There is the elderly man suffering from chronic pain who has been transported by ambulance to Raleigh emergency rooms 120 times in the last two years. A female patient with a history of mental illness called 911 nine times in June alone.

A little more than three years ago, Brent Myers, an emergency room physician, noticed that increasingly at the start of his shift more than half the beds were already full of patients needing mental health care, rather than physical care.

The head of Wake County Emergency Medical Services, Dr. Myers was also among a handful of paramedics in the county who are trying to expand the role of first responders. Seeing an opportunity to both accomplish that goal and help reduce the number of patients flowing into the hospital emergency room, he persuaded county and state officials to agree to an experiment.

Shortly thereafter, a group of Wake County paramedics began to be trained to perform mental health exams on patients in the field who are judged not to be in need of emergency medical care. By asking a series of questions, the paramedics are then able to evaluate a patient’s mental condition. While giving a patient the option of going to a local emergency room if they prefer, they also offer the choice of being taken to another facility that might be better suited to provide the kind of care they need.

Last year, more than half of the 450 patients identified with mental illness asked to go somewhere other than the emergency room.

Dr. Myers sees it as the start for connecting other types of patients with alternatives to hospital emergency rooms.

Emergency officials in many other areas are looking to replicate aspects of the Wake County program. But many states have laws and protocols that essentially dictate that patients may be transported by ambulance to only hospital emergency rooms. Moreover, Medicare and state Medicaid programs are largely unable to reimburse for transports to nonhospital facilities.