The recently released Consensus Statement of the National Association of EMS Physicians, International Association of Fire Chiefs, and the International Association of Chiefs of Police highlights the need for a structured, unified response to acute behavioral emergencies by EMS, law enforcement and fire personnel. These emergencies – characterized by severe patient agitation, aggression and sometimes violence – are complex and high-risk, often involving mental health crises, substance use or acute medical conditions.
The consensus statement identified a shared mission and intention: “To provide coordinated, safe, and compassionate care for individuals experiencing acute behavioral emergencies, prioritizing their dignity and well-being, while protecting public safety and ensuring the safety of all responders.”
I have broken down the core principles of this consensus and provided a 5-point checklist to help public safety agencies put these best practices into action. Combine these with the EMS Lawyer Doug Wolfberg’s critical takeaways for EMS providers working alongside law enforcement, and you will be well placed to deal with these emergencies in a collective and coordinated manner in the future.
Core principles: Safety, dignity and seamless coordination
The key tenet in managing acute behavioral emergencies is that it is about far more than protocols; it’s about safeguarding the dignity of individuals in crisis while ensuring the safety of everyone involved. Achieving this balance requires EMS and law enforcement to work together seamlessly, respecting each role. Law enforcement typically secures the scene, conducting an initial assessment, while EMS leads the medical response, minimizing role overlap and ensuring a structured approach.
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Training is critical, focusing on recognizing behavioral and medical distress, using de-escalation techniques, and applying restraints only as a last resort. To support fair, unbiased treatment, responders are trained to recognize and address biases that can cloud judgment under stress. EMS, supported by medical directors, oversees healthcare decisions, especially around pharmacological and physical interventions.
Lastly, post-incident reviews involving both EMS and law enforcement are essential to improve future responses, creating a culture of continuous learning and adaptation to enhance care quality and safety.
A practical guide for public safety agencies: The 5-point checklist
To bring these principles into daily practice, public safety agencies can follow this 5-point checklist for managing acute behavioral emergencies.
1. Develop clear, unified protocols and roles
- Checklist action: Create joint protocols between EMS, law enforcement and fire departments to define roles during acute behavioral emergencies.
- Goal: Ensure everyone knows who leads in each phase and prevent overlap or confusion during handoffs.
- Implementation: Host regular interagency meetings to review and adjust protocols, ensuring a shared understanding of roles.
2. Implement comprehensive, bias-aware training programs
- Checklist action: Train responders in de-escalation, behavioral and medical distress recognition, safe restraint practices and bias awareness.
- Goal: Equip responders with the skills to manage acute behavioral emergencies effectively and objectively.
- Implementation: Integrate scenario-based training simulating real acute behavioral emergency situations to help responders practice techniques and recognize biases.
3. Ensure consistent medical oversight and accountability
- Checklist action: Establish a system for EMS medical directors to oversee pharmacological management and physical restraints, with protocols for continuous monitoring.
- Goal: Maintain EMS as the healthcare authority and ensure interventions are safe and closely supervised.
- Implementation: Use clear reporting channels that allow EMS personnel to consult medical directors as needed.
4. Establish post-incident review procedures
- Checklist action: Conduct multiagency reviews after each acute behavioral emergency response to evaluate actions and improve responses.
- Goal: Identify areas for improvement and ensure that each incident contributes to a culture of continuous learning.
- Implementation: Schedule routine debriefs with EMS, law enforcement and fire personnel, reviewing reports and video footage to extract key insights.
5. Foster a culture of collaboration and mutual respect
- Checklist action: Build interagency relationships through regular training exercises and open discussions on acute behavioral emergency response challenges.
- Goal: Strengthen trust and respect across agencies, reinforcing a unified commitment to the safety, dignity and well-being of those in crisis.
- Implementation: Host workshops and joint exercises quarterly or biannually to improve communication and coordination skills, fostering a collaborative culture.
A unified mission, in action
The consensus statement sets a new standard for managing acute behavioral emergencies, one that underscores the need for a mission-driven, compassionate approach. EMS, law enforcement and fire personnel are united in their goal: to provide safe, dignified and effective care to individuals in crisis. By adhering to the core principles and checklist outlined above, agencies can ensure that their responses to these high-stakes events are professional, compassionate and grounded in shared respect for everyone involved.
This isn’t about protocols and checklists; it’s about putting values into action. When responders approach each incident with respect for each person’s dignity and a commitment to working together, they embody the best of what public safety can offer. This consensus-driven approach, if embraced widely, promises to create a more coordinated, respectful response to acute behavioral emergencies – one that upholds the shared mission to protect, serve and care for those in need.
EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.
