Persons Experiencing Homelessness Perceptions and Utilization of Emergency Medical Services in Los Angeles County

Persons experiencing homelessness (PEH) face high rates of chronic diseases and poor health outcomes. Los Angeles County has one of the largest PEH populations in the United States, with Emergency Medical Service (EMS) clinicians serving as frontline healthcare. This study examines PEH perceptions of EMS care and utilization to identify barriers to healthcare delivery.

Semi-structured, in-person interviews were conducted with a convenience sample of 30 adults experiencing homelessness in Los Angeles County. The interview guide explored attitudes and perceptions toward EMS, healthcare utilization, challenges to care delivery, and self-perceptions. Subjects were included if age ≥18 years, currently experiencing homelessness in Los Angeles County, English or Spanish speaking, and with at least one EMS interaction within the past 18 months. Interviews were audio-recorded, professionally transcribed and translated, and coded using an inductive, iterative approach. Thematic analysis was performed.

Participants were predominantly male (90%), with a mean age of 52.7 years and an average of 7.2 years of homelessness. 57% reported a history of substance use, 63% frequent alcohol use, and 54% had a history of psychiatric diagnoses. Self-rated health was poor or fair in 63% of participants, good or very good in 37%, and none reported excellent health. PEH reported EMS interactions for conditions related to medical complaints (58%), followed by trauma (17%), mental health (15%), and substance use or alcohol related calls (10%). Reported barriers to EMS care included the need for self-advocacy due to perceived EMS dissuasion of transport (35%); interpersonal conflict related to distrust, intoxication, or mental health crises (35%); and perceptions of differential treatment compared to housed individuals due to unhoused status (36%). Overall, 73% reported positive perceptions of EMS, citing professionalism and caring behavior.

PEH primarily use EMS for acute medical or trauma-related needs and generally report positive experiences. Barriers such as EMS dissuasion of care, interpersonal conflict, and perceived differential treatment limit optimal care. Further research is needed to characterize these barriers and develop targeted educational and operational solutions to improve EMS care for PEH.