Paramedic Assaults

In this photo taken Sept. 10, 2019, Ryan Russo, second from left, goes through a drill with instructor Sean Fuller, left, during a defensive tactic training class at the American Medical Response training center in Clackamas, Ore. Paramedics in Portland are undergoing mandatory training in defensive tactics after a rash of high-profile attacks against them as they respond to 911 calls for people in a mental health or drug-related crisis. (AP Photo/Steve Dykes)

By GILLIAN FLACCUS Associated Press

PORTLAND, Ore. — Trisha Preston was transporting a patient in a mental health crisis in the back of her ambulance when suddenly the woman undid her seatbelt, jumped off the gurney and began attacking the veteran paramedic, punching her and pulling her hair. By the time Preston’s partner wrestled the woman to the floor, Preston had a concussion and bite marks on her arms.

“It took me a good couple of months to get it out of my head. I was constantly thinking about it,” Preston said. “We’re all on high alert these days.”

Her experience is part of a rash of attacks in recent months on paramedics in this Pacific Northwest city as they respond to a growing number of 911 calls for patients in mental health or drug-related crises. The uptick in violence is so severe that the private ambulance company that holds Portland’s 911 contract is training more than 500 of its employees in defensive tactics.

The company is trying to better understand what’s happening in the field.

“The frequency appears to be increasing. The severity appears to be increasing,” said Robert McDonald, an operations manager with American Medical Response.

The increase in assaults dovetails with a new policy for the transport of patients in a mental health crisis that grew out of a 2012 federal investigation that found police used excessive force against those with mental illness.

Now, paramedics — not law enforcement — routinely take patients on mental health holds to the hospital, most often to a new psychiatric emergency room created specifically to stabilize those in the throes of a psychiatric crisis. In the past, police transported these patients in the backs of patrol cars, in handcuffs, to traditional emergency rooms less equipped to help them.

The policy puts the city at the forefront of a growing national movement to decriminalize mental health by treating a psychiatric crisis as a medical emergency similar to a heart attack — not as a crime.

Portland drew key parts of its new approach from Alameda County, California, where paramedic transports and a psychiatric emergency room model have reduced hospitalization rates for mental health emergencies by 85%, said Scott Zeller, vice president for acute psychiatry for Vituity, a multistate medical consultancy group. Cities from Billings, Montana, to San Bernardino, California, are also re-examining how they treat people in a psychiatric emergency.

At one defensive tactics training, paramedics in sweatpants and sneakers practiced deflecting blows from an instructor who was trying to hit them with padded batons, dodged a fake knife and worked up a sweat wrestling their way out of choke holds.

Instructor Jeff Birrer said he’s also noticed more attacks on ambulances from people who are not patients but are at or near a 911 response. The week before, he said, a man threw a rock at his ambulance, and another man pounded on its windows from the outside.

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