Communities Organizing Own Emergency Medical Service To Avoid Police

(Image: Lauren Walker / Truthout)

When Jens Rushing was working as an emergency medical technician (EMT) for a 911 service in one small Texas city, he was dispatched on a call where he witnessed a man suffering during a mental health crisis. He remembers how the police officer who accompanied him wanted to cuff the man’s hands behind his back and force him, face down, to the ground, until he “calmed down.”

“[The officer was] completely unaware of the threat of positional asphyxia, of which people die,” Rushing told Truthout. “We had to argue with him to get the patient away from [the police], and let us [EMTs] do it our way, chemically sedating the patient rather than physically restraining the patient, and actually tending to them as a patient, rather than as a person committing the ‘crime’ of having an acute psychotic episode.”

Rushing says that during his time as an EMT for this small Texas city, police officers were dispatched with him on almost every call, sometimes becoming unnecessarily confrontational and problematic – especially, he said, on calls in which patients were struggling with mental illnesses. In February 2012, he left that city to work for 911 services in Arlington, Texas, for a few months. Now, he works as an ambulance EMT paramedic for a Texas hospital he prefers not to name.

Though Rushing says there are occasions when having cops arrive first to secure the scene and guarantee paramedics’ safety can be useful, he says police can and do make unstable situations worse. He told Truthout he’s witnessed several officers physically and verbally abuse people while working closely with them in his role as an EMT.

“Occasionally [police] do make matters worse. I don’t see a way of changing that working relationship outside of changing the fundamental structure of the role that police play in our society,” Rushing said.

Issues like the ones Rushing observed are leading some communities to find alternative solutions to traditional 911 first responders and emergency medical services (EMS), as means of minimizing contact with the police in tense and volatile situations. Organizers and activists across the country are working to build first-response models that rely on community members taking medical knowledge into their own hands – and often acting to prevent medical crises before they happen.

Oakland Organizers Build Community Power With Medical Cohort Training

This month, organizers with the Oakland chapter of Critical Resistance (CR), which works to abolish prisons and policing, are launching the Oakland Power Projects(OPP). The OPP initiative aims to build “the capacity for Oakland residents to reject police and policing as the default response to harm and to highlight or create alternatives that actually work by identifying current harms, amplifying existing resources, and developing new practices that do not rely on policing solutions,” according to CR’s website.

The first Power Project is taking shape in the form of an “Anti-Policing Community Health Workers Cohort.” The cohort will participate in a training series that will be conducted during five Saturday sessions running from September 19 through October 17. In the series of workshops, community street medics and health-care workers of all backgrounds will work to build residents’ skills and knowledge so that they can provide health care for one another without relying on police.

“What we need are resources to build community strength from the ground up,” said CR development director Jess Heaney, who helps coordinate the OPPs. “The [City of Oakland] won’t invest in neighborhoods maintaining community building. They also won’t invest in a quality of resources. So we can do it on our own, at the grassroots level.”

The OPP initiative hopes to build upon the successes of the abolition and anti-police organizing efforts of the Stop the Injunctions Coalition (STIC) that successfully pressured the Oakland Police Department, city attorney and the City Council for more than six years to stop enforcing or expanding gang injunctions in Oakland. STIC scored a decisive victory earlier this year when the Alameda County Superior Court dismissed two civil gang injunctions, which allow the targeted policing of people or communities suspected of gang activity, that the coalition opposed.

Now, organizers are hoping to build on this momentum to build their own resources for addressing harm, as a means of divesting from policing. CR organizers in Oakland conducted a survey in 2014, soliciting responses from Oakland residents and allies of STIC about their experiences with the police, and asking them about how they think Oakland can best build alternatives to policing structures. The group detailed their findings in a report, in which community members overwhelming said they wanted access to health-care resources that aren’t connected to policing and alternative first-response models for emergency health crises.

“People wanted to have first responders come when they needed 911, but the cops showing up there and cordoning off the scene, and actually stopping people from getting health care until cops were able to do what they wanted to do, was negatively impacting the community’s experience in passing moments of crisis,” Heaney said.

Heaney says that once CR understood what the community wanted, she and other organizers reached out to street medics and health-care workers of varying stripes, from emergency room doctors and nurses to local herbal healers. From their dialogue the idea of a medical cohort training was established.

