Response to PPB’s Medical Aid Directive

FROM: Mental Health Alliance
TO: Mayor Ted Wheeler, City of Portland
TO: Chief Charles Lovell, Portland Police Bureau
Attention: Ashley Lancaster, Portland Police Bureau

April 20, 2022

RE: RE: Medical Aid Directive
PPB 0630.50, Medical Aid (New Title)
Second Universal Review: 3/22/22 – 4/21/22

The Portland Police Bureau Medical Aid Directive 0630.50 was reviewed by members of the Mental Health Alliance on April 20, 2022 and their comments below were agreed to unanimously. The Alliance created the comments as external subject matter experts in the area of policing people with mental illness and addiction, recognized by the Federal court as amicus curiae in US DOJ v City of Portland since 2018. We appreciate the opportunity to provide feedback on this important PPB policy.

This is the first set of comments the Alliance has made on PPB Directives and we will invite the PPB Policy Development Team to discuss in due course. Further, as the PPB is requesting routine public comment – including suggestions for amending directives – we assume there is a defined process of accepting or rejecting comments and suggestions. It’s essential to the Alliance’s engagement with reviewing additional directives that there be a clearly understood process, with identified personnel, criteria, and timelines. Once an executive summary of 0630.50 is available, the Alliance will invite a discussion with the Chief’s Office about their process and the results of external comments and suggestions.

In general the Alliance work group members remarked that vague language throughout the directive gives an officer leeway to not act with urgency in a situation where a person’s health could be damaged by delay. Officers should be given clear direction at all times and the welfare of an ill or injured person should be primary at all times.

We were surprised and dismayed to see that in Item 3 medical services are to be contacted by officers only after force is used. This is too late. Once force is planned by officers, or expected, or possible, emergency medical services should be called. Consider when an officer has time to put on latex gloves, an ambulance should already be rolling. If this is a contractual issue between PPB and the EMS vendor because the EMS vendor can only bill commercial or public insurance for an actual injury, PPB needs to source an alternative responder or other vendor.

For Items 3.1.3 and 3.7, the Alliance urges PPB to remove the term “excited delirium” from this directive and all other directives. Neither “excited delirium” or “agitated delirium” are accepted as diagnosis by the Diagnostic Statistical Manual or classified as diseases in the ICD 9 or ICD 10. Both terms, promoted since the 1980s by Taser International, now Axon, are employed to shield the corporation and cities from liability for misuse of force. As terminology they mislead and misinform both officers and the public. The Alliance can provide the PPB with substitute words and terms if they are needed.

Item 3.4 states in part, “Members shall notify corrections staff of the person’s injuries and medical treatment received…” This sounds like an invitation to increased liability for officers – and a task outside of their mandate. Medical personnel called to the location should directly and immediately message county corrections health staff with an assessment of injuries and treatment received by the arrested person, as well as explain necessary followup. If technology for direct written messaging is unavailable, medical personnel should use a telephone to contact and communicate with county corrections health staff.

Since force is used by police against people with mental illness and addiction more than any other type of person, we strongly suggest using emergency medical technicians who do not ride in a fire truck or conventional ambulance. Lights and sirens can easily escalate the behavior of both police officers and people in a mental health crisis leading to further force and harm. Calling for medical services before force is used rather than after is key to reducing lethal use of force.

Sometimes no medical aid should be provided by officers. In non-urgent and non-arrest situations, when a person has a mental health alert, or is in a real or perceived mental health crisis or is intoxicated, if an Enhanced Crisis Intervention Training officer is not at the location, officers should disengage and contact the Multnomah County Crisis Line to request Project Respond or another available and appropriate service or appropriate individual be dispatched. Here is a list of appropriate services. Officers should remain at the location and monitor the individual until an alternative responder arrives.

The definition of a “real or perceived mental health crisis” is fairly subjective. Members of the Alliance can help PPB form a solid understanding of this status to help keep everyone safer.

We were surprised and pleased to see the items in 3.8 – Crowd Control, instructing officers to allow “non-certified medics” to provide help. (Our experience is that most persons providing medical care at demonstrations are, in fact, certified medical professionals of some sort, so you might want to remove that unnecessary assumption.) Perhaps some of the “non-certified medics” could provide an alternative urgent response to people in mental health crisis if Project Respond is not available.

Please consider adding a directive – perhaps elsewhere – instructing officers not to use aerosol chemicals or sound weapons in residential areas – especially in areas where people who are homeless are encamped. Many people who are homeless do not have alternative places to go, and their property, including food, clothing and bedding, can easily be saturated with chemicals causing health problems.

Specific Comments

1.2 Barrier masks should be available in first aid kits.

2.1 The words encounter and compromise are unnecessarily mysterious. The words respiratory and cardiac are unnecessarily technical. Use the word will instead of the word shall throughout. Consider deleting items 2.1.1 and 2.1.2 entirely.

The sentence should be amended to read,

“When members encounter a restrained person is suffering from heart or breathing problems respiratory or cardiac compromise, they shall request EMS immediately if.”

If a person in custody is in “respiratory or cardiac compromise” EMS should always be summoned.

3 Since no requirements prior to this item are about force, we suggest you remove the word additional from the sentence.

3.1 “Earliest available opportunity” is vague. The word immediately needs to be used.

Add the word emergency to medical services – “emergency medical services.”

If force is expected and planned by officers, emergency medical services should always be called to the scene PRIOR to force being used, not after.

See also 3.7.

3.1.3 Do not use the term “excited delirium” in any way at any time. The term “mental health crisis” or “intoxication” or “agitation” are suitable replacements. You could also use “real or perceived mental health crisis.”

3.5 Replace “As soon as practical” with the word immediately.

3.7 See 3.1.3 above.

3.7.2 There is a typo in this sentence. This is very good. This is very good. Amend the text to read, “Take reasonable action to accommodate people with disabilities when issuing or enforcing order to disperse.

4.2 Why only marked patrol vehicles? Is this different from disguised vehicles?

The Mental Health Alliance is a program of the Mental Health Association of Portland, a nonprofit education organization. More information about the Mental Health Alliance, including a list of organizational and individual members, and further contact information can be found on the program’s website at