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Preventing suicide in high-risk patients

If you suspect your patient may be suicidal, don't be nervous or shy about clearly asking about intent

Editor's note: A quick-thinking firefighter 'kicked' a suicidal girl to safety during a dramatic incident caught on video in Russia.

While dramatic, this video shows an extreme act of stopping someone from a possible suicide.

It's difficult to armchair-quarterback the incident, especially since it was successful; as a counterpoint, this story shows what can go wrong in a similar event.

Suicide is tragic and requires a careful, thoughtful approach.

Those who try to kill themselves have come to the conclusion that there is no viable alternative for escaping what is causing such massive grief, pain or sorrow.

It is a common cause of death for teenagers and the elderly; indeed it's likely that many, if not most of us, have had fleeting thoughts of suicide at a low point in our lives.

As EMS providers, we see suicidal patients often. Some give away their intentions in their behavior. Other patients, however, may be subtler in their feelings about suicide. For example, you could be evaluating an elderly patient and determine that he may have far more medication tablets than he should, or a family member might report that the patient had been recently talking about death.

If you suspect your patient may be suicidal, don't be nervous or shy about clearly asking about intent. Consider using the following questions:

  • Do you plan on killing yourself?
  • Do you have a suicide plan?
  • Do you have what you need to carry out that plan?
  • Do you know when you plan on doing it?

The more the patient has concrete, realistic answers to these questions, the higher the risk of an actual attempt.

If you determine that you have a high-risk suicidal patient, you must intervene. It's likely that you need little more than a concerned voice and manner to convince the patient to cooperate and receive help.

It doesn't matter what you say exactly; just being empathetic and supportive during your assessment may go a long way in keeping someone from committing the ultimate act. Keep anything that could be used as a weapon a safe distance away, and don't allow the patient to leave your sight.

Unfortunately, some patients may be so agitated and beyond reasoning that your own safety is at risk. If so, retreat to a safe place and call for additional help. If you're unable to leave, attempt to barricade yourself in a safer location. The last resort is to fight the patient, using anything you can to incapacitate him or her.

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