“Around 80 percent of those who eventually kill themselves warn of their intent and 50 percent openly say that they want to die.” – Lerato Mokgethi, counselling psychologist.
By: Lesego Malete – senior staff writer
Trauma is part of every emergency management service (EMS) worker’s life and dealing with suicide cases is part of the job.
Experts say exposure to this kind of trauma affects first responders, but it is often not part of EMS culture to seek psychological help when they have experienced trauma as talking about feelings has been stigmatised as weak. When attending to a scene where a person has attempted to commit suicide, it is important to be sensitive to the person’s needs, to not be judgmental and to rely on experience and training to give sound advice.
Intermediary life support practitioner and ER24 spokesperson, Vanessa Jackson, explains that paramedics receive special training to deal with suicide cases.
“Whether it’s a gunshot wound, a hanging or some other method of attempting to commit suicide, we go according to what we find on scene. If someone has shot themself, we treat it as a gunshot wound. If a person has hanged him or herself, we treat it as respiratory distress or injury to the neck. If we find them still hanging, we will cut them down and depending on the situation, we resuscitate them or stabilise them,” says Jackson.
Theresa Geldenhuys, an advanced life-support paramedic, says paramedics are trained to deal with suicide cases in the pre-hospital context, including the assessment, classification, identification and management of mental illness.
“This specifically relates to dealing with mentally ill patients who may be suicidal, as well as the manual, psychological and pharmacological management of such patients from the scene of the emergency until hospital admission. Pre-hospital paramedical care is also the first medical assessment for these patients and relates to the long-term treatment plan after hospital admission,” she says.
Crying for help
Both Mokgethi and Jackson agree that it is not easy to spot someone crying out for help. The warning signs are different from person to person and this is because people react differently to stress and emotional pain.
“When you are dealing with a child or young adult threatening to commit suicide, the parents will sometimes tell you that they noticed a change in them. With an adult you do not really know. You will see that they experience stress, but you will not necessarily realise that they are suicidal,” says Jackson.
Jackson says EMS personnel do get emotional when they arrive at a suicide scene, but they are able to put their emotions aside and assess the patient and treat them according to what they need. “Initially they may be shocked by what they see, but they will change to ‘mechanical mode’ and treat the patient. “We will transport the patient to the hospital and if he or she is declared dead on arrival at the hospital, we leave the scene and the South African Police Service (SAPS) takes over. “All patients are managed according to what they present us with when we arrive at the scene. The protocol for responding to a psychiatric emergency is not rigid and relies on the individual practitioner’s approach. Typically the patient threatening suicide will be approached, if it is safe to do so, in a non-threatening manner and engaged in conversation. This interview will allow the paramedic to perform a variety of assessments such as the suicide risk assessment and mental status assessment. The patient is then categorised according to the crisis-triage rating scale to determine whether or not hospitalisation is required. All attempts will be made to convince this patient to agree to medical management, however in cases of extreme danger it may be necessary to subdue the patient and perform a forced removal to hospital,” says Geldenhuys.
If an EMS staff member experience trauma after dealing with a suicide or attempted suicide, there are trauma counsellors available at the scene and at the office. They can also use trauma lines at a later stage.
“There is support available, but generally the crew would rather talk among themselves as they debrief about the scene. They discuss what happened and talk about how they could have handled things differently. They also talk about what affected them about a specific case,” says Geldenhuys. Reverend David Niebuhr, president of Emergency Services Chaplaincy SA, says, “There is no shame in getting some psychological assistance, or even some short-term medical assistance, simply to help us through difficult times.”
What others have gone through?
An experienced firefighter in Colorado in the United States has done extensive research on the effects of suicides on EMS workers. As already mentioned, responding timeously to suicides or attempted suicides can be emotionally draining as it requires risky rescues or body recoveries.
For some EMS personnel, stepping away from the scene emotionally unscathed may not be so easy. The American researcher says, “Responders may carry intrusive sights, sounds, smells and memories of these violent and often gruesome deaths with them for their whole careers. The grief and sorrow expressed by the surviving family can splash over onto emergency personnel, causing critical incident stress.”
Another firefighter, captain Monte Fleming, who has dealt with a number of suicide cases says, “Each one of these suicides leaves a small mark on your soul, you just can’t help but feel sorry for each of these families knowing the reality they face.”
Although EMS personnel are trained to respond to suicide scenes, according to the researcher, most EMS providers have little or no training in suicide crisis intervention. There are a few standardised training programmes or response guidelines to help EMS workers address what to do or say to someone attempting suicide or how to support the surviving family of those who have completed suicide.
The effects of the law
When receiving a suicide threat call, ER24 immediately tries to determine whether it is a real call or one of the many prank calls they receive. They do this by getting as much information as possible from the caller. Thereafter, it will dispatch paramedics and police to the scene. “You can’t tell if the case is real, so each case is treated as serious. When the paramedics arrive on the scene that’s when we know if it’s real or not,” says Jackson.
“Generally we get police involved because if it’s a call with a suicide attempt using a weapon then we definitely have to have the police there. They need to secure the scene because we don’t carry weapons. If there is a threat to our lives then we would rather have the police there,” she adds.
Successful suicide scenes are considered as crime scenes and no one should be allowed near the crime scene except for the police. Afterwards, a detailed patient care report should be compiled and include the following information:
• Time of death;
• Environment conditions;
• Body position;
• Location of weapons;
• Types of injuries; and
• If there’s a suicide letter or not and more information for the investigation.
Police officials are expected to help prevent suicide. If a person is about to commit suicide, the officer is expected to negotiate with the person and persuade them not to commit suicide. Suicide is not an offence in South Africa but it goes hand in hand with other offenses such as murder and family murder.
Extending a helping hand
EMS staff’s work does not end with removing the body from the scene to the morgue. At this stage, family members and friends should be the number-one priority and EMS workers ensure loved ones are receiving counselling to deal with their loss. The person counselling the family should be sensitive to the raw emotions. Firstly the counsellor must introduce themselves, acknowledge the famiy’s loss and offer them support for whatever they need at that point. “We offer family members counselling on scene. Our trauma counsellors are available. Chaplains work well with us too,” says Jackson.
If the family does not need counselling immediately after the incident, the counsellor can leave contact details for counselling at a later stage.
Shout, let it all out
Seeking and receiving professional help is not a weakness. The effects of suicide do affect first responders and they can walk away from a scene feeling guilt, pain and anguish. It is important that EMS workers do not let this get to them as it can result in poor performance at work among other behavioural changes.
• Lerato Mokgethi – Lerato Counselling Psychologist (MA Couns Psych).
• Vanessa Jackson – ER24.
• Theresa Geldenhuys – Ekurhuleni Disaster Emergency Management Services (DEMS).
• Reverend David Niebuhr – Chaplaincy.