Paramedics, firefighters need more suicide response training

A recent story shows the importance of understanding how to handle patients threatening suicide and that we've got a lot of opportunity to improve training and response

Based on a news report out of Huntington, W.Va., there were several mistakes made during a recent call for a suicidal individual.

The fire department responded to a man threatening to jump from a bridge. The incident stretched out over more than 14 hours. During that time, one firefighter used the department union's Twitter account to post updates. He also posted videos to YouTube.

The trouble began when some in the mental health community called out the fire department for insensitive language used in the posts.

Obviously, there is a lot that has been and will be said about the right and wrong ways to represent the fire department on social media outlets. But that's not what jumped out at me in this story.

The local reporter was sharp enough to ask if this was a training problem — were firefighters properly trained to handle suicidal patients?

The answer is that it is a training issue and they were not prepared for it.

And it is not exclusively a Huntington issue. The report said many firefighters in West Virginia are not trained to handle suicide cases. And it's no great leap of the imagination to see how this lack of training extends to many parts of the United States.

In short, it's not this firefighter's, this department's or this state's problem. It is our problem.

It may not be the greatest problem facing fire and EMS personnel, but it is a problem — and a growing one at that. In 2014, Illinois reported that 72 percent of that state's suicide deaths occurred in the home. Whether it is at home, work or a public setting — other than police — fire and EMS are first on scene.

The American Foundation for Suicide Prevention reports that the rate of suicides in this country has increased every year between 2005 and 2014, the last year it posted statistics for. In addition to being the 10th leading cause of death in the U.S., for every suicide death, there are about 25 attempted suicides.

That 25-to-1 ratio makes me think of commercial fire alarms and the vast number that are false alarms. Those on slower departments are constantly reminding themselves to treat every alarm as a real one so as to not be lulled into complacency.

Where familiarity breeds contempt with false alarms, the calls for suicidal patients may be a case of both familiarity and unfamiliarity breeding contempt.

Are we too quick to assume that teen with a bottle of pills is only threatening suicide because she wants attention, or that the neighborhood drunk is always doing some "damned crazy thing?"

It comes back to a training thing. When we're not trained to recognize and handle suicidal patients, we naturally assign our own meaning to the situations.

Fortunately, the fire service is paying closer attention to suicide in an effort to reduce it in our own ranks. Fire Chief, EMS1 and FireRescue1 has devoted a lot of energy to covering this issue — and I'm happy to say, so too have our competitors.

Suicide recognition and response training
This attention is hopefully a gateway to improve overall suicide recognition and response training. One recommendation from the Illinois Department of Health is to include this training as part of the academy and annual refresher training like CPR — this suggestion mirrors that for teaching firefighters about their own mental health.

The Illinois Department of Health offers these four recommendations for first responders.

1. Ensure the safety of everyone present
This includes eliminating access to lethal means. If available, contact law enforcement who are trained in suicide prevention to intervene. Law enforcement officers should be aware of the dangers of a "suicide by cop" situation, where a suicidal person threatens harm to others in attempt to provoke officers to fire at him or her

2. Assess the person for need of medical treatment
Address any serious medical needs first, and if not equipped to handle mental health issues, involve somebody who is, such as a mental health clinician or crisis intervention worker. If not aware of the appropriate professional to contact, ask a supervisor for direction.

3. Establish rapport with the person
Listen carefully and speak with the person in a non-confrontational manner.

4. Assess the person for risk of suicide
Determine whether an attempt has already been made while keeping them under constant observation. If the person is suicidal, arrange for them to be transported to a local hospital or mental health center. 

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