International Street Medicine Symposium 2025
Nutritional needs, resources, and barriers among unhoused adults cared for by a street medicine organization in Chicago, Illinois: a cross-sectional study
Our Northwestern Chicago Street Medicine chapter published a study titled in BMC public health. It found that most houseless participants were unable to acquire a balanced diet and often relied on organizational efforts to eat. Read it here.
|
|
|
| ||||
International Street Medicine Symposium 2024
International Street Medicine Symposium 2023 Annual Meeting, London UK
International Street Medicine Symposium 2019 Annual Meeting, Pittsburgh PA
Assessing Capacity on the Streets (2018)
|
What is the Issue? There is currently no protocol for the assessment of capacity when practicing Street Medicine. Ethical Considerations: Street Medicine organizations work to address the health and social service concerns of the unsheltered homeless by engaging individuals in their spaces of residence and gathering. This population consists of marginalized and vulnerable individuals, who despite living with more chronic illness than the general population, are less likely to utilize primary care or outpatient care services. Additionally, this group is disproportionately affected by mental illness and substance use disorders. As such, caring for these patients and assessing capacity can be very complex. Persons experiencing homelessness, especially those with mental health disorders, are generally assumed to have diminished capacity, thus making them increasingly vulnerable to exploitation and manipulation.4 Therefore, it is important to facilitate trust and to only escalate care against protest when medically appropriate. |
| ||
Our Aim:
Many studies have highlighted the increased complexity of assessing decision-making capacity among individuals experiencing homelessness. However, no official protocols have been developed to address the complex needs of the population to ensure that appropriate medical care is given in a respectful manner. As such, our aim is to propose a streamlined protocol which could be used by street medicine practitioners to enhance the ability of providers to assess capacity and thus deliver higher quality health care.
Existing Protocols:
Chicago EMS Protocol
When an adult patient who is alert, oriented, and able to communicate refuses care or transportation, it is the responsibility of the EMS provider to advise the patient of his/her medical condition and explain the necessity for care or transport. If the patient continues to express steadfast refusal, online medical control should be contacted while on scene, and all events should be documented.
Alternatively, if the patient demonstrates behavior and/or has a medical condition that impairs decision making capacity, EMS should continue treatment and transport in the best interest of patient. Patient capacity may be impaired in trauma, intoxication, hypoxia, dementia, and psychiatric or behavioral emergencies, including suicidality and inability to care for self.
Inpatient Protocol
Clinicians often have to assess for capacity while treating patients in an inpatient setting. The main principles guiding capacity assessment include obtaining informed consent prior to initiating treatment and ensuring that patients are able to make informed decisions for themselves. There are many tools to assess mental capacity including the Mini Mental Status Exam and MacArthur Competence Assessment Tool for Treatment. To demonstrate capacity, patients and clinicians must work together to establish that patients can:
Many studies have highlighted the increased complexity of assessing decision-making capacity among individuals experiencing homelessness. However, no official protocols have been developed to address the complex needs of the population to ensure that appropriate medical care is given in a respectful manner. As such, our aim is to propose a streamlined protocol which could be used by street medicine practitioners to enhance the ability of providers to assess capacity and thus deliver higher quality health care.
Existing Protocols:
Chicago EMS Protocol
When an adult patient who is alert, oriented, and able to communicate refuses care or transportation, it is the responsibility of the EMS provider to advise the patient of his/her medical condition and explain the necessity for care or transport. If the patient continues to express steadfast refusal, online medical control should be contacted while on scene, and all events should be documented.
Alternatively, if the patient demonstrates behavior and/or has a medical condition that impairs decision making capacity, EMS should continue treatment and transport in the best interest of patient. Patient capacity may be impaired in trauma, intoxication, hypoxia, dementia, and psychiatric or behavioral emergencies, including suicidality and inability to care for self.