“This idea of ‘knowing your options’ emerged, so we started working on a health workers training that would provide ‘know your options’ education to Oakland community organizations,” Heaney said. “So that when a moment came and people needed health care, whether it’s a long-term health-care plan … or in times of crisis, people would feel confident, would have the skills and the understanding and resources available, and the relationships necessary, to not have to go to a place where cops would be present or cops would be first responders.”

CR has already been working in coalition with other national organizations, including the Ella Baker Center, to provide workshops focused on reducing harm and conflict, and reimagining community safety, without relying on the police. With their first Oakland Power Project, they hope to combine their previous workshops about abolishing the prison industrial complex with medical information and training, including not only preventative care for common issues like high blood pressure, diabetes and minor injuries, but also emergency skills, such as CPR and treating gun shot or stabbing wounds. Trainers also hope to distribute medical kits that community members can use for first-response emergencies to help prevent calls to 911.

Aside from emergency care, the training’s other key focuses will be mental health and de-escalation tactics, as well as chronic health conditions, with trainees participating in building distinct medical kits and lists of resources for their preferred focus area. The hope is that trainees will then become trainers in their focus area, and continue to distribute their newfound knowledge within their own networks, workplaces and neighborhoods throughout Oakland.

Rushing, the ambulance EMT paramedic based in Texas, is sympathetic to the need for initiatives like the OPPs. (He formerly volunteered as a street medic for Occupy Dallas in the fall of 2011 when the group was camping and actively organizing in the city.)

“There are many people divided amongst race and class lines who can and can’t call 911 freely, without fear, with or without the assumption that the people coming are public servants who are going to help you, or people that you try to avoid at all costs,” he said, referring to the fact that people of color are often targeted by police in routinely violent and lethal ways, resulting in a hesitancy among these communities to call the police or 911 – even when they urgently need assistance.

He added that the need for the program also betrays a stark injustice in the way public resources are utilized. “Everybody should absolutely have access to emergency health care and the level of care that paramedics are able to offer with our training and the advanced medical equipment and techniques that we have on our ambulances,” Rushing said.

However, Emergency Medical Services have always occupied an odd place in the health-care landscape. Rushing noted that most of his fellow EMS workers are sympathetic to police because they tend to identify more with emergency services such as firefighters and cops, even the military, rather than with other health-care workers.

“[EMTs] can be on the fire truck or on the ambulance on a day-by-day basis. It depends on the city and the department,” Rushing said. “And a fire department has always been a ‘paramilitary organization,’ in that it was originally made up of veterans, especially after the Civil War and World Wars, and retained much of the power structure from the military.”

However, some groups are finding a “third way” between working within the system, as Rushing has, and working completely outside of it, as CR organizers are building toward. This approach – working with the system in a partial way – aims to minimize police contact and provide alternative forms of EMS care.

Eugene’s “CAHOOTS” Shares Dispatch With Police While Minimizing Contact

In Eugene, Oregon, White Bird Clinic’s “Crisis Assistance Helping Out On The Streets” (CAHOOTS) program is a mobile crisis intervention service that shares a central dispatch with the Eugene Police Department (EPD) and is fully integrated into, and funded by, the City of Eugene’s public safety services.

The service is dispatched through the city’s non-emergency police, fire and ambulance call center, but is designed to provide an alternative to law enforcement action whenever possible for non-criminal drug and substance abuse, poverty-related issues and mental health crises. A majority of CAHOOTS clients, about 60 percent, are homeless.

The service was first created in 1989 as a collaboration between White Bird Clinic, a social service nonprofit organization, and the City of Eugene to address the needs of the city’s homeless population and people living with addiction or chronic mental illness, among other marginalized groups.

The CAHOOTS van dispatches between 11 am and 3 am, seven days a week, with at least one nurse or EMT and one crisis worker who provide free first-response services to people experiencing a broad array of non-criminal crises. The CAHOOTS team can provide non-emergency medical care and basic first aid, as well as mental crisis intervention services, including case assessment, referral and advocacy. CAHOOTS-trained teams also routinely provide counseling services, mediation in disputes and transportation to social services.

“A lot of citizens that I think would otherwise not be calling and getting support … because they’d be afraid of the type of responses they might get, I think feel more comfortable calling us because they know that we’re a human service response,” said Benjamin Brubaker, a White Bird Clinic administrative staff member and CAHOOTS team crisis worker. “In most municipalities, you have police, fire, ambulance and that’s what you’re going to get if you call 911 or a non-emergency number, and here in Eugene, we’ve been able to work with the local police department to build this kind of fourth human-service option.”

