The study examines the risk factors of suicidality among adolescents in a megalopolis and evaluates the role of emergency medical teams in the initial response and subsequent psychological support. A retrospective observational design based on 854 calls for 2019-2023 with inclusion criteria according to ICD 10 X60-X84 was adopted; after exclusions, the final sample was 776 cases. Descriptive statistics, Pearson's x2 with the Yates correction, Spearman's rank correlation and logistic regression with a significance level of p 0.05 were applied.; The analysis covered socio-demographic, temporal, and clinical parameters, as well as the tactics of the teams. The predominance of girls (67,9%) and older adolescents aged 16-18 (41,5%) was found, with the peak of incidents occurring in the evening and night period. 20:00-04:00 (44,1%). The most common methods are drug overdose (45,9%) and self-cutting (31,7%); alcohol intoxication/Surfactants were recorded in 28,1% of cases; 22,7% had a history of psychiatric diagnosis. Tactics at the prehospital stage are characterized by a bias towards somatization: hospitalization in somatic hospitals - 61,5%, in psychiatric hospitals - 19,3%, refusal of hospitalization 11,6%, deaths 1,8%. The most significant predictors of psychiatric hospitalization are the presence of an established psychiatric diagnosis (OR=4.2; 95% CI 2.8-6.3) and the absence of severe somatic injuries; weak negative associations with female sex and intoxication were revealed, indicating a possible underestimation of risk. The discussion highlights the systemic gap between NSR, somatic and psychiatric hospitals and the need for unified protocols for assessing suicidal risk, mandatory telemedicine consultation of a psychiatrist at the place of call, formalized transfer of assets to the HDP and the creation of specialized psychological and psychiatric teams. The findings indicate that the integration of clinical and psychosocial algorithms, suicidology staff training, and follow-up monitoring can reduce the frequency of repeat attempts.; Limitations are related to retrospectivity, single-centeredness, and incomplete documentation, which necessitates prospective multicenter studies.