A study out of the University of Arizona College of Medicine was recently published online in Preshospital Emergency Care. The researchers looked at all deaths that occurred in Arizona, as well as the deaths of Arizona residents in another state or country, between 2009 and 2015. Of the 350,998 adult deaths recorded, all were categorized as either suicide or non-suicide via the listed ICD-10 code. The suicides were then further categorized by the deceased’s occupation, a free text field on the death record.
Occupations were split into two categories: EMTs or non-EMTs. Because most first responders are required to also be EMTs, all fire- and EMS-related occupations were included in the EMT cohort. The decision to include firefighters was also made, in part, due to the shifting landscape of firefighting in the United States and their increased presence on medically-oriented incidents.
There were 1,205 EMTs and 349,793 non-EMTs in the database. Death-by-suicide occurred in 5.2 percent of all deaths in the EMT cohort, and 2.2 percent in the non-EMT cohort. This resulted in a crude Mortality Odds Ratio (MOR) of 2.43 and, once this was adjusted for race, ethnicity, age and gender, the MOR dropped to 1.39.
This means that EMTs are 1.39 times more likely to die by suicide than their non-EMT counterparts when controlling for basic demographics.
The EMT cohort was younger and more likely to be male. The mechanism by which the suicide was completed was no different between the two groups, with the three most common mechanisms being death by firearm, suffocation and poisoning.
Memorable quotes on EMT suicide risk
Here are four memorable quotes from the article:
“National survey data suggest EMTs have a tenfold higher incidence of suicidal thoughts and attempts, both of which are strongly associated with suicide completion.”
“Of those deaths, there were 63 deaths attributed to suicide in the EMT cohort, representing 5.2 percent of all EMT deaths compared to 2.2 percent among non-EMTs.”
“While performing EMS services, EMTs are exposed to suicide completions and suicide attempts … exposure to suicide has also been found to independently increase risk of suicidal ideation.”
“Elevated occupational stress, alcohol use and suicidal ideation among EMTs coupled with the established connection between these risk factors and suicide support our findings of increased suicide MOR among EMTs.”
Key takeaways on suicide in EMS professionals
Here are two key takeaways on the suicide rate among EMS professionals:
1. Mental health needs to (continue to) be a priority
This study further validates what most within this profession already know. Caring for patients during the worst period of their lives is emotionally draining. Providers often can’t help but take home that burden. We know from previous research that every exposure to a suicide attempt or completion only increases the risk to responders.
Organizations should make it easy and anonymous to reach out for help. There is no one-size-fits-all when it comes to mental health. What is tough for one person, doesn’t faze another. The idea that special resources are only made available after the more “difficult” calls fails to recognize the cumulative effect this exposure can have.
Some that are suffering have the capacity to find their own resources, while others will need a guiding hand. As the old guard retires, the next generation of administration has to ensure that mental wellbeing is considered the same priority level as any other operational initiative.
2. This study likely under-represents the burden of suicide within our industry
This research is not without its limitations, including the use of a free text field to identify the occupation of those who died. Since the study authors wanted to protect anonymity, they did not investigate each unique job description or determine the current status of their EMT certification.
Therefore, if being an EMT is not the deceased’s primary source of income, they were likely classified as something else. This means that retirees, former EMTs, volunteers, and those with a second job were more likely to be in the non-EMT cohort on their death certificate than the EMT cohort.
Additionally, the stigma of suicide is still prevalent and, in some cases, the cause of death may have been listed as “undetermined” or “accidental,” depending on the circumstances. This is particularly possible for those with comorbid risk factors such as a propensity for substance abuse or previously diagnosed mental health disorders, both factors which are known to be more prevalent in the 911 responder communities.
Mental health resources for EMS leaders, practitioners
Learn more about PTSD symptoms and finding help with these resources from EMS1:
- Do you have PTSD or Complex-PTSD?
- PTSD quiz: Find out if your symptoms qualify
- Use the RESPOND method to assess EMS provider PTSD
- Organization working on new PTSD diagnosis method
- Treating first responder mental health, addiction, PTSD and suicide
- Online service for responders aims to reduce stigma of PTSD
- ‘Groundbreaking’ treatment could help first responders with PTSD
- Retired paramedic creates group for responders with PTSD
- Study: Ariz. EMT suicide risk 39 percent higher than average
- Increasing sensitivity to EMS PTSD
