Homeless patients pose unique problems for EMS

EMS is the primary care provider for most homeless patients, creating a range of challenges for medics – from difficulty in getting histories to chronic diseases


By Drew Johnson, EMS1 Editor

Treating homeless patients can present overwhelming challenges for EMS providers.

Dwight A. Polk, a paramedic with the University of Maryland Department of Emergency Health Services and volunteer with the Grassroots Crisis Center in Columbia, Maryland, presented on the topic of homeless patients at EMS World Expo in Las Vegas last Friday.

Image Drew JohnsonDwight A. Polk, a paramedic with the University of Maryland Department of Emergency Health Services and volunteer with the Grassroots Crisis Center in Columbia, Maryland, presented on the topic of homeless patients at last week's EMS World Expo in Las Vegas.

Image Drew Johnson
Dwight A. Polk, a paramedic with the University of Maryland Department of Emergency Health Services and volunteer with the Grassroots Crisis Center in Columbia, Maryland, presented on the topic of homeless patients at last week's EMS World Expo in Las Vegas.

"These folks have nothing," Polk said. "The number one misconception I hear about this population is that they're homeless because they want to be."

Polk pointed to a number of causes that may lead people to homelessness, including a shortage of affordable housing, an increase in poverty, a lack of affordable healthcare, mental illness, and addiction.

The homeless are an entrenched problem in many areas – one that politicians and policymakers struggle often to face, Polk said. "It's a primary example of not in my backyard."

Because there are scant resources to help these patients with their medical problems, the burden of treatment often falls to medics.

"EMS is the primary care provider for homeless patients. You are on the front line, and the sad truth is that some medics react to these patients with disgust, rudeness, and abuse," Polk said.

The scope of the problem
There are two categories of homeless, Polk said: the sheltered and the unsheltered.

In 2010, 1.59 million people experienced a bout of homelessness. Of those, 649,000 lived in shelters, transitional housing or on the streets. Just under 110,000 were chronically homeless

More than 60 percent of homeless people have lifetime mental health problems; more than 80 percent have lifetime alcohol and drug probs.

Families are the fastest growing homeless population. Thirty-five percent of the homeless population in America are families, Polk said, and the average family stays in a shelter for 70 days.

Runaways are also a big part of the population. They have a shorter life expectancy than average children and adolescents, and many are dealing with issues of sexual orientation and self-esteem. Young homeless people are often escaping abusive environments, many of them facing issues of post-traumatic stress disorder and trauma.

Forty percent of homeless men have served in the armed forces, Polk said. "Vets are going to continue to be a big issue in this country. We saw it with Vietnam and we're likely to see it with the vets that are coming home now."

Challenges for EMS
The primary challenge for medics who deal with the homeless is to shift away from the old way of dealing with these patients. "We have to move away from the mentality of 'treat 'em feed 'em and street 'em'," Polk said.

Homeless patients have complicated, vague medical histories, Polk said, which means that communicating with them – getting a good history – is very difficult. Often, homeless patients live far from society, in camps that pose special dangers for medics who try to enter them.

"If you're called to go into a camp, you go in loud because they may have traps," Polk said.

The session was told of the common medical problems that affect the homeless, which include:

  • Cardiac disease
  • Hypertension
  • Dehydration
  • Hypothermia and hyperthermia
  • Diabetes
  • Alcohol-related cardiomyopathy
  • Emphysema
  • Pneumonia
  • Asthma
  • Tuberculosis
  • Malnutrition
  • Alcohol gastritis and ulcers
  • GI bleeding
  • Esophageal varices
  • Hepatitis
  • Cirrhosis

Many homeless patients have dogs – unconditional companions and that have also been rejected by society. In treating patients with dogs, medics should be prepared to bring the dog with the patient, lest they separate the patient from the only friend they have.

"For these patients, the one thing that loves them is their dog. Get ready to have some fleas in your ambulance," Polk said.

Finally, Polk said, EMS systems must have a protocol in place to handle these patients, and it will often be up to individual medics to help these patients get the treatment they need.

"There are services out there for the homeless, but medics are going to have to go find them," Polk said.

 

 

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