EMS World Expo: 30 Years of MIH in Oregon

By: John Eric / EMSWORLD

In the counterculture hub of Eugene, Ore., not everyone trusts authority. And in Eugene and neighboring Springfield, like everywhere, public safety providers like EMS and law enforcement have their plates well-filled. Serving those citizens and alleviating the loads of police and EMS is CAHOOTS, a novel mobile integrated healthcare-style program operating since 1989.

CAHOOTS—for Crisis Assistance Helping Out on the Streets—is a free 24/7 mobile crisis intervention organization that field teams of clinicians (EMTs and higher) and trained crisis workers (experienced in mental health issues) to provide stabilization and referral or transport of noncriminal police contacts and low-acuity medical/social patients to social service alternatives better suited to address their needs. It’s a project of Eugene’s White Bird Clinic, a “collective environment organized to enable people to gain control of their social, emotional, and physical well-being through direct service, education, and community.”

The program began as a collaboration between White Bird and the Eugene Police Department, which funds it entirely in that city. Officers were encountering low-level contacts who didn’t pose any real danger to the public or need to be in jail: inebriates, the homeless, trespassers, people just having conflicts or emotional or psychological distress. Those subjects often overlap with the EMS and hospital worlds, so the realization came to both sides early that they could likely be better served at other facilities or by connections to social services.

Today CAHOOTS has developed a wide array of contacts to help such individuals: homeless and abuse shelters, sobering centers, and more. Often crews will resolve issues in the field if they can, even if it’s just providing tarps, water, and dry socks to someone on the streets. “We’re really meeting people where they’re at,” CAHOOTS crisis worker Laurel Lisovskis told attendees at EMS World Expo Thursday.

Dispatched through police and EMS nonemergency lines, it provides 24-hour coverage in both cities, which account for two-thirds of the population of Lane County, and has a second truck on part-time duty in Eugene. All services are free, voluntary, and confidential. The clinicians on the team can provide expanded BLS care (adding wound care, King airways, Narcan and glucagon, and medication review), while the crisis workers can contend with mental parts of people’s equations. Their primary target is the medically underserved—roughly half their contacts are homeless—and they get roughly 70 requests for service a day. Lane County even entrusts CAHOOTS with suicide risk assessments (a lone exception to their confidentiality policy if self-harm seems imminent), but interventions can range all the way down to welfare checks, grief/loss counseling, and conflict mediation. “We consider ourselves mobile troubleshooters,” Lisovskis said.

Of course there’s no perfect remote triage, and if a CAHOOTS contact turns out to have greater medical problems, crews stabilize them and summon ALS care. They also have police radios if things turn dangerous. The transport breakdown Lisovskis and EMT colleague Robert Parrish provided at Expo included 36% to medical services (urgent care, primary care, pharmacies, etc.), 27% to substance abuse treatment, 15% to homeless shelters, and 14% to social services. They can also take patients to emergency departments if needed, keeping EMS units in service.

Besides benefiting the area’s most vulnerable, CAHOOTS is an MIH program that’s proven to save money: At an average price for an ambulance ride starting around $1,600, it saved an estimated $3.5 million in costs in 2017, while costing roughly $2 million a year to run.

There’s more: White Bird and CAHOOTS can provide home visits and fill short-term care gaps for seniors; conduct drop-in clinics at schools; provide sexual-assault support, and even connect people to mundane-seeming day services like showers. “Preventing crisis,” Lisovskis said, “takes these little opportunities people need to feel human.”

Among the Expo attendees Thursday was a medic who’d worked in Eugene alongside CAHOOTS. His summary: “They were a godsend.”

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