An adult patient with depression says there is nothing to live for and wants to stay with a friend. How should EMS respond?

• A. Ask the patient whether he/she has a plan to kill himself/herself and remove those implements from the home.
• B. Make arrangements for the friend to stay with the patient for the next 24 hours to prevent any harm.
• C. Give the full disclosure of risk and allow him/her to refuse care as long as the patient is alert and oriented.
• D. Attempt verbal means to gain cooperation, bring the patient in against his or her will if necessary.

Answer: (D)

The key idea is safety through compassionate assessment and de‑escalation. When an adult with depression says there’s nothing to live for, the EMS response should focus on building rapport, acknowledging their distress, and using verbal techniques to assess risk and encourage care. Start with a calm, nonjudgmental approach, listen actively, and validate their feelings rather than arguing or dismissing them. Ask about whether they have a plan, access to means, and timing, but prioritize trying to gain voluntary agreement to receive help and go for a crisis evaluation. If the patient agrees, arrange transport for further assessment and treatment.

If the patient is at risk or refuses care after reasonable de‑escalation, you may need to transport them against their will to protect them from harm, using the proper authority. This approach balances respecting the patient’s autonomy with the duty to prevent self-harm and ensure safe evaluation.

In contrast, simply removing means or leaving the patient with a friend for 24 hours does not adequately address the acute risk or ensure access to needed psychiatric care, and giving the patient an opportunity to refuse care when they’re at risk can prevent timely intervention.