On any day of the week, first responders in Buncombe County might be dispatched to this common scenario: A business owner or a bystander sees a woman on the sidewalk who is agitated, yelling, screaming, and pacing back and forth.
Concerned, a bystander calls 911 to get this person help; it’s unclear whether she’s injured, reacting to drugs, having a mental health episode or something else. In these instances, the 911 call center makes an assessment on who should be dispatched: law enforcement, the fire department, the Buncombe County Emergency Medical Services or some combination.
A new mobile outreach team within the BCEMS now can address the mental and physical health issues that can lead to these complex calls to 911 in the first place, explains lead paramedic Claire Hubbard.
Unhoused people and people experiencing severe mental health issues often lack the money or transportation to obtain regular health care. “Homelessness is a health crisis,” says Amy Cantrell, co-director of the nonprofit BeLoved Asheville, which works with the unhoused community. “It really exacerbates chronic illness; it often creates its own health crises.”
Hubbard explains that this lack of access means people might not seek medical care until they’re experiencing an emergency — a wound has become infected, or a prescription for a lifesaving medication has run out. It is then that many people call 911. Explains Hubbard, “People use 911 as primary care, as a basic needs resource.” And, as with the situation above, some individuals call 911 for them.
Whenever first responders are dispatched, they’ll transport a person to an emergency room if needed. But Hubbard explains that the outreach team is an option for care for people before a crisis. Law enforcement, the fire department and BCEMS also can request the outreach team if it would be a better fit for a person’s needs. In both cases, relying on the outreach team for these complex situations frees up the county’s first responders for more pressing emergencies
Hubbard says the county is still figuring out how the outreach team will be dispatched, and the protocol will be announced publicly once established.
For some emergencies, calls to 911 and the actions needed from first responders are clear immediately. A cardiac arrest means performing CPR until a defibrillator can be used. A wound that won’t stop bleeding from direct pressure needs a tourniquet applied. In other cases, the type of response needed isn’t clear-cut. For example, a woman who appears to be passed out and in need of medical attention may actually be healthy and sleeping on a park bench.
“It’s very difficult for the average person to know exactly what kind of help or first response is needed in complex nonemergent medical/mental health scenarios,” Hubbard writes in an email to Xpress. “This is not a burden that should fall on any one person without advanced medical, psychiatric or law enforcement training to tease out. It takes a diverse working group of people with access to resources to address these situations.”
First responders have limited time to spend on calls. The mobile outreach team aims to provide “higher levels of care” than BCEMS is able to provide daily, Hubbard says. A basic life support ambulance and SUV will allow the team to offer mobile wound care, provide emotional support and refer people to places for food or shelter. The department is hiring emergency medical technicians, nurses specializing in wound care, community health workers and two mobile mental health clinicians for the mobile outreach team.
Mobile outreach is a program welcomed by the Buncombe County’s Sheriff’s Office. “We support looking further into co-responder models that work to better serve community members who are experiencing a crisis but are not committing crimes or compromising public safety,” writes Aaron Sarver, spokesperson for Buncombe County’s Sheriff’s Office, in an email statement.
He continues, “Our deputies are certainly very busy with high-call volumes, and any level of relief helps. Any expansion of services that allows for a more tailored and/or comprehensive approach to someone in crisis is a win.”
Bill Davis, spokesperson for Asheville Police Department, did not respond to multiple requests for comment.
Mobile outreach is the latest addition to the BCEMS community paramedicine program, which began in November 2020 to address the effects of substance use, particularly opioid overdoses. BCEMS responds to several overdose calls each day, writes Justin Hall, community paramedic peer coordinator, in an email to Xpress.
In 2021, the BCEMS launched a post-overdose response team to dispatch paramedics, a mental health counselor and a peer support to overdose calls. Within 72 hours of the overdose, a member of the overdose team follows up and encourages the individual to seek treatment. The overdose team has responded to 3,568 calls since the program started, Hall writes. In March, the overdose team began offering medication-assisted treatment for opioid use disorder; it can treat a patient on nights and weekends when traditional programs aren’t open.
The community paramedic program is now expanding into other health care needs. In the request for proposals from the spring, BCEMS explains the mobile outreach team will be “dedicated to the overwhelming amount of calls we receive outside of our current funding parameters (overdoses).” For example, the nurse practitioner with a specialty in wound care on the mobile outreach team will be able to redress bandages; an EMT or mental health clinician can counsel someone experiencing severe anxiety attacks.
The bigger idea behind the mobile outreach team, Hubbard says, is to address “social determinants” of health, like access to nutritious food, transportation or affordable housing. Mobile outreach workers can build on the rapport they’ve developed by assisting and checking in on people in vulnerable situations, Hubbard says. These relationships can be used as a bridge for referrals to organizations or agencies that can provide assistance with larger issues.
BCEMS requested $1.14 million from coronavirus state and local fiscal recovery funds for the two-year pilot, Hubbard says.
‘A lot of crossover’
Mobile outreach teams exist in municipalities around the country, including New York City and Eugene, Ore. And Hubbard emphasizes that outreach teams are not even a new concept in Asheville, as several local nonprofits have teams that serve different aspects of the community.
The four-person outreach team at Homeward Bound of Western North Carolina primarily interacts with people who are unhoused. They can help people get on waitlists for housing and navigate housing-related issues, like acquiring identification, explains outreach program manager Mike DeSerio.
Homeward Bound’s outreach team already has “a lot of crossover” with the community paramedics because their demographics often overlap, DeSerio says. The establishment of a dedicated outreach team within BCEMS that can be proactive “is putting more legs on something [community paramedics] do well already,” DeSerio says.
Nonprofit Beloved Asheville also has people it calls “street medics” who distribute first aid supplies, like Neosporin, and educate people on how to recognize the signs of a heart attack, hypothermia or stroke. Cantrell says street medics have their own vehicle to use, but there are also “dozens” of homeless or formerly homeless individuals who assist on an as-needed basis.
The nonprofit has offered its volunteers CPR and first-aid training led by nurses and EMTs. It also offered training with an expert in wilderness survival about safety precautions in extreme heat and extreme cold, Cantrell says.
Beloved Asheville’s street medics are equipped with bags containing basic first-aid supplies like bandages and a blood pressure cuff, as well as naloxone, the opioid reversal drug. Cantrell says street medics call BCEMS when people require a more advanced level of health care.
Cantrell applauded the county government for expanding its outreach team. Local nonprofits are already doing this work, she says, and she’s glad to see it “move into a systemic solution.”
Another component the outreach team plans to offer is customized training for community members, particularly in the downtown business area, Hubbard says. The team will solicit information on best practices on deescalation from groups like the Haywood Street Congregation Mercy League, she adds.
In addition, DeSerio says Homeward Bound would like to offer engagement training that will provide verbiage for bystanders to use when talking to someone who may be in distress, such as during a mental health crisis or under the influence of drugs. “[Bystanders] don’t necessarily know how to handle those things,” he explains. They can “offer people some tools that we found through our experience that have been super helpful and get somebody to calm down to maybe be a little bit more logical,” he says.
But DeSerio is careful to note, “We’re not trying to fill a gap where their safety [is concerned] — if someone’s waving a knife or a gun or threatening to hurt somebody, that would be an instance where someone could call 911.”