Rethinking EMS Outreach: The Patient Who Thought They Weren’t Wanted
We were making rounds when an individual experiencing homelessness approached us, quiet at first, almost hesitant. Then I saw it.
I’ve been in EMS for years, and I can say without hesitation that it was one of the worst wounds of my career. The smell hit next, and I remember thinking how long this person must have been suffering, living with a wound so severe it prevented them from even sitting.
I begged the individual to let me take them to the hospital. They shook their head.
“They don’t want me,” they said. “They don’t take care of our people.”
That moment stayed with me — not because of the wound, but because of what that person believed. Not just that they were sick, but that they were unwanted. In their mind, healthcare, something most of us take for granted, simply wasn’t available to them.
That encounter embodies the reason we started an unhoused outreach program at American Medical Response in Knoxville. We recognized a gap between the unhoused population and access to care, and it compelled us to act. What began as a small, field-driven effort has grown into a collaborative initiative supported by partners such as the Knoxville Health Department, Project Relaunch, Knox Area Project Access, Metro Drug Coalition, Knoxville Fire Department, Knox Street Outreach Medicine, and the Knox Area Rescue Mission.
And that story is not unique.
It reflects the reality for many individuals experiencing homelessness. These are not “those people” or “them.” These are individuals — people who have often experienced profound trauma, loss, and instability. Many are living without reliable shelter, safety, food, or access to healthcare. Yet despite all of that, they continue to fight to survive every single day.
From an EMS perspective, this challenge is impossible to ignore. At one point, we identified that 6% of our calls were originating from a single location associated with our local mission district. In EMS, we often talk about high utilizers and system strain, but behind those numbers are people with unmet needs, untreated illness, and few places to turn. When individuals lack access to preventive care and consistent support, the effects ripple across the entire healthcare system — from overcrowded emergency departments to increased 9-1-1 demand and strained emergency resources. This is not an isolated issue; it impacts the entire community.
Changing The Model: Community Paramedicine
For too long, EMS has operated under a simple model: “you call, we haul.” But that model is no longer sustainable. It doesn’t reflect the complexity of what we are seeing in the field. Many of these patients do not need a ride to the emergency department. They need consistent care, meaningful follow-up, and someone willing to meet them where they are. Hospitals, already overwhelmed, are often not equipped to bridge that gap. The result is a mismatch that keeps patients cycling through episodic care without meaningful, long-term improvement.
What we built in response didn’t begin as a formal program. It wasn’t developed in a boardroom or rolled out with a polished plan. It grew organically from repeated encounters, unmet needs, and a willingness among providers to do something different.
At its core, our approach is relationship driven. Instead of focusing solely on the call, we focus on the person. We show up consistently, engage with respect, and treat every individual with dignity, regardless of their circumstances. Over time, that approach changes everything. People who once refused care begin to open up. They accept help — not because they were pressured, but because trust was built.
We have also redefined the role of EMS; not as the endpoint of care, but as a connector. In many ways, this is community paramedicine in practice: meeting patients where they are, addressing needs before they become emergencies, and connecting them to the right level of care. Through partnerships with healthcare providers, shelters, outreach organizations, and community resources, we can link patients to care beyond the back of an ambulance. This includes virtual care options, alternative transport destinations like urgent care, access to medications through local pharmacies, and coordination with shelters or warming centers when conditions become life-threatening.
Meaningful Results
The results have been meaningful, measurable, and life-enhancing. We have provided wound care to hundreds of individuals who otherwise would have gone untreated. We have helped connect many to rehabilitation and sober living programs. But numbers alone don’t tell the full story. What matters most is the shift in trust. Individuals who once avoided the system are now actively seeking care. Some are pursuing insurance coverage, entering recovery, or reconnecting with services they had long written off.
There are benefits for providers as well. In a field where burnout is high, this work reconnects clinicians to their purpose. It reminds us why we entered EMS — not just to respond, but to truly care. Being a patient advocate should never be situational or influenced by socioeconomic status or bias.
The broader healthcare system feels the impact as well. With improved access to preventive care and follow-up, crisis-driven 9-1-1 calls can decrease. Emergency departments experience less strain from repeat visits that could have been managed elsewhere. Resources become better aligned with what patients need.
But the most important outcome isn’t operational — it’s human. It’s the restoration of dignity and trust. It’s the moment when someone who once believed they didn’t matter begins to believe that they do.
This matters now more than ever. Housing insecurity is increasing, and healthcare systems are under significant strain. At the same time, EMS agencies are facing staffing shortages, rising call volumes, and burnout. EMS sits at a critical intersection between public safety and healthcare, often serving as the only consistent point of contact for this population. That position creates both an opportunity, and a responsibility, to do more.
We have the ability to help redefine EMS as a true healthcare partner, moving beyond a system built solely on transport.
The lesson we have learned is simple: start small, build relationships, and focus on people over process. Rigid protocols alone don’t work in environments that require flexibility, empathy, and trust. Sustainable change happens when clinicians are empowered to adapt, collaborate, and advocate.
When someone believes they are not worth care, that is not just their story, it’s ours.
So, the question isn’t whether EMS should be involved. It’s how we choose to show up — and whether we are willing to truly see the person in front of us, not just the call.
About the Author
Daniel "Wesley" Brookshear is a critical care paramedic and field training officer program supervisor with American Medical Response in Knoxville, Tennessee. Brookshear helped develop an outreach initiative focused on building trust, expanding access to care, and connecting individuals experiencing homelessness with healthcare and community resources. He is passionate about community paramedicine, patient advocacy, and strengthening the role of EMS as a healthcare partner.
