■经历无家可归(PEH)的人是最脆弱的人群之一,并且经历了巨大的健康差距。在全国范围内,PEH利用紧急医疗服务(EMS)的费率比他们的同行高得多。制定最佳策略来照顾PEH已变得至关重要。然而,关于最佳实践的数据有限,挑战,以及为PEH提供护理的经验。这项研究的目的是描述这些经历,洛杉矶(LA)县的EMS运营机构医疗主管面临无家可归危机的挑战和观点。
■我们对洛杉矶县的9-1-1运营EMS机构医疗主管进行了横断面调查,是全国人口最多的国家之一。29个9-1-1运营EMS机构在洛杉矶县运营。匿名的链接,基于网络的调查审查文件,培训,资源,运营影响,在研究期间(2023年4月19日-2023年9月15日),护理挑战通过电子邮件发送给医务主任,并附有3次提醒.
■四分之三(75.9%;22/29)的运营EMS机构对调查做出了回应,在69%(20/29)的调查中,所有问题都得到了回答。其中,71.4%(15/21)的机构记录住房状况,75%(15/20)同意或强烈同意无家可归带来的运营挑战。没有提供机构报告关于无家可归的EMS临床医生培训。提供者机构最常利用家庭暴力资源(43%,9/21),社会服务(38%,8/21),和执法(38%,8/21)协助PEH的服务。推荐受到可访问性的限制(86%,18/21),时间(52%,11/21),缺乏意识(52%11/21)和缺乏授权(52%,11/21).所有提供者机构都同意或强烈同意精神健康和物质使用障碍是PEH的主要问题。最常见的日常挑战是心理健康(55%,11/20),物质使用(55%,11/20),和患者抵抗(35%,7/20)。
■在洛杉矶县,EMS机构在照顾PEH方面经历了重要的运营和临床挑战,资源有限,最少的训练,以及高比例的物质使用障碍和精神健康合并症。进一步的院前研究对于规范住房状况的文件至关重要,为了确定干预领域,加强与服务的联系,并定义最佳实践。
UNASSIGNED: Persons experiencing homelessness (PEH) are among the most vulnerable populations and experience significant health disparities. Nationally, PEH utilize Emergency Medical Services (EMS) at disproportionately higher rates than their housed peers. Developing optimal strategies to care for PEH has become critically important. However, limited data exists on best practices, challenges, and experiences of providing care to PEH. The objective of this study was to describe the experiences, challenges and perspectives of operational EMS agency medical directors in Los Angeles (LA) County as they confront the homelessness crisis.
UNASSIGNED: We performed a cross-sectional survey of 9-1-1 operational EMS agency medical directors in LA County, which has one of the largest populations of PEH nationally. Twenty-nine 9-1-1 operational EMS agencies operate in LA County. The link to an anonymous, web-based survey examining documentation, training, resources, operational impact, and care challenges was emailed to medical directors with three reminders during the study period (4/19/2023-9/15/2023).
UNASSIGNED: Three quarters (75.9%; 22/29) of operational EMS agencies responded to the survey, with all questions answered in 69% (20/29) of surveys. Of these, 68.2% (15/22) of agencies document housing status and 75% (15/20) agreed or strongly agreed that homelessness presents operational challenges. No operational EMS agency reported adequate EMS clinician training on homelessness. Operational EMS agencies most commonly utilized domestic violence resources (43%, 9/21), social services (38%, 8/21), and law enforcement (38%, 8/21) services to assist PEH. Referrals were limited by accessibility (86%, 18/21), time (52%, 11/21), lack of awareness (52% 11/21) and lack of mandates (52%, 11/21). All operational EMS agencies agreed or strongly agreed that mental health and substance use disorders are major issues for PEH. The most common daily challenges reported were mental health (55%, 11/20), substance use (55%, 11/20), and patient resistance (35%, 7/20).
UNASSIGNED: In LA County, EMS agencies experience important operational and clinical challenges in caring for PEH, with limited resources, minimal training, and high rates of substance use disorders and mental health comorbidities. Further prehospital research is essential to standardize documentation of housing status, to identify areas for intervention, increase linkage to services, and define best practices.