Episode #115
Knoxville’s Mission District model takes EMS beyond the 911 call
In this episode of EMS One-Stop, Rob Lawrence speaks with Wesley Brookshear, critical care paramedic and FTO program supervisor with AMR in Knoxville, Tennessee, about a community-led effort that is changing how EMS responds to the city’s Mission District. What began as an attempt to understand unusually high 911 utilization has evolved into a multidisciplinary outreach program bringing EMS, public health, addiction services, shelter providers, clinicians and other community organizations directly to Knoxville’s unhoused population. By concentrating on relationships, consistency and basic human needs, the initiative has produced a reported 32% reduction in traditional EMS call volume while dramatically expanding access to wound care, food, addiction treatment, mental health support, nurse navigation and other services. Wesley explains why the program’s success is less about creating another specialized EMS unit and more about connecting people to the resources that already exist. The team initially arrived without uniforms, handed out fruit, listened and built trust before attempting to provide care. Two years later, the program has recorded thousands of encounters, helped more than 140 people enter treatment or sober living and generated remarkably few ambulance transports from its outreach activity. The conversation explores how other EMS systems can identify high-utilization areas, develop community partnerships, protect the mental health of outreach staff and start small—even with a single motivated employee. Above all, Wesley argues that EMS has an opportunity to move beyond simply transporting patients and instead become the connector that gets people to the care and resources they actually need. Additional resources: Global Medical Response - AMR Mission District Medical Team Program Sees 32 Percent Decline in 911 Calls eBook: How to fund community paramedicine Very high EMS utilizers: 7 strategies for local action From sirens to solutions: Guiding paramedics to a patient-centered mindset Public health at the front door: An MIH model to emulate Key quotes “We did go down without our EMS uniforms on. We went in black t-shirts, blue jeans and started making connections.” — Wesley Brookshear “We have noticed a 32% reduction in our normal call volume down at the mission since we started this program 2 years ago.” — Wesley Brookshear “MIH, mobile integrated healthcare, isn't a title; it's actually a list. It's mobile, it's integrated and it's healthcare.” — Rob Lawrence “This is not Wesley Brookshear, this is not AMR, this is an entire community of Knox County citizens that are coming together to support.” — Wesley Brookshear “We talk about the homeless or the unhoused, and I do use both terms, but the unhoused, and we act like it's those individuals; it's never those individuals, those are humans within your community.” — Wesley Brookshear “My mission wasn't admission avoidance, it was arrival avoidance.” — Rob Lawrence “Our folks are wrapping their own wounds now. We are providing supplies. We are giving education.” — Wesley Brookshear “Do not go down with the idea that you're going to cure this idea that homelessness is going to go away.” — Wesley Brookshear Episode timeline 00:49 – Rob introduces the episode and the concept of specialist teams focused on populations at risk 01:52 – Wesley introduces himself, AMR Knoxville and the multidisciplinary Mission District outreach team 03:25 – Identifying concentrated 911 utilization around the North Broadway area 04:22 – The headline result: a 32% reduction in normal call volume after 2 years 05:08 – Building services around Maslow’s hierarchy of needs: food, water, shelter and safety 06:10 – How the project began with surveys asking community members what they actually needed 06:50 – Wesley emphasizes that homelessness should be understood as a human and community issue 08:05 – Building partnerships and establishing a consistent Tuesday outreach presence 08:28 – Why the team initially attended in jeans and black t-shirts rather than EMS uniforms 10:10 – Rotating team members to manage emotional and mental-health pressures 11:27 – Training new outreach personnel and protecting the culture of the program 12:10 – The practical work: washing wounds, basic dressings and human contact 13:02 – Patients begin managing and dressing their own wounds with education and supplies 13:26 – Taking CPR and Stop the Bleed education directly into the Mission District 14:00 – Using GMR nurse navigation to expand access to alternative care and follow-up 16:09 – Nurse navigation, mental-health pathways and bypassing the emergency department when appropriate 18:28 – Discussion resumes: community paramedicine versus mobile integrated healthcare 19:23 – Rob defines MIH as “mobile, integrated and healthcare” 20:01 – Building relationships with partner organizations beyond the street-level outreach work 21:23 – Program numbers: approximately 4,800 encounters, 515-plus people served, 140-plus entering treatment or sober living, and only nine outreach encounters requiring ambulance transport 22:14 – A frostbite patient whose feet were saved through coordinated community intervention 24:23 – Wesley reflects on severe wounds, winter outreach and the impact of simple acts of care 25:18 – Where another EMS chief should start: find the hot spots and find someone who cares 26:39 – Starting small and expanding services gradually through community partnerships 27:08 – Why handing someone a resource list is not enough 27:36 – EMS as clinicians and navigators rather than simply a transport service 28:50 – Rob discusses “arrival avoidance” and directing patients into appropriate pathways of care 29:51 – The minimum viable program: one person who builds connections and physically links patients to resources 30:42 – Costs, donated supplies and the operational value of reducing unnecessary 911 demand 31:55 – The broader return: increased ambulance availability and potentially improved workforce engagement 33:14 – What not to do: don't approach outreach expecting to “solve homelessness” 33:43 – Managing compassion fatigue and rotating team members 34:58 – Food, coffee and small gestures as tools for relationship-building 35:26 – Challenging assumptions about who becomes unhoused 36:51 – Wesley's closing message: seek opportunities for EMS to grow and approach vulnerable populations with compassion 38:38 – Rob closes the episode with a challenge to EMS leaders: start something, even if it is small Enjoying the show? 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