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The Role of Paramedic in Suicide Prevention

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Understanding why suicide prevention fits with your role as a paramedic

Marvyn, a 4th-year student paramedic responded to a call that was dispatched as a suicide attempt. He found a young man, his wife, and an empty bottle of organophosphate (animal insecticide). The distressed husband said his wife had taken a large amount of the animal insecticide to try to kill herself.

Marvyn asked the depressed-looking woman, Alice, what had happened. She said she was stressed and had taken some animal insecticide. Marvyn asked Alice directly, but compassionately, if she had been trying to kill herself. Alice could not give a clear answer, so Marvyn asked if she had ever attempted suicide. Alice became emotional and started to cry and said she had attempted it when she was in high school and had promised to never do it again. But now life was too difficult for her husband was unemployed and lost his job due to the covid-19 pandemic, and she couldn’t take it anymore. Marvyn advised Alice and her husband to go to the hospital to talk with a doctor to get some help for Alice.

Like Marvyn, Paramedics are often called to situations involving an individual who is suicidal. These include:

  • A person is communicating a desire or an intent to attempt suicide
  • A person has just made a suicide attempt
  • A person has died by suicide

On reaching the hospital, Marvyn told the emergency department doctor that Alice had taken a large amount of animal insecticide, had attempted suicide in the past, and now just couldn’t take it anymore. The doctor thanked Marvyn and said it was helpful.

Key steps to Reduce Suicide Risk among the community you serve

  • Understand why suicide prevention fits your role as a paramedic
  • Identify patients who may be at risk of suicide
  • Respond to patients who may be at risk for suicide or have attempted suicide
  • Help suicide loss survivors at the scene
  • Consider becoming involved in suicide prevention in the university and community

You have an important role to play in these situations. You are key in addressing any immediate medical needs the patient may have. You can also provide clarity and support to the patient and other people at the scene.

You may also notice and document behavior and suicidal means that may help hospital staff determine the best care for the patient .The case about Alice shows how important a sensitive, direct response can be.

Know the suicide Report

Suicide touches everyone-all ages and incomes; all races, ethnic communities, and religious groups; and in all parts of the country.

  • Suicide takes the lives of about 500 Kenyans are reported to have committed suicide in three months to June this year, more than the whole of 2020, according to the Kenyan police.

The youngest person to take their life was nine years old; the oldest 76.The 483 deaths recorded during the period were a marked increase on the annual average of about 320 cases, the Ministry of Health reported.

  • Data from the World Bank puts suicide mortality rates in Kenya at 6.1 people in every 100,000 with men in every 100,000 affected.
  • Globally, 703000 people take their own life every year, with the WHO stating that suicide
  • Was the fourth leading cause of death among 15-to-29-year-olds in 2019.

However, there is help and hope when individuals, communities, and professionals join forces to prevent suicide

  • Identify People Who May Be At Risk for Suicide
  • Look for signs of immediate risk for suicide

There are some behaviors that may mean a person is at immediate risk for suicide that should prompt you to take action right away:

  • Talking about wanting to die or to kill oneself
  • Talking about family rejection,bullying,violence
  • Talking about feeling hopeless or having no reason to live

Other behaviors may also indicate a serious risk, especially if the behavior is new; has increased; and/or seems related to a painful event, loss, or change. Ask if the patient has been showing these behaviors:

  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

(Adapted from suicide prevention Resource center) Suicide Prevention hotline in Kenya

There are very few organizations addressing suicide in Kenya despite the number of incidences in the country.

The Befrienders Kenya is a 24-hour service line for people in suicidal crisis or emotional distress. The phone number is +254736542304/+254722178177.or go to http://www.befriendskenya.org

Be alert to problems that increase suicide risk

Certain problems may increase a person’s risk for suicide. Asking if the patient has any of these risk factors can help you assess the current situation more accurately and enable you to provide more complete information to medical staff.

Some of the most significant risk factors to ask about are:

  • Prior suicide attempt(s)
  • Alcohol and drug abuse
  • Mood and anxiety disorders, e.g., depression, post-traumatic stress disorder (PTSD)
  • Access to a means to kill oneself, i.e., lethal means

Suicide risk is usually greater among people with more than one risk factor. For individuals who are already at risk, a “triggering” event causing shame or despair may make them more likely to attempt suicide. These events may include relationship problems or breakups, problems at work, financial hardships, legal problems, and serious illness. Even though most people with risk factors will not attempt suicide, they should be evaluated by a professional.

(Adopted from cdc.gov/suicide/index.html)

Address Cultural Differences

Differences in cultural background can affect how people respond to problems, the way they talk about their attitudes toward suicide, as well as how they feel about sharing personal information and seeking help. It is important to be aware of these possible differences and tailor your responses accordingly.

Responding to Patients Who May Be At Risk for Suicide or Have Attempted Suicide

Preparing ahead of time

  • Review the protocols and procedures required by your organization and in your local area for responding to potential suicides.
  • Consult your medical team leader or supervisor to learn how you should handle a suicidal patient who refuses to be taken to hospital for an evaluation.
  • Meet with law enforcement officers to discuss how to work together with suicidal patients, including those who refuse to be taken to hospital.

