Frequently Asked Questions

The primary goal of de-escalation is to help the individual calm themselves. By doing so, responders can reduce the need for physical force, restraint, and sedation during behavioral emergencies. Sources: Richmond 2012

Physical restraint and sedation carry significant risks for both patients and responders: For patients: They can lead to physical injuries, hypoxia, acidosis, negative psychological impacts, and in rare cases, death. For responders and agencies: First responders risk physical injury. Additionally, responders may face lawsuits, criminal charges, and psychological impacts such as guilt and post-traumatic stress disorder. For governments and agencies: They have faced financial liability. Sources: McDowall 2023 · Richmond 2012 · Foley 2024 (AP) · AMA CSAPH 2021

Given the risks associated with restraint and sedation, de-escalation offers multiple benefits as the primary strategy for managing agitated patients during behavioral emergencies. Evidence suggests EMS providers often don’t attempt de-escalation or abandon de-escalation efforts too soon. But the Project BETA Guidelines state that it can often be successful even in situations where it seems unlikely to succeed, including where the individual initially seems uncooperative. The Guidelines report that de-escalation often requires extended efforts to be successful, and that inexperienced providers often give up too soon. Sources: Richmond 2012

In 2015, the President’s Task Force on 21st Century Policing recommended that “law enforcement agency policies for training on use of force should emphasize de-escalation” and that “Crisis Intervention Training (CIT) [be] a part of both basic recruit and in-service officer training.” More recently, the Police Executive Research Forum (PERF) published 15 Principles for Reducing the Risk of Restraint-Related Death that stated police should “De-escalate Wherever Possible, but at a Minimum – Don’t Escalate.” Sources: Task Force 2015 · PERF

When executed properly, de-escalation can: Reduce the need for force Reduce injuries to both individuals and first responders Avoid unnecessary restraint Improve individual trust Lower medicolegal risk Reduce implicit bias Sources: Jaeger & Mehkri 2026

Tincture of time: De-escalation cannot be rushed! Remain chill and empathetic: Patients can sense frustration. Designate one person to speak. Get down on the patient’s level: Don’t tower over the patient. Offer food: It is a powerful connector. Validate how the patient feels: “It’s okay to be frustrated.” Agree: Find ways to agree with the patient. Sources: Richmond 2012 · Stubbe 2023

Effective de-escalation reduces the need for physical restraint and sedation, the source of much of the patient harm and potential liability associated with managing agitated patients. In addition, many of these chaotic scenes are caught on video and as such, demonstration of competence, confidence, and compassionate de-escalation attempts may be protective for first responders.

The available evidence shows significant benefits, but more high quality studies are needed. The studies that have been performed in the law enforcement and psychiatric environment show reductions in: (i) injuries to the patients, (ii) use of physical restraints and force, (iii) officer and healthcare worker injuries, and (iv) aggressive events. Sources: Engel 2022 · Hahn 2023 (Niskanen) · Celofiga 2022

While law enforcement officers frequently receive de-escalation training through programs like Crisis Intervention Training, EMS providers generally receive little formal education in de-escalation and often report acquiring these skills on the job. A standardized, national, evidence-based EMS curriculum is needed for de-escalation. And de-escalation training must be incorporated into initial and continuing EMS education. Sources: Cheung 2024 · RCPsych 2022 · Keefe 2020 · Shah 2026

Celofiga A, Kores Plesnicar B, Koprivsek J, Moskon M, Benkovic D, Gregoric Kumperscak H. Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study. Front Psychiatry. 2022;13. doi:10.3389/fpsyt.2022.856153 Cheung EH, Whitfield DA, Kipust A, et al. Advancing Emergency Medical Services’ (EMS) Response Capability for Behavioral Health Emergencies: Los Angeles County’s Performance Improvement Initiative. Prehosp Emerg Care. 2024;28:1006-1016. doi:10.1080/10903127.2024.2333494 Council on Science and Public Health. Use of Drugs to Chemically Restrain Agitated Individuals Outside of Hospital Settings (CSAPH Report 2-JUN-21). American Medical Association; June 2021. https://www.ama-assn.org/system/files/2021-05/j21-csaph02.pdf Engel RS, Corsaro N, Isaza GT, McManus HD. Assessing the impact of de-escalation training on police behavior: Reducing police use of force in the Louisville, KY Metro Police Department. Criminology & Public Policy. 2022;21(2):199-233. doi:10.1111/1745-9133.12574 Foley RJ, Johnson CK, Lum S. Dozens of deaths reveal risks of injecting sedatives into people restrained by police. AP News. 2024. https://apnews.com/article/investigation-police-use-of-force-sedation-injections-demetrio-jackson-621909ba7491abc2af8ad2e33ba3415b Hahn R. Police de-escalation tactics can lead to meaningful improvements in officer and civilian safety. Niskanen Center. July 12, 2023. Accessed November 8, 2026. https://www.niskanencenter.org/police-de-escalation-tactics-can-lead-to-meaningful-improvements-in-officer-and-civilian-safety/ Jaeger E, Mehkri F. Revamping Our Approach to Behavioral Emergencies. NAEMSP. July 24, 2026. https://naemsp.org/revamping-our-approach-to-behavioral-emergencies/ Keefe B, Carolan K, Wint AJ, et al. Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills Advancement. J Behav Health Serv Res. Epub ahead of print 2020. doi:10.1007/s11414-020-09687-4 McDowall J, Makkin AW, Jarman K. Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review. Afr J Emerg Med. 2023;13(3):157-165. doi:10.1016/j.afjem.2023.03.006 Police Executive Research Forum (PERF). 15 Principles for Reducing the Risk of Restraint-Related Death. Policeforum.org. https://www.policeforum.org/trending20sep24 President’s Task Force on 21st Century Policing. (2015). Final report of the President’s Task Force on 21st Century Policing. U.S. Department of Justice, Office of Community Oriented Policing Services. https://www.ojp.gov/library/publications/final-report-presidents-task-force-21st-century-policing Richmond JS, Berlin JS, Fishkind AB, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25. doi:10.5811/westjem.2011.9.6864 Royal College of Psychiatrists. College Position Statement PS02/22: ‘Acute behavioural disturbance’ and ‘excited delirium’. 2022. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps02_22.pdf Shah FI, Lew G, Lee R, et al. Management of Agitation in Emergency Medical Services for Older Adults: A Qualitative Exploration. Acad Emerg Med. 2026;33:e70183. doi:10.1111/acem.70183 Stubbe DE. Psychiatric Emergencies: Empowering Connections to De-escalate Aggression. Focus. 2023;21:54-57. doi:10.1176/appi.focus.20220079