The man was lying on his back in the middle of the sidewalk on the 500 block of Main Street, a primarily residential area near the International District with a handful of small restaurants and art galleries nearby. His head, covered in a mass of red hair flecked with gray topped with a cap, was propped up against his backpack, which, in turn, rested against the pole of a street sign. He gripped a screwdriver in his right hand.
There was little pedestrian traffic that warm afternoon, and the three people who walked by barely spared a glance for him, a stranger, maybe dangerous, definitely beyond their capacity and expertise to help.
A block away was Fire Station 10, full of firefighters trained in emergency medicine.
The enormity of the homelessness crisis in Seattle and its human toll is staggering, and sights like that — a seemingly unconscious man lying vulnerable and exposed on the sidewalk — are so common that they blend into the scenery, a gritty piece of the urban fabric over which an individual, operating on their own, has little control.
Are they asleep? Are they actually in danger? Would they want the authorities involved? It’s easier to walk on.
But taking a few minutes to assess the situation, pick up a cell phone and make a 9-1-1 call can save lives and improve outcomes for the prospective patient and the emergency responders that come to their aid.
Fire Station 10, near Pioneer Square and a concentration of services and shelters for people experiencing homelessness, receives the bulk of calls for what Lt. Sue Stangl refers to as “man down, sick unknown.”
Fire Station 10, near Pioneer Square and a concentration of services and shelters for people experiencing homelessness, receives the bulk of calls for what Lt. Sue Stangl refers to as “man down, sick unknown.”
“Those are potentially the most dangerous for us because we’re walking into the scene with no information at all,” Stangl said.
Emergency calls follow a predictable pattern. A police dispatcher will pick up first, determine the nature of the emergency and route the call accordingly. Fire or medical calls go to the Fire Department, where a uniformed firefighter will answer and begin triage.
All firefighters in the city of Seattle receive emergency medical training, a 135-hour course that qualifies them to splint broken bones, use an automated external defibrillator (AED) to jumpstart a heart or conduct CPR. More intensive medical services require a paramedic, who’s gone through a year-long course run through Harborview by doctors at the University of Washington.
Having dispatchers trained in emergency medicine pick up the phone makes a world of difference, Stangl said.
“It’s critical to how good we are in the field,” she said.
Every emergency call begins with three crucial pieces of information: the address or general location of the patient, a call-back number for the reporting party and a quick assessment of the patient’s level of consciousness and breathing.
That information determines the type of emergency responder sent to the scene, or whether the dispatcher has to walk the caller through CPR until medical help can arrive. Once that hurdle is cleared, the dispatcher requests additional information such as approximate age and, if possible, a general classification of the medical problem and gender of the patient.
“Something, anything,” Stangl said.
The challenge is getting people to stop at all. Many people found outside are catching whatever sleep they can.
The challenge is getting people to stop at all. Many people found outside are catching whatever sleep they can, and might not take kindly to being awakened by a stranger calling to them to see if they wake up or remain unresponsive. But Stangl sees it minimally as an avenue for her to offer services, and, in a minority of cases, a life-saving call.
The fire department fields roughly 7,000 to 9,000 medical calls relating to homeless people each year, said Jon Ehrenfeld, the low-acuity alarm program manager for the SFD. That’s roughly one out of every 10 calls that the department receives.
“They’re by far concentrated in Pioneer Square and the downtown core, but there is no part of the city we don’t see these cases,” Ehrenfeld said.
SFD finished the rollout of a new medical care software package in June, a move that allows Ehrenfeld to map calls and observe patterns quickly. The previous system relied on paper forms to gather information that employees would later have to enter manually into the computer. Data-entry backlogs stretched from seven months to a full year.
Now, the department can use data to demonstrate what emergency responders have known anecdotally for a long time. For instance, calls for service tend to spike at 6 a.m. and 6 p.m., hours when shelters and day centers close, leaving people experiencing homelessness once again outside.
