EMS and the Growing Problem of Suicide

Several years ago, when Micki Savelkoul became director of suicide prevention in North Dakota, she recognized that EMS could play an important role in this growing health problem. A self-described systems thinker, Savelkoul envisioned EMS working in concert with the public, law enforcement and hospitals to create a system of prevention that could save lives.

Last fall, the Centers for Disease Control and Prevention announced that suicide had surpassed motor vehicle deaths, homicides and falls as the leading cause of death from injuries in the United States. If that’s not sobering enough, consider these additional facts:

In the U.S., suicide has increased steadily over the past decade and is now the fourth leading cause of all deaths in adults aged 18 to 65.

Hundreds of thousands of suicide attempts are treated in EDs (some estimates exceed 750,000), and millions more people contemplate or threaten suicide.

A recent national survey of ninth to 12th graders found that 16 percent had seriously considering suicide, 13 percent had created a plan, and 8 percent had attempted suicide in the preceding 12 months.

Suicides among veterans now account for more than 20 percent of all suicides, while veterans make up only 7 percent of the population.

Worldwide, suicide claims more lives each year than war and homicide combined. Imagine six jumbo jets full of people crashing each day and you get an idea of the numbers.

Why suicide is on the rise is a complex social and psychological problem, but research increasingly demonstrates that it is preventable. We are learning that thoughts of suicide are common and that, contrary to popular notions, most people who contemplate suicide don’t really want to die. Suicidal thoughts are often transient and more a desire to escape deep emotional suffering than a frank desire to die. Talking openly and directly about suicide and helping the suicidal find a connection to others, manage risks and get help save lives. This is where EMS comes in.

“We view EMS as vital to the suicide prevention system,” Savelkoul says. “Because EMS often sees suicidal people at critical times in the settings of their suffering, they have an opportunity to channel people to essential lifesaving resources.” Yet too often, the opportunities EMS has to help are thwarted by a lack of provider preparation, little guidance and a poor system of care. That’s why Savelkoul has thrown her energy into strengthening prevention in her state by creating a series of programs aimed at educating the public, EMS, law enforcement and hospital ED staffs.

In addressing EMS, Savelkoul reached out to Tom Nehring, director of North Dakota’s Division of EMS and Trauma. Together they created a project that developed one of the nation’s first comprehensive state protocols for EMS response to suicide. I was privileged to help facilitate the project and am impressed with Savelkoul and Nehring’s efforts to tackle this problem.

Approved in September 2012, the protocol was developed with the input of EMS, mental health experts, physicians and suicide prevention experts. Drawing on the work of researchers Nels and Teri Sanddal and the protocol developed by Littleton (Colo.) Fire Department EMS Chief Wayne Zygowicz, the North Dakota protocol incorporates the latest understanding of suicide prevention. It lays out specific guidelines for response to threatened suicide and attempted suicide, and specifically addresses how to help family members and friends at the scene of a suicide death. During the first half of this year, the protocol will be introduced across the state to EMS responders in a two-hour workshop.

Savelkoul and Nehring are hoping other states will follow them in bringing more attention to suicide prevention and encourage people to review the North Dakota program and adapt it to their own needs. The protocol can be found at here.

John Becknell is the founding publisher of Best Practices. He is a consultant and partner at SafeTech Solutions.

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