Verbal Deescalation

Ma’am, you’ve cut your arm very badly. I understand that you don’t want anyone to help you, but someone cares enough about you to call for help. Now you have six people working very hard to take care of you, so please stop fighting with us.

You’re going to the hospital. I know that you don’t want to, but the police have made that decision already. Pulling against the restraints isn’t going to change that. I promise that this will be much easier for all of us if you just let us help you.

You’ve hit an artery and blood will squirt everywhere if I leg go of your arm. I understand that you don’t care. I just happened to be the one sent to help you, and I don’t deserve to be sprayed with blood because you keep moving your arm.

Thank you for letting us take care of you. Is there anything we can do to make you more comfortable? I can’t take the restraints off, but as long as you don’t fight with anyone they should stay off at the hospital. Would it be okay if I give you some oxygen now? You’ve lost a lot of blood, and the hospital will ask why I didn’t give you oxygen. Thank you.

I don’t know how long you will have to stay at the hospital. You probably will be committed, but I promise that everything will be much easier if you let the people there help you. You’ve been very nice to us, so please be nice to the people at the hospital. They’re just doing their job, just like I’m doing mine. Thank you.

 No, we didn’t give her any drugs for sedation. We just talked to her.


  1. I just found your blog. I wanted to say “thank you” for the way you handled this call. If you look at the Vision for Change website, you’ll see that we train first responders on mental health disorders. What you did is exactly the kind of thing we try to teach.

    We’ve trained paramedics in a few departments (once we trained fire and police together — that one didn’t work very well! Each service tells us that the other service escalates mental health calls!) We have a few more EMS trainings coming up, and I’m trying to find out from paramedics what they wish they’d known about mental illness when they started, or what have they have since found worked well for them to de-escalate the situation. That’s why I was so happy I found this post.

    We’re not sure how much they are taught about this before they graduate. If you would ever have a few minutes to email me & let me know that, or what you feel needs to be highlighted in order to make mental health crisis calls go better, I’d be really appreciative. I realize you’re busy, so if you can’t, no problem. (Or if you’re on twitter, we’re @VFCillinois …if you wouldn’t mind putting a tweet out there asking the EMS tweeters to let us know.)

    Again, thank you for this post that shows the gold standard for mental crisis care.

    • emspatientperspective says:

      Thank you Mary. Hmm, where to start. Therapeutic communication is lacking at all levels of EMS education, and unfortunately is viewed as something to be learned on the job. I will follow up with you about this, and share your site on Twitter.

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