Arriving at the scene

  1. Take all suicide threats and attempts seriously. Follow the recommendations below:
  2. Ensure the safety of everyone present. This includes working with law enforcement officers to remove any lethal means the patient may have.
  3. Address any serious medical needs first, for example, if the patient is unconscious or having difficulty in breathing.
  4. Establish rapport with the patient. Talk in a calm, accepting, and supportive manner. Explain what is happening and how you can help.
  5. Assess the patient:
  6. If the patient has just made a suicide attempt, first determine any medical needs and intervene appropriately.
  7. Whether or not an attempt has been made, encourage the patient to talk about how he or she is feeling. Acknowledge the feelings and do not judge them. Since patients may be inhibited by the presence of law enforcement officers, it is often best to have officers stay outside the specific area while you are assessing the patient.
  8. If the patient has not made an attempt, ask several direct questions to determine the person’s risk for attempting, such as “Are you thinking about ending your life (killing yourself)?” and “Do you have a plan?” Do not be afraid to ask these questions. Asking a person about suicide will not encourage him or her to attempt suicide. Many people who are suicidal are relieved to find someone they can talk with about how they are really feeling.
  9. Ask whether the patient has been behaving in ways, or having any of the problems, described earlier that indicate potential suicide risk.
  10. Monitor the patient constantly. If necessary, set up protective measures so that the patient cannot engage in suicidal behavior.
  11. Collect items such as toxic substances, alcohol, drugs, or medications that might have been taken (even just empty containers). Bring these items to the hospital to help medical and mental health staff determine the appropriate treatment.
  12. Transport the patient to the hospital. Many Paramedics advise that any patient whose words or actions indicate he or she may be suicidal be taken to a hospital for an evaluation. If the situation is unclear or the patient refuses to be treated or taken to the hospital, follow your organization’s protocols and/or call the medical team leader or your immediate supervisor for assistance.

Documenting your findings

Document all of your findings on the patient’s intervention sheet, including suicidal statements or behavior, suicide notes, pills, rope, weapons, information provided by people at the scene, and any other evidence showing the person may be suicidal. These findings will be used for the following:

  • Patient treatment and support as needed before arriving at the hospital
  • Assessment and treatment of the patient by the hospital staff
  • Reports on the numbers and types of suicide-related calls to which Paramedic respond

Interacting with family or friends present at the scene

  • Family and friends who are present at the scene are often the ones who called the emergency number. Give them support, reassurance, and a general explanation of what you are doing.
  • Family and friends may be able to provide you with useful information and help calm the patient.
  • You may also want to obtain information directly from the patient, away from others who are present.

Help Suicide Loss Survivors at the Scene

When it is clear that an individual has died by suicide, the police and a medical examiner become responsible for the body. Paramedics need to turn their attention to any family or friends of the deceased who are at the scene.

Here are some recommendations for helping survivors:

  • Establish rapport and explain that you are there to help. Be sensitive to the feelings of suicide loss survivors. Allow the survivors to express their thoughts and feelings. Convey caring and compassion provide support, and let them know that their emotions are okay.
  • Help survivors identify other people from whom they can get support, such as other family members, close friends, or clergy. Offer to contact any of these people.
  • Provide written information about community organizations they can contact for support, such as mental health providers and suicide survivor groups. Also consider giving them information on coping with a suicide death.
  • Take care of yourself after you have left the scene. It is natural that paramedics may be affected by what they have seen and experienced in helping people who are suicidal and suicide loss survivors. It is important to pay attention to your feelings and get support from other people you trust, such as co-workers, family, friends, or your organization’s employee assistance program.

Suicide Loss Survivors’ Reactions

Survivors of suicide loss include anyone who is close to the person who has died. They will likely experience a mixture of strong and conflicting feelings, including emotional shock, confusion, denial, grief, guilt, blame, anger, and shame. They may show physical and behavioral signs similar to those of victims of other types of emotional trauma.

Consider Becoming Involved in Suicide Prevention in Your Organization and Community

Helping individuals who are suicidal is a crucial role for Paramedics. In addition, you may want to participate in broader suicide prevention efforts in your organization and local community. Here are some ways you can get involved:

  • Suggest that your employer sponsor a presentation on suicide awareness by a mental health professional for co-workers, community groups, or the general public.
  • Identify a gatekeeper training program for your colleagues or members of your local community. Gatekeeper programs help people learn how to identify individuals at risk for suicide and respond appropriately
  • Distribute, to your colleagues and the public, written materials on suicide prevention developed by national organizations, such as the American Foundation for Suicide Prevention, American Association of Suicidology.

Helping Your Colleagues

Suicide can occur among your colleagues as well as among the people you serve. Paramedics are at risk for suicide because of the stresses of their jobs. If you notice signs of risk for suicide among your colleagues, you can assist them in receiving help.

For more information on helping co-workers,see the Resources section,including the information sheet The Role of co-workers in suicide prevention.

Resources

A guide for Early Responders Supporting Survivors Bereaved by Suicideu, By winnipeg scuicide prevention network(2012)

The Role of Co-Workers in Preventing Suicide, By Suicide Prevention Resource Center(published 2006;partialy updated 2011)

http://www.suicide.org/sites/default/files/resource-program/CoWorkers.pdf

This information sheet helps people in any type of workplace learn how to respond to the warning signs for suicide in their co-workers.

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References

1. Centers for Disease Control and Prevention(CDC).(2010).Web-based injury statistics query and reporting system (WISQARS).Retrieved from http://www.cdc.gov/injury/wisqars/index.html

2. Substance Abuse and Mental Health Services Administration.(2012).Results from the 2011 National Survey on Drugs Use and Health:Summary of national findings.Retrieved from http://www.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2k11MHFR/NSDUHmhfr2011.htm#2.3

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