By Jamie Thompson
EMS1 Senior Editor
BALTIMORE — The elderly man who shot himself at the front of Station 13 was no stranger to its firefighters — just six months earlier, almost to the day, they had found him in the garage at his home with the car running.
As with the first incident, crews transported him to the hospital. But this time, medical staff were unable to save him.
For Wayne Zygowicz, EMS Chief at Littleton, Colo., Fire Rescue, the incident in 2008 highlighted an issue within the department — a severe lack of awareness of how to support suicidal patients. With further research, he discovered it was, in fact, an area EMS providers nationwide know little about.
“It’s a subject people don’t like to talk about,” Chief Zygowicz told a session at EMS Today in Baltimore on Friday.
Zygowicz went on to spend several months researching the subject of EMS responses to suicidal patients for his master’s degree. He found that few departments or agencies have suicide training for first responders and even fewer have SOPs in place.
“I had no idea when I began writing the research paper on suicide what I was going to discover,” he told the session. “I found a niche of what we do in EMS. Not a lot of people have any education on suicide prevention, what to do with suicidal people or what to say to them; there’s nothing really in our medical texts on what we can do for them.”
Zygowicz said there is still a stigma attached to suicide and that most people simply want to ignore the problem.
“But the problem is preventable if you get the right help for these people,” he told the session. “If you get them through the crisis phase they are going through, you can get them on the road to recovery.”
One of the major problems for responders, Zygowicz said, stems from not knowing what to say to suicidal patients.
“We can make a big impact for people that are contemplating suicide, interacting with them on that 20-minute ride to the hospital, but we don’t know what to say because no one has taught us what to do,” he said.
The session was told responders can help suicidal patients open up by talking to them in a sincere way: “It gives them a sense of wellbeing that they are talking to someone who cares about them.”
The scope of the suicide problem is huge, Zygowicz said. It is the eleventh leading cause of death overall and the second leading cause for teenagers.
As part of his research, Zygowicz sent surveys to fire and EMS agencies across the United States. Nearly 35 percent of respondents said they had gone to 25 or more suicide deaths in their careers. Nearly 90 percent said their agency had no SOP for responding to suicide calls.
“When you’re in the back of the ambulance, if you engage these people … it actually eases their anxiety if you’re sincere about it,” the session was told. “It shows them you really care about them.
“If it was a heart attack you would show a lot of sincerity, but this is a mental health issue and most of us don’t like to talk about that.”
Zygowicz, who has drafted an SOP for his department on how to respond to suicidal patients, said the process starts with the communications center.
“We make sure they don’t take any suicidal threats lightly,” Zygowicz said. “We also make sure our communications staff understand that every individual has the responsibility for their final actions.”
Communications staff are told to build a rapport with the caller and start to develop a relationship, he added. “That’s something that not a lot of us like to do — we don’t like to establish relationships with the patient because of the number of deaths we see.”
The same is true for the responders themselves when they arrive on scene and take the patient to the hospital, the session was told. Zygowicz said a rapport needs to be established.
When responding to “completed suicides,” Zygowicz offered the session several tips.
At the scene of a completed suicide, Zygowicz said providers:
- Should secure the scene
- Not disturb potential evidence
- Not disturb the body except to declare death
- Confirm the identity of the person, DOB, time, place and manner of death
- Detailed PCR
And when it comes to consoling bereaved family members, he offered these suggestions on what not to say:
- I know how you feel
- Time heals all wounds
- You must go on with your life
- You must focus on your precious memories
- They are in a better place
- You must get a hold of yourself