It’s not unusual to see an ambulance parked along the stretch of Broadway around the I-40 overpass, lights flashing. It’s one of those scenes that has become part of the downtown landscape, though no less sobering for its familiarity.
The “Mission District,” home to Knox Area Rescue Ministries, The Salvation Army and a concentration of other service providers, has long been one of Knoxville’s busiest destinations for emergency medical crews. People gather here because it’s where meals are served, beds can sometimes be found and resources are available. It’s also where many people living with chronic illness, addiction, mental illness and homelessness spend their days.
For years, that translated into a steady stream of 911 calls. In many cases, they might not be having a medical emergency, but they do need medical care.
When American Medical Response (AMR) launched the Mission District Medical Team about two and a half years ago, the goal was to reduce repeated non-emergency ambulance responses that were tying up EMS resources.
Since then, Mission District 911 requests have since declined by 32%, helping keep ambulances available for time-critical emergencies like serious crashes and heart attacks that cannot wait.
In the process, though, the team’s understanding of the problem has evolved.
What began as a field-driven outreach effort has since grown into a partnership between AMR, the Knox County Health Department, Knoxville Fire Department, Metro Drug Coalition, Project Relaunch, Knoxville Area Project Access and other community organizations that return to the Mission District every Tuesday.
Instead of waiting for the next emergency, the team provides wound care, first aid, health assessments, chronic disease support, patient navigation, virtual healthcare access and connections to behavioral health services, recovery programs, veteran services, insurance assistance, food resources and other community partners before another emergency occurs.
Yesterday, I spoke with Wesley Brookshear, the critical care paramedic who helped develop and now leads the initiative.
“I thought people were overusing 911,” said Brookshear. “What I realized was they were using the only healthcare system that would respond.”
Homelessness is such a complicated issue. Last fall, in an effort to better understand it, I spent a couple of days in the “day camp” beneath the I-40 overpass, just listening. I met people who had lost jobs, people battling addiction, people living with serious mental illness and people whose stories defied any easy explanation.
I also watched others drift through the camp looking to exploit that vulnerability, selling drugs and otherwise taking advantage of people with few good options.
There was hardship and some tensions, certainly, but there was also humor, generosity and a sense of community. Like any neighborhood, it contained all kinds of people. Unlike most neighborhoods, nearly everyone there was living through trauma. Being unhoused is traumatic in itself, Brookshear notes. And for many it’s only one chapter in a much longer story.
Under the overpass, I wondered aloud to a few folks about their resistance to help, even when surrounded by organizations and people genuinely trying to offer it. The answer, unsurprisingly, isn’t simple.
For some, the barriers are bureaucratic, like missing identification, lack of insurance, transportation or a phone. For others, years of disappointing or traumatic experiences with healthcare, shelters or other institutions have eroded trust. A couple folks I spoke to worried that they couldn’t bring their dog. What can look from the outside like refusing help is often a survival strategy shaped by experience.
By showing up every Tuesday without judgment, and without expecting immediate results, the Mission District Medical Team has begun earning that trust back.
“What we realized quickly is folks had lost faith in our entire healthcare system,” Brookshear said. “They didn’t feel like they belonged in the emergency room, but they didn’t have access to primary care.”
Many of the people repeatedly calling 911 were living with untreated diabetes, hypertension, seizure disorders, infections, chronic wounds (“some the size of a fist … the sort of thing you shouldn’t see in a civilized nation,” Brookshear said) and other conditions that had gone unmanaged because they lacked consistent access to healthcare.
Brookshear, along with some other members of the team, knows from personal experience how precarious safety and stability can be. He speaks about the unhoused community they serve with obvious respect, pushing back against stereotypes.
“We meet people where they’re at,” Brookshear said. “A lot of them have families. They have hopes and they have dreams. They want a job. They want a life. They just need a little help.”
Over the past two years, the team has responded to more than 4,800 Mission District encounters and requests. Only nine outreach encounters required ambulance transport. The initiative has served more than 515 individuals and helped more than 140 people enter treatment or sober living.
I asked Brookshear whether any particular stories stood out.
He thought for a moment before recalling one unhoused person who suffered what he described as “horrific frostbite.” They had already lost several toes and were at risk of losing both feet. The team coordinated emergency podiatry appointments while volunteering to provide daily wound care for weeks: “They saved their feet.”
Today, that person returns on foot not as a patient, but bringing others who need help. Brookshear added, “I have a thousand stories like that.”
After a great deal of research over the past year—attending meetings, talking with stakeholders and spending time with people living this reality—I wish I could say I had some original and profound insight into Knoxville’s homelessness situation. I don’t. It’s an enormously complex issue with no simple solutions. What I do know is that I’m grateful for the many people and organizations, including the Mission District Medical Team, who keep showing up and doing the work of helping our neighbors.
