{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:55:28Z","timestamp":1791550528527,"version":"4.3.4"},"reference-count":24,"publisher":"Hogrefe Publishing Group","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Crisis"],"abstract":"<jats:p>Abstract: 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\u2019s (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\u2019s EMS agencies\u2019 policies; conducting interdisciplinary case reviews of EMS encounters with patients with SIB; surveying emergency departments on suicide screening practices; collecting EMS clinicians\u2019 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.<\/jats:p>","DOI":"10.1027\/0227-5910\/a001074","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:38:40Z","timestamp":1791549520000},"source":"Crossref","is-referenced-by-count":0,"title":["The Evaluation and Management of Patients With Suicidal Ideation or Behavior by Emergency Medical Services"],"prefix":"10.1027","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3402-9085","authenticated-orcid":true,"given":"Erick H.","family":"Cheung","sequence":"first","affiliation":[{"name":"Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0385-6184","authenticated-orcid":true,"given":"Matt Jason V.","family":"Llamas","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7833-2661","authenticated-orcid":true,"given":"Frederick","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1607-8183","authenticated-orcid":true,"given":"Zainab N.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Rifenburg","sequence":"additional","affiliation":[{"name":"Department of Health Services EMS Agency, Los Angeles County, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Tadeo","sequence":"additional","affiliation":[{"name":"Department of Health Services EMS Agency, Los Angeles County, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7267-9604","authenticated-orcid":true,"given":"Denise","family":"Whitfield","sequence":"additional","affiliation":[{"name":"Department of Health Services EMS Agency, Los Angeles County, Los Angeles, CA, USA"},{"name":"Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"101","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"c1","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.70016"},{"key":"c2","volume-title":"Local EMS agency information","author":"California Emergency Medical Services Authority."},{"key":"c3","volume-title":"Division 5 Community Mental Health Services, Chapter 2 Involuntary Treatment","author":"California Welfare and Institution Code \u00a75150 et seq."},{"key":"c4","volume-title":"Preventing suicide [fact sheet]","author":"Centers for Disease Control and Prevention.","year":"2024"},{"key":"c5","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2024.2333494"},{"key":"c6","volume-title":"Self-directed violence surveillance: Uniform definitions and recommended data elements","author":"Crosby A. E.","year":"2011"},{"key":"c7","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2020.1771489"},{"key":"c8","volume-title":"Prehospital care manual, Ref 1300 medical control guidelines, evaluation and care of patients at risk of suicide","author":"Department of Health Services, Los Angeles County Emergency Medical Services Agency (LAC EMS Agency).","year":"2025"},{"key":"c9","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000003851"},{"key":"c10","doi-asserted-by":"publisher","DOI":"10.1016\/s0160-2527(97)00013-7"},{"key":"c11","volume-title":"Law enforcement increasingly likely to avoid mental health calls","author":"La L.","year":"2025"},{"key":"c12","volume-title":"A3 report","author":"Lean Enterprise Institute."},{"key":"c13","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2024.2402530"},{"key":"c14","volume-title":"Los Angeles County EMS system report (Issue 13)","author":"Los Angeles County Emergency Medical Services Agency (LAC EMS Agency).","year":"2024"},{"key":"c15","volume-title":"NEMSIS EMS data cube","author":"National Emergency Medical Services Information System.","year":"2025"},{"key":"c16","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14439"},{"key":"c17","doi-asserted-by":"publisher","DOI":"10.1176\/appi.focus.20220072"},{"key":"c18","volume-title":"They called for urgent help with a mentally ill loved one. Why California Police Refused","author":"Romney L.","year":"2025"},{"key":"c19","volume-title":"Use of patient restraints","author":"San Joaquin County Emergency Medical Services Agency.","year":"2023"},{"key":"c20","unstructured":"Scott V. Smith. No. 23-15480 D.C. No. 2:20-cv-01872- RFB-EJY. (2024). https:\/\/cdn.ca9.uscourts.gov\/datastore\/opinions\/2024\/07\/30\/23-15480.pdf"},{"key":"c21","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.13005"},{"key":"c22","unstructured":"State of California Emergency Medical Services, Health and Human Services Agency. (2020).\n                      State of California Emergency Medical Services Law, Health and Safety Code Division 2.5 Statutes in Effect as of January 1, 2021. California Code of Regulation (CCR) Title 22, Division 9, Chapter 5: Community Paramedicine and Triage to Alternate Destination\n                      . https:\/\/emsa.ca.gov\/wp-content\/uploads\/sites\/71\/2021\/01\/EMSA-Statutes-Book-2020.pdf"},{"key":"c23","volume-title":"National model EMS clinical guidelines","author":"The National Association of State Emergency Medical Services Officials, Medical Directors Council.","year":"2022"},{"key":"c24","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2019.1654024"}],"container-title":["Crisis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/econtent.hogrefe.com\/doi\/pdf\/10.1027\/0227-5910\/a001074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:38:44Z","timestamp":1791549524000},"score":1,"resource":{"primary":{"URL":"https:\/\/econtent.hogrefe.com\/doi\/10.1027\/0227-5910\/a001074"}},"subtitle":["Development of a Comprehensive Policy in Los Angeles County, CA, USA"],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":24,"alternative-id":["10.1027\/0227-5910\/a001074"],"URL":"https:\/\/doi.org\/10.1027\/0227-5910\/a001074","relation":{},"ISSN":["0227-5910","2151-2396"],"issn-type":[{"value":"0227-5910","type":"print"},{"value":"2151-2396","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"0227-5910\/a001074"}}