Life After Suicide

How emergency responders can assist those left behind


      Every year in the United States, there are 30,000-32,000 suicides, roughly one every 18 minutes. Most of these deaths bring together two groups of people under very unpleasant circumstances: emergency responders and family members or others close to the victim, known as "suicide survivors."

   Suicides do not occur every day in any community, but emergency responders will be involved when one happens. It may be treating and transporting someone who made a suicide attempt and succumbs to his injuries. It may occur on site when a suicide attempt results in death, or it may be notifying the family of a suicide. Emergency responders are trained to deal with suicide attempts, but few are prepared for aiding after a completed suicide, when the survivors become the "patients."

   In 2001, the U.S. Department of Health and Human Services (DHHS) called for training paramedics and EMTs to better help those they encounter after a suicide. The National Strategy for Suicide Prevention: Goals and Objectives for Action (see www.mentalhealth.org/suicideprevention) notes that emergency personnel can "set the tone for being respectful and sensitive to the needs of survivors and need to be prepared themselves for the impact such events may have on their own thoughts and emotions." A few communities offer such training, but most often it is learned on the job.

   DHHS called for an increase in "the proportion of those who provide key services to suicide survivors (i.e., emergency medical technicians) who have training that addresses their own exposure to suicide and the unique need of suicide survivors." This article details an effort to meet this goal in southeastern Pennsylvania by Montgomery County Emergency Service, Inc., a nonprofit psychiatric crisis facility in Norristown, PA, the home of Pennyslvania EMS Station 305, a BLS service that responds only to psychiatric emergencies (see www.mces.org).

WHAT IS SUICIDE POSTVENTION?

   Suicide postvention attempts to reduce the negative consequences that may affect those close to the victim of a suicide or those who have experienced a suicide. Its purpose is to facilitate recovery from traumatic loss caused by a suicide.

   Suicide postvention involves (1) providing aid and support with the grieving process and (2) assisting those who may be vulnerable to conditions such as anxiety and depressive disorders, suicidal ideation, self-medicating and other harmful outcomes of severe grief reactions.

   Suicide postvention should begin as soon as possible after the suicide. That's where emergency responders come in.

WHY DO SUICIDES HAPPEN?

   Every suicide is different, and the circumstances are unique to the individual involved. However, two common underlying factors are intense psychological pain and extreme hopelessness.

   Psychological pain arises when there is some seemingly unsolvable and totally frustrating situation in an individual's life, such as a compelling personal, interpersonal or financial problem, or something else.

   Whatever the problem, it is something the person finds devastating and believes cannot be "fixed." Coping and problem-solving skills fail; self-esteem and sense of control over one's life diminish. This brings on hopelessness, which may lead to suicidal thinking. In the absence of strong protective factors (e.g., social supports) and with high risk factors (e.g., drinking, access to a gun), a suicide attempt may occur.

   Suicide risk is increased by drinking or drugs, which lessen inhibitions and increase impulsiveness. This heightens vulnerability to thoughts of suicide and makes depression and anxiety much worse.

   Some suicides may be sudden and impulsive, but most are the result of a process over time. As it unfolds, it offers many points for getting help. While not all can be prevented, suicides are preventable.

WHO'S DYING AND HOW?

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