Brubaker said that the acronym CAHOOTS is the team’s tongue-and-cheek way of being upfront with the community about the fact that they partner with the EPD in certain situations. “We’re going to show up on the scene, maybe where the police are there,” Brubaker said. “But how that’s been broken down for the folks out on the streets, and how they kind of see that is: The police are there. They don’t really want the police to be there. They call us and we show up and say, ‘OK guys, we got this,’ and the police clear out.”

Brubaker told Truthout that typically people call up the non-emergency police number, and the EPD determines whether or not the call is appropriate for a CAHOOTS team to handle. If so, the EPD will dispatch the CAHOOTS van directly to a scene. But if the EPD determines there’s a criminal and/or dangerous element involved in a situation, many times they’ll respond first, and have a CAHOOTS team staged nearby or call a team to take over for them.

But occasionally the CAHOOTS team will escort EPD officers to a scene and work out with them what the best approach to a situation is, and whether or not it requires CAHOOTS crisis workers or police action.

“We’re not there to do what we call ‘inflicting help.’ We want to assist people in finding their own answers because we believe ultimately that everybody already has the answers inside of themselves for the situations that they’re in,” Brubaker said. “We’re going to sometimes have to call someone [the EPD] who can ‘inflict help,’ but we try to make sure that that doesn’t happen very often.”

As the CAHOOTS program has developed its relationship with the City of Eugene over the years, the service has grown so that it now responds to more than 9,000 calls every year in the city alone, taking an average of 34 calls a day before the program announced its expansion into the neighboring city of Springfield in October 2014.

Rushing thinks the CAHOOTS model is, in part, helping to fill the gaps in health-care services that traditional EMS “can’t or doesn’t cover.” He told Truthout that, in his experience, about 90 percent of the calls he’s been on have been non-emergencies.

“There’s a lot of people who have a lot of chronic illnesses that don’t need a trip to the [emergency room], but still need medical attention,” he said. “So [a similar model] could potentially be able to relieve the strain on an EMS system, which would be great, and also provide better access to health care for a lot of more vulnerable people.”

But Rushing cautioned that nonprofit models that are embedded with the police might be more feasible in places like Eugene, which is predominantly white, than in other areas with higher demographics of people of color.

“I’m sure the demographic of Eugene would have something to do with how successful the program is. Certainly in a place … with majority-minority populations and a police department with, let’s charitably say, a non-progressive record, it would definitely be more difficult to integrate a service like that with the police department and with the community at large,” Rushing said.

According to the CAHOOTS teams’ own internal analysis of the calls they handle and other internal data collected from January 1 through June 8, the CAHOOTS team expects to take approximately 6,000 additional calls on average by the end of this year.

The team estimates that, so far in 2015, about 11.4 percent of the calls they’ve taken have involved providing direct assistance to EPD officers in the field, and 3.6 percent of their calls have involved CAHOOTS workers directly assisting EMS workers. CAHOOTS crisis workers provide counseling services in about 64 percent of calls in which they are not providing transportation to social services or the hospital. The program provides medical services in 22 percent of these non-transport calls. The remaining 14 percent of those calls involve substance abuse issues.

Additionally, the CAHOOTS team analyzed dispatch data from their own cases as well as EPD data, and estimated that, in 2012 and 2013, the CAHOOTS service handled more than half of all cases involving personal welfare safety checks and transport to social services.

CAHOOTS is a win in terms of the municipal budget, too. Citing the city’s own estimates, CAHOOTS workers estimate that their service saves EPD over $4.5 million annually. The organization has also calculated that their work adds up to more than $1 million in ER and EMS diversion savings (without including the cost of ambulance services).

“There’s a large lack of foresight as far as spending goes in governments across the country. They have a hard time spending money on mental health and substance abuse issues to help actually treat [patients],” Brubaker said. “Instead, what’s happening is a lot of that money is just getting transferred to law enforcement legal systems in order to deal with those individuals, where really what I think needs to happen is more money needs to be in mental health and substance abuse treatment.”

Brubaker hopes other municipalities will consider replicating the Eugene/CAHOOTS model of partnering city services with social service nonprofits to provide care in non-emergency situations – instead of relying on city police departments to do so. He noted that when there is an assumption that police will always be involved in emergency services, many people simply do not seek help.

“I have countless examples of when I was able to be of service to folks who really needed it that may not have reached out for services if they thought anyone else but CAHOOTS was going to show up,” Brubaker said.