The Evaluation and Management of Patients With Suicidal Ideation or Behavior by Emergency Medical Services

Emergency medical services (EMS) clinicians, such as paramedics and emergency medical technicians, frequently respond to 911 calls involving patients with suicidal ideation or behavior (SIB); however, guidance for these complex prehospital encounters remains limited. This article describes the Los Angeles County EMS Agency's (LAC-EMSA) initiative to develop a comprehensive policy for evaluating and managing patients with SIB. A quality improvement (QI) committee approach was used to assess current practices, identify targets for improvement, design countermeasures, and implement policy changes. Key activities included reviewing national model guidelines and California's EMS agencies' policies; conducting interdisciplinary case reviews of EMS encounters with patients with SIB; surveying emergency departments on suicide screening practices; collecting EMS clinicians' perspectives on challenges and potential interventions; and evaluating commonly used suicide risk screening instruments. Findings were synthesized through committee discussions, identifying five critical domains for improvement: (1) standardized terminology; (2) evidence-based guidance for evaluating suicide risk; (3) enhanced decision support for patient disposition; (4) protocols for safety planning; and (5) strategies for collaboration with law enforcement and conflict resolution. The committee recommended a new comprehensive policy addressing these domains which was subsequently developed and implemented. Limitations include the initiative's focus on a single county EMS system, the absence of validated prehospital suicide risk screening tools, and the need for evaluation of the policy's effectiveness. This initiative demonstrates that EMS agencies can leverage QI methodologies to create evidence-informed policies that advance prehospital care for SIB and reduce variability in practice.