Understanding the burden and mitigating risks in the utilisation of the Emergency Medical Services in the management of community mental health emergencies

Introduction Mental health disorders are highly prevalent globally with access to appropriate care oftentimes problematic. The Emergency Medical Services (EMS) have been suggested as a potential solution to improve access, however, it is unclear whether these services provide the most appropriate response with respect to the needs of patients experiencing a mental health emergency. Methods A multi-method study was conducted to assess the current burden and potential risks associated with the transportation of patients experiencing a mental health emergency by EMS. Part 1 utilised a cross-sectional study of routinely collected clinical data for the period January 2018 to December 2019. Part 2 employed a systematic risk identification methodology focused on identifying the hazards associated with the transportation of this patient cohort, to identify key action plans towards mitigating their occurrence. Results Patients experiencing a mental health emergency were transported at an average rate of 11.96 per 1000 transports. Approximately 7% were administered prehospital sedation, with Ketamine administered as the most common sedative. Altogether, 50 potential hazards were identified involving the transportation of patients experiencing a mental health emergency. The Patient Assessment subprocess contained the most potential hazards/failure points (n=13). Risks categorized as occasional (n=33) and moderate (n=16) made up the majority. Conclusion The burden of mental health emergencies on EMS is considerable, with the potential for several significant risks. Despite this, there was unequal focus on the development of care pathways and clinical guidance for this patient cohort compared with the more "traditional" case types serviced by EMS. Consequently, we identified several strategic-level action plans to mitigate these hazards and improve the delivery of care for these patients in the community.