The department has also narrowed down a list of “high utilizers,” people with whom first responders have frequent contact. A year ago the department hired an employee who works on engagement and outreach with these “frequent fliers,” following up with case managers or other social services after the current emergency concludes.
“It’s a step in the right direction,” Ehrenfeld said.
Only 10 percent of people contacted by the fire department for emergency medical care end up at Harborview or another hospital, Ehrenfeld estimated.
The effort points to a larger shift in the role of first responders in medical care, be it for physical maladies or mental health crises. Only 10 percent of people contacted by the fire department for emergency medical care end up at Harborview or another hospital, Ehrenfeld estimated. Others may get referred to DESC’s Crisis Solutions Center for help with chemical dependency or mental health care.
Firefighters respond to and treat illness, wounds and physical maladies, but a 9-1-1 call for a person experiencing a mental health crisis always results in the arrival of the Seattle Police Department (SPD).
SPD, like police departments across the country, requires training in crisis intervention. The workshops are supposed to teach officers how to assess and approach a person in crisis and deescalate the situation so that person can be diverted into medical care rather than taken into custody.
Many in Seattle are suspicious of the approach, recently called into question after the death of Charleena Lyles, a pregnant mother of four who was shot by two SPD officers while she was in crisis.
The Crisis Intervention Team (CIT) model was born out of the realization that police were encountering and arresting large numbers of people with mental illness. Data from 1999 suggested that roughly 10 percent of people who came into contact with police had a serious mental illness. More recent estimates of the prevalence of mental illness in jails concluded that 14.5 percent of men and 31 percent of women in the system had a serious mental illness.
The original CIT program originated in Memphis, Tennessee. In 1988, police shot and killed a man with a history of mental illness and substance abuse, prompting a community task force to collaborate and develop the first iteration of the program.
SPD officers may receive either an eight-hour course or a more in-depth 40-hour course, said SPD Crisis Intervention Coordinator Sgt. Dan Nelson.
SPD estimates that of the 10,000 contacts with people experiencing a crisis, 50 percent result in voluntary or involuntary mental health evaluation, 18 percent are referred to a crisis clinic and 9 percent go to the DESC Mobile Crisis Team. Approximately 7 percent end in arrest, Nelson said.
Unlike firefighters, who provide medical aid or possibly transport to the hospital, police intervention holds a threat for individuals living on the street. Some could have outstanding warrants for something relatively benign could fear re-entering the criminal justice system when they are at their most vulnerable simply because they needed help.
The only time an officer has to make an arrest on a warrant is in the case of domestic violence, Nelson said.
“Officers have discretion,” he said.
For others, it’s not the possibility of arrest they fear, it’s the question of whether or not they will walk away from an encounter with police with their lives.
Jay Hollingsworth is a member of Seattle’s Community Police Commission (CPC), a civilian-led body tasked with crafting policies for police reform in Seattle. Hollingsworth represents the indigenous community, which has lost people to police violence who needed a hospital, not bullets.
Asked if there was an alternative to calling the police in the case of a mental health crisis, Hollingsworth barked out a laugh.
“I would love to know what that is,” he said.
“The Native American community doesn’t want to call the police right now, because people that need the help end up being shot and killed,” Hollingsworth said. “Who do we call?”
Mayor Ed Murray created a team to create a new Community Service Officer (CSO) program, which trains people from the community in which they work to respond to nonemergency incidents like neighbor disputes and crime prevention. It’s a reboot of a program that fell to the wayside in the late 1990s.
Hollingsworth hopes that CSOs will also receive mental health training so that they can be the first responders in the event of a mental health crisis rather than armed police officers. The CPC is “looking at what that might entail,” he said.
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Twitter @AshleyA_RC
RELATED ARTICLES:
For Seattle homeless people, high temperatures can be just as dangerous as the cold
Rising rent means more homelessness
Access Denied: Voting and the right to participate
Wait, there's more. Check out articles in the full August 9 issue.
Real Change is reader supported. Just $5 a month provides work for more than 300 active vendors and keeps community journalism strong.