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The work of a CCHS has been compared to being a volunteer fire spotter for the Forest Service. Fire spotters are placed out in the forest to look for signs of an emergency. The more a fire spotter knows and sees, the better. While a fire spotter might fight a small fire, for anything else a fire spotter calls in better supplied professional fire crews.


It is much the same for a CCHS. An MD/DO/NP/PA/RN/EMT, CCHS is placed in the middle of homeless shelters, feeding projects, and other gathering areas to look for signs of an emergency. The more a CCHS knows and sees, the better.


The goal is early intervention. The results can truly be lifesaving.


For example, the top medical diagnosis of homeless patients who go to Tucson hospitals is cellulitis. Cellulitis is a spreading bacterial infection just below the skin's surface. It is most commonly caused by Streptococcus pyogenes or Staphylococcus aureus. According to the U.S. National Library of Medicine, if cellutltis isn't recognized and treated, a patient may experience such conditions as sepsis, endocarditis, meningitis, shock, and/or gangrene -- all of which can lead to death.


One goal of a CCHS is to save lives (and limbs) by spotting the early signs of cellultis. Thanks to extensive training designed and implemented by CCHS Foundation doctors and researchers, the first group of CCHS have become exceptionally good at doing just that.


The result? Consider Mark's story:


Mark is an 18-year-old homeless man who has spent much of his life on the streets. Because of his combative nature, Mark has been sent away from area clinics and hospitals on multiple occasions. At a recent feeding project, an RN, CCHS noticed Mark limping slightly. The RN, CCHS approached Mark and struck up a conversation -- a conversation made possible by many months of previous casual conversations with Mark. Within minutes, the RN, CCHS had discovered the cause of Marks subtle limp: a not-so-subtle life-threatening skin infection. The RN, CCHS immediately referred Mark to a local clinic for antibiotic treatment and then -- over the next several weeks -- other CCHS found Mark on the streets to make sure the treatment was successful.


Mark is just one of the thousands of homeless patients who have been seen, assessed, and referred by the Tucson CCHS team. Because of this extraordinary record of success with helping and healing homeless patients, the CCHS group now has an even larger goal: the spread of the CCHS project worldwide.


Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for homeless women and 51 for homeless men.

According to Randall Kuhn, PhD, UCLA Fielding School of Public Health, "During the last five years, mortality rates have increased by 76% among homeless adults ... . Although the majority are men (80%), the number of homeless women dying has more than doubled."

Homeless service providers warn that their homeless clients are getting older and, therefore, sicker.

The U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years, according to the Association of American Medical Colleges (AAMC).



• Researched and developed the CCHS-A Training Program (3 modules)

• Researched and developed the CCHS-1 training program (30 modules)

• Researched and published the CCHS-1 Manual (763 pages with over 1,700 citations, view at this link)

• Researched and published the textbook GIMME SHELTER: A Physician’s Guide to Identifying the Unique Medical Needs of the Homeless (135 pages, view at this link)

• Developed and taught an upper division course at the University of Arizona (CHS 334) which teaches a sociological approach to homeless medicine to pre-meds, pre-nursing, and pre-social work majors

• Introduced medical students at the University of Arizona College of Medicine to the CCHS approach in hands-on homeless clinics

• Introduced nursing students at the University of Arizona College of Nursing to the CCHS approach in hands-on homeless clinics

• Taught the CCHS-1 program at the National Medical Academy of Kyrgyzstan in Bishkek, Kyrgyzstan

• Introduced the CCHS program to the US Public Health Service at the 54th annual USPHS Scientific & Training Symposium in Minneapolis

• Developed over 100 risk assessment sheets for the primary health problems of the homeless

• Trained hundreds of CCHS and CCHS-1 certificate holders


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