Office of Rural Health and Primary Care - emergency models

Successful Model for Rural and Underserved Communities

Itasca County Crisis Response Team & Meds-1 EMS

Geographic Area: Itasca County

Background: Patients in behavioral health crisis are often viewed differently than other patients requiring triage, treatment and transport. Commonly hospital emergency rooms are not prepared to adequately assess and care for patients presenting with mental/behavioral health issues. Law enforcement will be called to intervene in situations not involving criminal activity or public safety concerns.

The same is true for medical transportation. Daily, across Minnesota, hospitals are unable to locate nearby appropriate facilities for inpatient behavioral health care and rely on either law enforcement or an Emergency Medical Services (EMS) ambulance team to provide transportation. This takes these valuable resources away from communities for extended periods of time. Patients discharged from these distant facilities have little coordinated re-entry care planned with community-based providers.

Description: In 1994, the Moose Lake Regional Treatment Center closed. Then in 1997, after the local psychiatric unit closed, a group of mental health care providers, medical care providers including EMS, and social/human service employees collaborated to formulate a plan to meet the mental health needs of individuals in Itasca County. The Itasca County Crisis Response Team was formed.

This team is composed of mental health professionals who can provide face-to-face or telephone crisis intervention service, as well as consultation services to professionals in the community. The team is accessed through First Call for Help. Necessary funding is made available through a joint effort between the county and Minnesota Departments of Health and Human Services.

In partnership with Meds-1 EMS and local hospitals, team members act as consultants in the emergency department and aid in developing care plans that many times do not include inpatient care or transfers. When inpatient care is deemed necessary, the team member is instrumental in finding services at the closest appropriate facility. When EMS transports occur because of medical necessity, the crisis response team member assists in assessment and care during transit allowing for the beginning of discharge planning to occur enroute and at the time of admission. Team members also provide ongoing community-based support for the patient after the initial contact.

Outcomes: Since 1999, the Itasca County Crisis Response Team has responded to over 25,000 requests and in each case has developed care plans that involve community-based services rather than distant, often difficult to access resources. This single strategy has resulted in measurable clinical benefits and cost saving.

Challenges/Lessons Learned: To be successful, community-based plans require all resources to “buy-in.” Using consultants in both emergency departments and in the EMS arena requires training and acceptance. Once the benefits are explored and experienced the crisis response team process is accepted and utilized as an essential public health and safety service and the shared intervention strengthens the understanding and capabilities of both entities. Medical providers including EMS, law enforcement personnel, and the public all have enhanced sensitivity regarding patients in a behavioral health crisis. The community views these crises as requiring plans of care similar to that of acute trauma, stroke or heart attack.

Partners:  Itasca County Health & Human Services; Meds-1 EMS, First Call 211 Information & Referral, The Itasca County Law Enforcement community, and the community of Itasca County.

Plans for the Future: Improved data collection for internal planning and response and continued cooperative planning with local providers.

For more information
Contact: Itasca County Crisis Response Team, Tom Gaffney, M.A., R.N.C., L.P.C. – Director, 218-327-6139 or or Timothy J. George N.R.E.M.T.-P., Meds-1 EMS Director of Operations, at 218-326-0020 or

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Updated Wednesday, September 21, 2011 at 03:15PM