What constitutes a “mental health emergency” in the field?
Ken Euler:
Typically, EMS is dispatched for what sounds like a physical emergency — but there’s often a mental health component behind it. For example, a call might come in as a self-inflicted injury or a domestic dispute. The mental health aspect is part of the situation, even if it’s not the primary reason we’re dispatched.
Jaran Floyd:
That’s changed over time. We now get called specifically for mental health evaluations more often, especially by law enforcement. They may ask us to determine whether there’s a medical issue — like blood sugar, medication effects, or something else — that’s causing altered behavior.
So part of our job is figuring out: is this a medical condition presenting as a mental health issue, or is it primarily a mental health situation?
We’re also thinking ahead: will we need additional support? These calls often involve collaboration with police and fire departments.
Will Winters:
And sometimes it goes the other way. You might get called for something like difficulty breathing, and it turns out to be a panic attack. In those cases, we shift quickly, helping the patient regulate their breathing and de-escalate.
We can’t force someone to go to the hospital, so if they’re a danger to themselves or others, law enforcement may need to step in.
How often do these types of calls occur?
Will Winters:
It depends on the area. In a busy system, you might see one every shift.
Jaran Floyd:
Even in smaller towns, we’re seeing them a few times a month. And that’s increased over the years. It used to be more of a secondary issue, and now it’s something we’re regularly dispatched for.
Ken Euler:
In larger metro areas, it’s even more common. It’s definitely prevalent enough to be a concern.
What are some of the biggest concerns on scene during these types of calls?
Jaran Floyd:
Scene safety is number one — for the patient, for us, and for anyone nearby. Not every situation is violent, but the potential is always there, especially if substance use is involved.
We’re constantly assessing: could this escalate? Is it safe to stay? There are times when crews have had to leave a scene because it became unsafe.
Will Winters:
Also, what you’re dispatched for isn’t always what you find. That unpredictability is part of the challenge.
Another factor is family members. They often mean well, but sometimes their presence or what they’re saying can unintentionally escalate the situation. In those cases, we may need to separate them from the patient to de-escalate effectively.
How do you build trust with someone who’s overwhelmed or in crisis?
Will Winters:
A lot of it is how you approach them. If they’re anxious or panicking, you use a calm tone and a compassionate approach. If things escalate, you may need to be more assertive — but most of the time, it’s about calming the situation.
Jaran Floyd:
We’re taught communication techniques, but a lot of it comes from experience. Tone, body language, and how you present yourself matter. You don’t want to come across as a threat.
We try to position ourselves as advocates: “We’re here to help you.” Often, we’ll separate the patient from the environment and have a one-on-one conversation to understand what’s really going on.
Will Winters:
Nonverbal communication is huge. Getting down to their eye level, maintaining eye contact — those things show you’re engaged and that you care.
And once trust is established, people start to open up. They may not tell you everything right away, but over time, they will.
Do patients often share more once they feel safe with you? Does the situation sometimes change mid-call?
All:
Absolutely.
Jaran Floyd:
Once they realize we’re not there to get them in trouble, they’ll start telling you more — what they took, what’s going on at home, what led to this moment. And sometimes that completely changes how we treat the situation.
Will Winters:
You might start treating one issue, and then new information comes out that requires a different approach. It’s an ongoing assessment — both medically and mentally.
Ken Euler:
We always start with the basics — airway, breathing, circulation. Then we assess mental status and begin to understand the bigger picture.
What happens if a patient refuses care, but may be a danger to themselves or others?
Jaran Floyd:
We work under a medical director, so we may consult them first. If a patient isn’t fully alert and oriented, we have more authority to intervene.
If they are alert but still a danger, law enforcement can initiate an emergency detention. That allows transport to a facility even if the patient refuses.
Ken Euler:
Other agencies may also get involved — like Adult Protective Services or Child Protective Services — depending on the situation.
Will Winters:
Sometimes we notice patterns too — frequent calls, unsafe living conditions, signs of neglect or abuse. That’s also when we involve additional services.
So our role isn’t just treating the immediate issue — it’s also recognizing when someone needs broader support.
It varies by jurisdiction, but it’s always a coordinated effort across multiple agencies.
What do you wish families or bystanders understood before calling 911?
Will Winters:
Early awareness is key. If you notice changes in behavior, don’t ignore them. Early intervention can prevent things from escalating.
And if you do call, be honest with the dispatcher. Give them as much information as possible.
Jaran Floyd:
Also, don’t be afraid to call. If something doesn’t feel right, it’s better to act. You’re helping that person, even if they don’t see it that way in the moment.
You can also request that responders arrive without lights and sirens if you think that might help keep things calm.
Ken Euler:
EMS is often who people call when they don’t have anyone else. We’re there to help — whatever the situation is.
Any final thoughts?
Will Winters:
Mental health emergencies are more common than people think, and there’s no shame in them. Everyone goes through difficult moments at some point.
Jaran Floyd:
Exactly. And not everyone has someone to turn to. That’s why we’re there.
Ken Euler:
Our role is to treat the patient, coordinate care, and connect them with the right resources. And often, that takes more than one interaction — it’s part of a longer process.
Participants
Jaran Floyd
Jaran Floyd is a lieutenant and paramedic with nearly 20 years of experience in fire and EMS. He holds advanced certifications including Master Structure Firefighter, Instructor II, and Officer II, and specializes in areas such as Swiftwater Rescue and Vehicle Extrication. Jaran also serves as a Field Training Preceptor and is a Senior Regional Sales Director at MASA.
Will Winters
Will Winters is a paramedic with over 20 years of experience across urban, rural, and air medical settings. He has led a county EMS service and worked in air medical business development. He currently serves as Vice President of Brokerand Strategic Partnerships at MASA.
Ken Euler
Ken Euler is a former lieutenant and paramedic with more than 20 years of service. His experience includes emergency response, trauma care, and specialized rescue operations. He is currently Vice President of Group Benefits Sales at MASA and remains active in supporting local first responder programs.
