Emergency Medical Evaluation of Dangerousness

eMed International Inc

Suicidal and Homicidal Assessments

executive summary

     eMed Colorado™ has developed evidence-based and statistically relevant rating scales to advance the rapid emergency psychiatric screening of suicidal youth patients.  These valid assessments reliably answer the question, “Should the person be held in, or transferred to, the hospital for a full psychiatric evaluation?”    

     Over 1,000,000 emergency psychiatric assessments on children, adolescents, and young adults are conducted in U.S. hospitals and outpatient offices annually, and research shows wide variability in the accuracy, admission, and discharge decisions.  Recent analysis by the National Institutes of Mental Health indicates that there is little or no evidence about the value of current risk assessments.  This is in part due to the fact that ideation is common and depression variable in youth populations.  Although there has been convergence concerning factors considered important for formulating violence assessments, high false-positive and false-negative results have compounded the inaccuracy of screening measures with associated financial, emotional, ethical, and legal consequences.

     eMed Colorado™ assessments address these appreciable variances in diagnostic accuracy by demonstrating construct and logical validity, strong correlation coefficients, internal consistency, inter-rater and test-retest reliability, concurrent “gold standard” validity, balanced sensitivity and specificity, and likelihood ratios. In fact, VISTA™ is the first neuropsychiatric assessment to utilize the likelihood ratio as a measure of diagnostic usefulness.

     The two innovative cooperative scales, the adolescent and child urgent threat evaluation (ACUTE™) and the violence ideation and suicidality treatment algorithm (VISTA™) assess and score the patient rapidly on the basis of near-future dangerousness as a potential consequence of four areas:


  1. 1. early predisposing and late precipitating historical and clinical risk factors;
  2. 2. acute adjustment disorder (AD);
  3. 3. selective serotonin reuptake inhibitor (SSRI) adverse effects; and
  4. 4. nonideation suicidality (NIS). 

     ACUTE™ specifically addresses early historical and late clinical factors across multiple diagnostic categories.    

     VISTA™ differentiates between deliberate self-harm (DSH), AD and SSRI subgroups.

      eMed Colorado™ assessments have been reviewed, summarized, and published in the American Journal of Emergency Medicine and Pediatrics in Review.  The ACUTE™ practice manual and rating forms, with VISTA™ analysis, have been in world-wide publication for over eight years.  These cooperative assessments have been accepted for international presentation by peer-review scientific committees including the American Association of Suicidology, Irish Association of Suicidology, Canadian Association of Suicidology, U.S. Psychiatric and Mental Health Congress, Colorado Department of Public Health and the Environment, National Association of School Psychologists, XIV European Symposium on Suicide and Suicidal Behavior, and the 7th World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders.  

     eMed Colorado™ assessments follow the strategic directions, goals, and objectives of the 2012 National Strategy for Suicide Prevention by:


  1. 1.  Increasing the awareness of warning signs for suicide and how to connect individuals in crisis with assistance and care.
  2. 2.  Promote timely access to assessment, intervention and effective care for individuals with a heightened risk for suicide.
  3. 3.  Encourage health care delivery systems to incorporate suicide prevention and appropriate response to suicide attempts as indicators of continuous quality improvement efforts.
  4. 4. Develop standardized protocols for use within emergency departments based on common clinical presentation to allow for more differentiated responses based on risk profiles and assessed clinical needs.   

     eMed Colorado™ assessments are standardized in accordance with the NIMH “Issues to Consider in Intervention Research with Persons at High Risk for Suicidality, and the Expert and Consensus Statements of the Suicide Prevention Resource Center and the American Foundation for Suicide Prevention. 

     eMed Colorado™ assessments are consistent with current advances in information technology and are creating new opportunities for research-based decision support tools in emergency psychiatry.  These tools can systematically and reliably scale the domains of evidence used by primary care and emergency physicians in psychiatric assessment.  Benefits of ACUTE™/VISTA™ cooperative assessment include:


  1. • Affords guidance in psychiatric emergencies
  2. • Gender and cross culturally appropriate
  3. • Aids consistent interdisciplinary communication
  4. • Psychometrically sound
  5. • Provides systematic process of evaluation
  6. • Identifies modifiable and treatable risk factors
  7. • Encourages interactive process between patient, family, and clinician
  8. • Utilized as follow-up where serial assessment is important
  9. • Guideline to “asymptomatic” patients who often deny ideation
  10. • Quickly evaluates impact of neurocognitive factors on violent behavior
  11. • “Do-able”, “must ask” questions completed in minutes