Stabilization Centers and EMS Diversion
You’ve seen this patient before. Found sitting on a curb, intoxicated, protecting their airway, with stable vital signs, and ultimately headed to an emergency department where they will spend hours being observed with little to no intervention. It is a familiar call, and one that quietly consumes time, beds, and system capacity.
In a recent Prehospital Care Research Forum Journal Club article, the author described their work examining an alternative approach to this patient population. Building on their published study, the author team explored a stabilization center model in Toronto, Canada, designed as a nonmedical destination for select patients with alcohol or opioid intoxication transported by paramedics. As the authors described in both the paper and related podcast, the goal was not to replace emergency departments, but to better align patient needs with the most appropriate care environment. In essence, this model rethinks a common EMS call and offers a potentially better destination supported by evidence.
Study Overview
The study evaluated 3,744 patients transported by paramedics to a stabilization center between December 2022 and December 2024. Approximately 80% of patients were transported directly from the community, while the remainder were initially taken to an emergency department and later redirected. The stabilization center was a 10-bed, nonmedical facility operating 24/7 and staffed by allied health and support personnel. It focused on supervised recovery, harm reduction, and connection to services, with patients able to remain for up to 24 hours and transferred to an emergency department if medical necessity warranted. As described by the authors, this model intentionally shifts away from traditional emergency care toward a more social and recovery-focused approach.
Results
Several findings stand out from the study. Approximately 95% of patients required no paramedic medical intervention during transport, and naloxone was administered in only a small percentage of cases (1.6%). The most documented provider impression was drug or alcohol overdose (83%). Only 8.6% of patients required subsequent transfer to an emergency department, and most of these transfers were unrelated to intoxication, suggesting appropriate initial triage and patient selection.
While the majority of patients were only transported once, a small group of frequent users accounted for a disproportionate number of visits, with the authors noting this subset represented nearly one quarter of all encounters. Importantly, no patients required resuscitation or life-saving interventions after transport to the stabilization center, further supporting the safety of the model when appropriate inclusion criteria are applied.
Discussion
This model represents a meaningful shift in paramedic practice. Rather than transporting all patients to emergency departments by default, paramedics apply structured criteria to identify those who may safely benefit from alternative destinations. Clear inclusion and exclusion criteria, including stable vital signs and the absence of time-sensitive conditions, were essential to ensure consistent and defensible decision-making in the field.
From an operational perspective, the model has the potential to reduce time spent awaiting transfer of care, allowing units to return to service more quickly. In high-demand EMS systems, even modest reductions in offload time can translate into meaningful improvements in system availability and response capacity.
This study reinforces a growing recognition within EMS that not all 9-1-1 patients require emergency department care. For intoxicated patients who primarily need monitoring rather than intervention, a nonmedical environment may be both safe and appropriate. The authors also highlighted that stabilization centers can connect patients with services that are often difficult to provide in the emergency department, including harm reduction strategies and social support, creating an opportunity to address underlying needs in a more meaningful way.
Successful implementation of this model requires clear protocols, focused training, and strong coordination between EMS agencies, hospitals, and community partners to ensure continuity of care and patient safety.
The authors noted several limitations, including the retrospective nature of the data and variability in documentation. Additionally, the study reflects a single urban system, which may limit generalizability to other regions or system designs. Future research should focus on long-term outcomes, including repeat EMS utilization and patient engagement with support services, as well as evaluating the applicability of similar models to other patient populations.
Conclusion
The stabilization center model offers a promising approach to aligning patients with the most appropriate care. As described by the authors, carefully selected intoxicated patients can be safely managed outside the emergency department, reducing strain on hospital resources while providing care that is better matched to their needs. This work reflects a broader shift toward more flexible, patient-centered EMS systems, where destination decisions are guided by clinical appropriateness rather than tradition.
Not every patient needs an emergency department, and when EMS systems are equipped with the tools and protocols to make that distinction, the entire system benefits. We thank the authors for their work and for continuing to move EMS forward through thoughtful, evidence-based innovation.
About the Author
Michael Kaduce, MPS, NRP, is director of the Falck Health Institute, West Coast Board Director for the National Association of EMTs, and a research associate for the UCLA Prehospital Care Research Forum.
