medicaid doesn't pay for long term treatment.

At 1:16 PM, Blogger Richard Layman said...

on an e-list someone raised the new Amazon-JPMorgan-Berkshire Hathaway initiative to disrupt "health care." Really?

There is a difference between health care and health insurance although they are conflated.

The problem is that our system is focused on insurance not health care. (Insurance was created as a way to regularize income for hospitals, not to make people healthier.)

Were it focused on health care, then problems like the one you identify would be addressed.

I was reading a story about this, don't remember where, and it said insurance lasts about one month, but it takes 4-6 months or more (damn, I should have saved the article) to address the biophysical changes that result from opioid use and the ability to wean the person off drugs.

Similarly, so many diseases are chronic and our system isn't set up to deal with it. (There are some articles in the Guardian about this wrt automobility vs. exercise and health. It's the same kind of issue.)

and yes, wonkery has its limits. A lot of people aren't able to think beyond the ways things are organized now.

Big data is good, because it helps. The reason I don't like it is that I have the talent to see that kind of stuff without needing to deal with the big data sets, but that doesn't seem to matter...

At 11:46 AM, Blogger Richard Layman said...

At 8:50 AM, Blogger Richard Layman said...

Sad story about a 911/hospital failure in Somerville, MA

At 9:18 AM, Blogger Richard Layman said...

There aren't national standards for training of 911 dispatchers. Need for training, such as to give instructions on how to do CPR over the phone.


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