"These are the worst calls you can go on."
That's how Steve Berry, BA, NREMT-P, described responding to a suicide during the Wisconsin EMS Association's "Working Together: Emergency Services Midwest Conference and Exposition," held January 25–28.
Whether it's the suicide or attempted suicide of a patient or of someone we know, we're often left with only questions. Why did they do it? What can I say? How can I help someone who is contemplating suicide? How can I heal from my own loss? What separates fact from fiction about suicide?
There are no easy answers, if there are even any answers at all. But there are some key points EMS providers can take away from Berry's presentation, "Suicide—Shedding the Veil of Silence," which may bring a sense of understanding and comfort to those who are touched by suicide.
- After a completed suicide, your patients become the survivors—the victim's family, friends and even other responders. "The crime of suicide lies in its disregard for the feelings of those left behind," says Berry, a paramedic for Southwest Teller County EMS in Colorado with more than 25 years of experience. Survivors often experience a second loss, as family members, friends and co-workers distance themselves from the survivors. It's a societal stigma born because we want to understand suicide but rarely can. "You can be the most brilliant person in the world and still never answer 'why?'"
- Don't ever let survivors back in to see the body or the scene after a suicide. Even go so far as to clear pets from the scene. "When a survivor finds the body there is no adequate adjective to describe the horrific scene," says Berry. "It's forever imprinted on their brain." Survivors may beg, even demand to see the body of a loved one, but EMS providers shouldn't let them. "They’re in shock, but it's also a potential crime scene," explains Berry. "(At that point) you need to protect the evidence."
- There are often—but not always—red flags that someone is considering suicide. The problem is, survivors may have only seen one warning sign, which when taken on its own doesn't seem out of the ordinary. It's often only in the aftermath that all the red flags come to light and survivors realize the depth of the situation. Common red flags are giving away possessions or cherished items; hoarding prescription medications or buying a handgun; writing notes to loved ones; non-lethal suicide hand gestures; updating a will or making funeral arrangements; visiting or calling friends a person rarely sees.
- When EMS providers are talking to survivors, have a mental script to follow, calm yourself down, talk slowly and make sure beforehand that there isn't any blood on your uniform. Make good eye contact with survivors and address the one who looks the most composed. Use the deceased person's name when you're talking about them and avoid complicated medical jargon. Use, don't avoid, the "D" word—death. It generally takes about 30 minutes for shock to subside, so allow for extended periods of silence when you speak to survivors. Above all else, don’t try to answer "why?"
- Most people who attempt suicide do not want to die. Rather, they're seeking a way to make the pain of their situation stop. "It's exhausting trying to find reasons to hope," says Berry. If a person considering suicide gets professional treatment the risk of self-injury does decrease, but there's a caveat. Sometimes a person is so depressed and tired that they mentally and physically don't have the energy to kill themselves. But when they start to get treatment and get their energy back, then they successfully take their own life. Many suicides happen three months after treatment begins, says Berry. This can be attributed to the fact that while the person is feeling better, the problems which made them feel suicidal in the first place may still be present.
Perhaps one of the greatest lessons to take away is that when dealing with suicide it's always better to talk about it. If you can talk to the patient you have a chance to stop them. The same goes for talking to family, friends and co-workers. The worst response an EMS provider can get from a survivor is no response. You want people to be able to express their emotions without judgment. And children, despite our instinct to protect them, need to know that a loved one has committed suicide. Usually a child already knows the truth without being told, Berry says, so it's important to talk to them about it so they don't think it's OK to hide suicidal feelings themselves.
Suicide by the Numbers
- 80% of suicides necessitate an EMS response.
- Every 18 minutes someone in the U.S. dies by suicide, and suicide claims more than 32,000 lives in the U.S. each year (although that total may be as much as 3 to 5 times higher because suicide often goes unreported). That's more people killing themselves than killing each other, by a wide margin.
- A person is 7 times more likely to commit suicide when a family member has previously taken their own life.
- Women attempt suicide 3 times more often than men, but men are 3.8 times more likely to die. The reason is often in the method. Women prefer attempting suicide by taking pills, which can be reversed, while men are more likely to use firearms.
- Nevada has the highest suicide rate in the U.S.; New Jersey has the lowest.
- People in law enforcement are the most likely to commit suicide, and 9 out of 10 police officers will use their own gun. Doctors are the next most likely to commit suicide and their method of choice is usually prescription drugs. There are no statistics on suicides for EMS providers, but due to the similarities which EMS shares with law enforcement and medicine—high stress, macho isolation, a fear that counseling may jeopardize a career, and easy access to weapons and/or prescription medications, it's likely that EMS has a higher rate of suicide than the general public.
- While rates may vary, people from every race, gender, age group, socio-economic background and country commit suicide. Suicide does not discriminate.
Jason Busch is an associate editor for EMS World.