Inpatient Protocol
Clinicians often have to assess for capacity while treating patients in an inpatient setting. The main principles guiding capacity assessment include obtaining informed consent prior to initiating treatment and ensuring that patients are able to make informed decisions for themselves. There are many tools to assess mental capacity including the Mini Mental Status Exam and MacArthur Competence Assessment Tool for Treatment. To demonstrate capacity, patients and clinicians must work together to establish that patients can:
- Clearly communicate their understanding of their medical condition
- Clearly communicate the available treatment options
- Clearly communicate the result of not receiving treatment
- Clearly communicate their choice of treatment (or refusal of treatment)
Medication assisted Detoxification in the Emergency Department (MAD-ED): A Policy Proposal for Safety Net Hospitals (2018)
What is the issue?
There is currently no protocol for initiating Medication-Assisted Detox in the Emergency Department (MAD-ED) in safety-net hospitals in Chicago
Why is this is an issue?
Patients suffering from opioid-use disorder have very complex medical needs that are not currently being addressed. Chronic drug users utilize 30% more emergency healthcare services than the general population and are at higher risk for hospitalization, but due to fears of withdrawal and stigmatization, these patients frequently delay care and leave AMA far more often than the general population. This leads to increased costs for their care and increased morbidity and mortality after hospitalization.
There is currently no protocol for initiating Medication-Assisted Detox in the Emergency Department (MAD-ED) in safety-net hospitals in Chicago
Why is this is an issue?
Patients suffering from opioid-use disorder have very complex medical needs that are not currently being addressed. Chronic drug users utilize 30% more emergency healthcare services than the general population and are at higher risk for hospitalization, but due to fears of withdrawal and stigmatization, these patients frequently delay care and leave AMA far more often than the general population. This leads to increased costs for their care and increased morbidity and mortality after hospitalization.
Details from: D’Onofrio, G, et al. “Emergency Department-Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial.” JAMA, vol. 313, no. 6, 2015.
Key Further Reading
|
Data to support
When compared to Screening and Referral (with or without Brief Interventions), initiating medication assisted treatment in the emergency department was significantly more effective in:
Establish a Medication Assisted Detox in the Emergency Department (MAD-ED) in Chicago’s safety-net hospitals 
| ||
Association of Medicine and Psychiatry 2018 Annual Meeting, Chicago IL
Frostbite Injuries in Chicago's Unsheltered Population
Owen Lewer, Cassandra Singler, Emily Wong, Danielle McGinnis, Theresa Nguyen
Lewer O, Singler C, Wong E, McGinnis D, Nguyen T. Frostbite Injuries in Chicago's Unsheltered Population. J Health Care Poor Underserved. 2025;36(1):284-294. doi: 10.1353/hpu.2025.a951597. PMID: 39957650.
Abstract
People experiencing unsheltered homelessness (PEUH) have an increased risk of frostbite injury, which can be a dangerous and debilitating condition. Our study aims to determine the prevalence, incidence, and impact of frostbite in the unsheltered population in Chicago and nearby suburbs. We administered a survey at a Chicago Transit Authority metro station in suburban Cook County to assess the frequency of frostbite injury and the circumstances surrounding frostbite in this community. Our results demonstrated that frostbite is both common (incidence rate (IR) =1271.67 cases of frostbite per 100,000 life-years (LY)) and highly morbid (IR=46.24 amputations per 100,000 LY) in PEUH in Chicago. We hope to include more street medicine partners to raise awareness about the impact of frostbite injury in the unsheltered population and advocate for improved emergency preparedness plans during the cold winter season.
Abstract
People experiencing unsheltered homelessness (PEUH) have an increased risk of frostbite injury, which can be a dangerous and debilitating condition. Our study aims to determine the prevalence, incidence, and impact of frostbite in the unsheltered population in Chicago and nearby suburbs. We administered a survey at a Chicago Transit Authority metro station in suburban Cook County to assess the frequency of frostbite injury and the circumstances surrounding frostbite in this community. Our results demonstrated that frostbite is both common (incidence rate (IR) =1271.67 cases of frostbite per 100,000 life-years (LY)) and highly morbid (IR=46.24 amputations per 100,000 LY) in PEUH in Chicago. We hope to include more street medicine partners to raise awareness about the impact of frostbite injury in the unsheltered population and advocate for improved emergency preparedness plans during the cold winter season.
