Department to train community paramedics to initiate some 5150 holds as street teams expand

Assistant Deputy Chief Sandy Tong told the commission that, as the local EMS authority transitions and the department expands community paramedicine, the city will phase in authority for community paramedics and rescue captains to initiate certain 5150 psychiatric holds.

"This will happen either on the street crisis response team initially, with the wellness. All the community paramedics will be trained to be able to provide, or to be able to, put somebody on a 51 50 hold," Tong said, describing a phased approach that begins with clinicians already riding on SCRT units and then expands training for other rescue captains and paramedics.

Tong and other staff said the goal is to reduce police involvement when medically appropriate and to provide more immediate clinical assessment and case management on the street. Commissioners asked about protocol, training length and oversight; Tong said training curricula are being developed with the Department of Public Health behavioral-health unit and EMSA, and that training for community paramedics may be only a few hours beyond existing clinical training, with additional instruction for nonparamedic rescue captains.

Commissioner Ken Cleveland and others highlighted data in the packet showing that about 20–25% of 911 medical calls are for people experiencing homelessness and that frequent callers impose a disproportionate demand on department resources. Tong said the SCRT data show most police requests did not result in police responses (533 police requests yielded nine instances that required police that month) and that the department will continue to refine its triage and response protocols as programs expand.

Officials emphasized a measured rollout, training oversight, and continued collaboration with EMSA and DPH as the department implements the expanded roles for community paramedicine teams.