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.

Physical restraint and sedation carry significant risks for both patients and responders:

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.

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 Guidelines for Reducing Restraint-Related Death that stated police should “De-escalate Wherever Possible, but at a Minimum – Don’t Escalate.”

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

When executed properly, de-escalation can:

- Tincture of time

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.

Jaeger E, Mehkri F. Revamping Our Approach to Behavioral Emergencies. NAEMSP. July 24, 2026. Accessed July 24, 2026. https://naemsp.org/revamping-our-approach-to-behavioral-emergencies/

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, officer and healthcare worker injuries, and (iv) aggressive events.

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.