#HM12DoC 9 Homeless Psychs

On the ninth Day of Christmas Happy Medic gave to me…

9 Homeless Psychs

8 Asthma Attacks

7 OBs Crownin’

6 Priapisms

5 Golden hours

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green
Man, if it was only 9…

Homelessness in America is a serious concern and my jurisdiction has it pretty rough.

San Francisco is the 12th most densely populated city in the US and has a serious homeless issue.  I will not say problem, because it is not one, but an issue.  One that drains services from residents of the City and affords them to anyone who gets off the bus and seeks treatment for substance abuse, mental health issues, or just wants to live the “hippie” lifestyle they read about.

Homelessness in America has no trigger, no seminal event that caused it, but the numbers of homeless exploded in the 1970s and 80s when government run mental hospitals were closed and simply let people go.  With no continued treatment and no place to go, they took up residence wherever they could.  Under overpasses, in doorways, you get the idea.

Some of you may have seen a few shopping carts being pushed around the lesser desired areas of your town, or even a beggar or two.  In my City, we have them by the thousands.  Literally.

Nearly 10% of the Nations reported 123,000 homeless Americans reside within the City and County, with a majority of them being single males and a majority of them being African-American.

Unfortunately, the largest growing segment of homeless is families with children.  And of those a majority report having a regular job.  Think about that for a minute.  A family, with kids, and one of the parents has full time work, yet are unable to keep an apartment, house, shack, anything.

And these numbers only reflect the persons the authors of the surveys were able to find and speak to.

As a paramedic who deals with at least 2-3 homeless persons per shift, I can tell you that substance abuse is a key factor in their healthcare regimen.  I used to joke that they drink because they are homeless, but later realized the two just fit together.  If I had to sleep outside in 44 degree weather, I’d drink too.

And we have it rough here because we are a giving City, offering services, as I mentioned before, to anyone who shows up.  And we do get everyone.  When I used to work one of the downtown 24 hour ambulances that covered the bus depot, we would get so many calls there we would often just choose to post in the turn around out front and wait.  Most nights an entire bus of folk would disembark and start wandering towards us.  No baggage, no jackets, no money, but looking for a shelter.  We would guide them to it, knowing they wouldn’t make it, but end up calling us later.

Regulars were a good source of relief in my early years.  Our regular homeless knew the system and how to manipulate it, sometimes with such cunning and cleverness I wished they wrote fiscal policy or worked at NASA, but instead drank cheap vodka and soiled themselves.  Not because they had to, but almost because they could.

One of these regulars successfully beat the street and made it out alive, a rarity these days and I had the opportunity to speak to him when he actually needed an ambulance a few years ago.  He told me that he never chose to be homeless, he just woke up one day and noticed that his slow spiral downward had struck bottom.  From losing steady work, to losing his family, to no job, to staying with friends, to no longer welcome to stay with friends, to shelters to the streets, literally sleeping in the gutter, it was a slow and steady fall that landed him in the system, but no one seemed able to actually help him.  But we have so many resources available and yet he is one of the few success stories out there.

As you know, gentle reader, one of our homeless regulars died recently and it was a shock to many providers.  The old grizzled fellow that seemed unbreakable despite multiple trips, falls, stupors and fights but always seemed to run out of the ER.  I remember his name, DOB, SSN and meds but I can’t remember where he was from.

They’re from all over nowadays and they are sent here not out of desperation, but out of convenience.  Since Smalltown USA doesn’t have the resources to deal with chronic homeless psych issues, send them to SF seems to be the simplest answer.

In 1965, seeing a coming wave of homeless, a group started an outreach program in the later famous Haight Ashbury district of the City, now a tourist destination.  It was started by a group called the Diggers who believed all services should be free.  Was this the beginning of what I see today or what we need again?

You may ask yourself why so often my solutions to modern EMS seem to revolve around Paramedics being able to assess and redirect persons to appropriate services.  This is why.  Because the EMS 2.0 MY system needs is to address the mobile, hard to understand homeless population that demands services more than they need them, yet don’t get the basics they need to break the cycle, their cycle, that keeps them where they are.

Call them lazy if you want.  Call them names and swear at them if it makes you feel better, but somewhere inside that person soaked in week old urine, intoxicated and fighting you is someone who keeps asking themselves…

“When did it get like this?”

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4 thoughts on “#HM12DoC 9 Homeless Psychs”

  1. It is a sad state of affairs but like you stated paramedics could easily be the solution. We often see those who are unwilling or indifferent about seeking assistance. The primary city we cover has a transit station and we constantly see an influx from other towns because they know our hospital is literally half-a-block away from the platform. Often our BLS units see these patients so often the chart is written before arrival simply based on who calls for what.

    Part of the future of EMS is to enable responders to act not only as health care and public safety professionals but as field public health advocates. We have the potential to affect the outcome of those who enter the system and maybe in the future affect more of those who will never have to use an ambulance.

    Keep up the strong work and everyone have a happy and safe holiday.

  2. It is a sad state of affairs but like you stated paramedics could easily be the solution. We often see those who are unwilling or indifferent about seeking assistance. The primary city we cover has a transit station and we constantly see an influx from other towns because they know our hospital is literally half-a-block away from the platform. Often our BLS units see these patients so often the chart is written before arrival simply based on who calls for what.

    Part of the future of EMS is to enable responders to act not only as health care and public safety professionals but as field public health advocates. We have the potential to affect the outcome of those who enter the system and maybe in the future affect more of those who will never have to use an ambulance.

    Keep up the strong work and everyone have a happy and safe holiday.

  3. I deal with them every shift here and dealt with them a lot in ABQ too. As much as we try to get the EDs we take them to to help them out wiht referrals to other services, the sad fact is that a lot of times the EMS crews are the only ones to listen to the homeless patient’s complaints.

  4. I deal with them every shift here and dealt with them a lot in ABQ too. As much as we try to get the EDs we take them to to help them out wiht referrals to other services, the sad fact is that a lot of times the EMS crews are the only ones to listen to the homeless patient’s complaints.

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