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DENVER -- The Los Angeles homeless population made up 0.8% of the city's residents in 2018, but they accounted for 10.2% of all 911-emergency medical services (911-EMS) incidents, and 13.3% of all 911-EMS transports, a researcher reported here.

The rate of calls to 911-EMS was 1,135 per 1,000 among people without homes versus 81 per 1,000 people with housing, reported Joel Lombardi, MD, of the Los Angeles County-University of Southern California Keck School of Medicine.

Additionally, the rate of homeless individuals transported to hospitals was 18.9 times higher than people with housing, at 909 per 1,000 individuals versus 48 per 1,000, respectively, he said in a presentation at the American College of Emergency Physicians (ACEP) annual meeting.

"Homeless individuals in Los Angeles constituted a disproportionately high number of both 911-EMS incidents and transports in 2018," Lombardi and colleagues wrote. He added the problem will most likely get worse before it gets better as "Urban areas [in general] have seen a ."

L.A. city is 480 square miles with a population of about 4 million, of which 31,825 were estimated to be homeless in 2018 by the L.A. Homeless Services Authority. More recent estimates put that figure at 60,000, Lombardi said.

"There is a large concentration of homeless individuals in the downtown [Skid Row] area, which is the location of several homeless shelters and missions," Lombardi's group noted.

"Rescue 9 is the primary fire department station that handles the Skid Row area," Lombardi said. "It is not unusual for Rescue 9 to make 20 runs a day in response to calls from the area."

The study was a 12-month retrospective review from January to December 2018 of electronic health records for 911-EMS incidents attended by the Los Angeles Fire Department (LAFD), which is the sole EMS provider for the city of Los Angeles, the authors explained.

Housing status is a mandatory field on EHR patient care reports completed by out-of-hospital responders on scene for all incidents, they added.

During the study period, LAFD recorded 355,421 911-EMS incidents, of which 10.2% were for homeless individuals and 89.8% were for housed individuals.

The battalion covering the Skid Row area produced 3% of all 911-EMS incidents citywide, with 31.4% of incidents in this battalion being for homeless patients, the authors reported. Of the 217,977 calls resulting in treatment and transport, 13.3% were for homeless individuals and 86.7% were for housed individuals.

Lombardi's group also found that treatment with no transport against medical advice rates were higher for housed individuals at 5.4% than for homeless patients at 2.3%.

The situation in Los Angeles is not unique, said ACEP session moderator Ayanna Walker, MD, of the University of Central Florida College of Medicine in Orlando.

"We see a similar problem in Central Florida too" she said, "One of the things I would like to know is, whether there are super users? Of those people who are activating 911, are they the same few homeless people? Are these calls being activated by the homeless people, or by bystanders who are concerned about the health of someone who may be sleeping on the sidewalk? I think our situation in central Florida might be even worse because we don't have shelters for these people in our county."

Lombardi said that anecdotally he is aware of some homeless people in his area who call 911-EMS >100 times in a year. Also, some patients are taken directly to sober homes or to psychiatric services, depending on the circumstances.

"The emergency departments [ED] are becoming overcrowded and overwhelmed, so if we can do things to divert certain populations away from the ED resources ... do these people really need ED care or do they need something else," Walker stated.

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