Descriptive Analysis Of Mental Health-Related Presentations To Emergency Medical Services

Abstract

Objective: In many developed countries, a lack of community-based mental health services is driving increased utilization of emergency medical services (EMS). In this descriptive study, we sought to describe the demographic and clinical characteristics of mental health-related EMS presentations in Victoria, Australia. Methods: A retrospective observational study of EMS presentations occurring between January and December 2015. Computer Aided Dispatch and electronic patient care record data were extracted from an electronic data warehouse. Characteristics of EMS-attended mental health presentations were described and compared to other EMS-attended patients using descriptive statistics. Results: Of the total 504,676 EMS attendances, 48,041 (9.5%) were mental health presentations. In addition, 4,708 (6.6%) cases managed by a paramedic or nurse via the EMS secondary telephone triage service also involved mental health complaints. EMS-attended mental health patients were younger and more often female compared to other patients attended by EMS. Most mental health patients were transported to hospital (74.4%); however, paramedics provided treatment to significantly fewer mental health patients compared to other EMS-attended patients (12.4% vs. 50.3%, p < 0.001%). The majority of mental health patients (76.8%) had a documented mental health history. Social or emotional issues were the most common presentation in mental health patients aged ≤15 years (19.1%); whereas, for patients aged ≥65 years, anxiety was the most common clinical presentation (41.2%). For patients undergoing secondary triage, 52.5% were frequent callers or anxiety presentations. A total of 27.7% of triaged patients were referred to an alternative service, while 24.6% were managed under an existing care plan. Conclusion: Mental health-related cases represent one in ten EMS attendances in Victoria. A large proportion of mental health presentations receive little intervention by EMS, and could benefit from community-based services provided by mental health clinicians.