Suicide rates in “Colorful Colorado” and across the nation continue to climb. Nationally, suicide claims more than 31,000 lives every year — or one person every 17 minutes. In any given year in„Colorado as many as 720 people will die from suicide and hospitals will admit 2,600 for attempts.
The actual numbers of annual suicide deaths may be understated, since some suicides are classified as accidents and may go unreported. These intentional acts, designed to take one_s own life, are costly to society, devastating to the surviving families and difficult for emergency responders to understand. Public safety personnel are at personal risk when they interface with suicidal individuals before, during or after their act of self destruction. Responders jeopardize their own safety trying to rescue people who feel they have nothing left to live for. Even national park rangers, from the Golden Gate National Recreation area in„San Francisco to the„Colorado„National Monument in„Grand Junction,„Colo., have seen a sharp increase in suicides amid the natural beauty of our parks system. First responders often perform demanding and dangerous search-and-rescue operations in difficult terrain during bad weather to access horrific scenes in attempt to provide life-saving care to suicidal people.
People who complete their suicide on the first attempt have often given no indication of their intent to die. Their means often involve highly lethal methods, such as firearms or hangings. The suicide of a 70-year-old man by two self-inflected gunshot wounds on the sidewalk of„Littleton (Colo.) Fire Rescue_s Station 13 on Oct. 29, 2007 brought a strong dose of reality to first responders working that day. The incident left them wondering about their own personal safety and security while at work — in their second home, the fire station. (For the complete story, read„Too Close to Home: Part 1: Suicide at Station 13).
This incident has served as a wake-up call to many first responders. What were the intentions of this man who„Littleton crews had successfully rescued from a previous carbon monoxide suicide attempt earlier in the year? Was this a planned public suicide or a more complex homicide-suicide averted when the man found the crew members missing from the station? No one will ever know his real intentions but some somber lessons can be learned from this “near miss.” Below are some safety tips to ponder from the suicide at Station 13.
- Develop Standard Operating Procedures (SOP) that address station security. Develop a department-wide plan that outlines measures to improve personnel safety at the station and also raises awareness among department members.„
- Develop “situational awareness.” Responders should always remain vigilant and have an awareness of who is in and around stations, ambulance bases or on department property. Individuals who are unfamiliar to the crew should be questioned as to who they are and why they are there.„
- Any time, day or night, when a crew member is on station grounds (cutting grass, shoveling snow, relaxing in a lawn chair) they should have a department radio available to immediately call for assistance if necessary. New radios have emergency alert buttons that quickly signal the dispatch center of the emergency without having to say a word on the radio.„„
- Restrict open bay doors at all times, especially at night. It_s common in most fire stations or ambulance bases to leave the bay doors open while the crew works out, eats dinner or watches a movie in the day room. Bay doors are often left open for hours, allowing anyone easy access to enter the building while the crew is distracted by doing other things.„
- Service doors should remain locked at all times. Install a key-card access system to prevent easy access for intruders, including employees who have been terminated. If an employee is terminated, their access card should be immediately shut off — ending their ability to enter all stations. Changing locks on service doors can be time-consuming and expensive. Key-card access systems can save money while adding a high level of security and accountability.„„
- Crew members should have a warning signal (a word, phrase or gesture) that will alert other members that something isn’t right and to be alert and assume a defensive posture or “code red.”
- Develop an SOP that addresses what to do if a civilian is injured or killed on department property.„„„
- Develop an SOP on how to clean up large pools of blood safely and effectively.„
During an Incident on Department Property„
- Notify the communication center of the situation. Communication specialists will immediately notify law enforcement and the administrative staff.„
- Administrative staff should respond to the scene to provide support and advice. They should assume the role of a liaison between your department and law enforcement. A member with investigate powers is preferable.„„
- Notify any schools or churches in the immediate area of the incident. They may choose to go into “lock down” mode. Information from the incident can be provided to parents so they and their children can be directed away from the immediate area. Special considerations are important when a body is in a public area or a large amount of blood is on the ground.„
- Shield the incident from the street and passing motorists by restricting access. Use fire trucks, ambulances or tarps to block the public_s view. Protect the public from unpleasant sights.„„
- Secure the building. Check the utilities (cooking on the stove) if the crew left the building in a hurry.„
- Having a second crew respond to the scene to assess the needs of witnesses and bystanders. Witnessing a person commit suicide in a public place can cause emotional distress and physical illness.„
- Support the responders who were directly involved in the incident. Any violation of their personal space by a traumatic event can be threatening and unsettling.„„
- Complete an internal investigation of the incident. Take pictures of the scene and get witness statements from the crew members.„
- Notify and brief all stakeholders of the situation. A written and verbal report should explain the details of the event.„
- Notify the rest of the members of the department. Specific details of the incident should be disseminated to everyone from an administrator instead of through the “rumor mill.”
- The department_s safety committee should review the incident and make recommendations to improve safety and security.„„„
- Consider the need for critical incident stress management (CISM) interventions.„
A Vital Link in Prevention„
First responders find themselves in a complicated position when answering suicide calls. Suicidal behavior is usually viewed as a mental health issue, and first responders have no cure for that in their medical kit. Responders usually have had no formal education in suicides. They also often don_t understand the individual_s behavior or what role they play in suicide prevention. Suicide scenes are often ugly and leave everyone involved feeling empty and frustrated. Often, suicide calls are the worst situations public safety personnel experience in their careers.
EMSresponders are usually the first medical professional to interact with people involved in a suicide plot.„EMS has a window into the private lives of our patients and must be able to identify common suicide predicting factors. The providers then must provide a link to definitive care and mental health support. Some common suicide predicting factors are:
- Hopelessness (believed to be a primary predicting factor of suicide);„
- Isolation, living alone or loss of support;
- Work problems or unemployment;
- Marital problems;
- Stress caused from negative life events;
- Alcoholism or drug abuse;„
- Major depressive illness or disorder;„
- Anger, aggression or impulsivity;„
- Significant physical illness;
- Family history of suicide;„
- Suicide thoughts, talk or preparation;„
- Prior suicide attempts, and
- Use of lethal means.„
Police, fire,„EMS and other first responders who find themselves in the crossfire of individuals attempting suicide must develop strategies to prevent or reduce these tragedies. The future vision of„EMS and public health is injury prevention, not a continued response to preventable deaths. Public safety personnel provide a vital link in suicide prevention and should recognize their unique position in providing emotional support and direction to those contemplating their own demise. Educating those in “gatekeeper” positions to recognize individuals exhibiting suicidal behavior is a key component in a comprehensive community suicide prevention program. Public safety personnel must recognize the importance of providing outreach connections to at-risk individuals while responding effectively to those in a suicide crisis.„EMS has primary access to homes, schools, senior centers and other community-wide settings to launch educational programs directed at suicide prevention. Below are key components to consider in a broad-based community suicide prevention strategy:
Encourage At-Risk Individuals to Seek Care
- Encourage public awareness of suicide.
- Develop community-based prevention programs.
- Improve primary-care providers’ ability to direct, treat and refer suicidal patients.
- Create suicide prevention in schools.
- Expand gatekeeper training.„
- Provide services to people experiencing traumatic events.„
Improve Care for At-Risk Individuals„
- Refine and distribute screening assessment tools.
- Expand professional training on suicide prevention.„
- Improve the ability for mental health providers to address suicide.
- Provide support for suicide survivors.
- Encourage culturally competent approaches.„
Promote Policies to Help Reduce the Risk of Suicide„
- Improve financing for mental health services.„
- Reduce access to firearms.„
Many lessons were learned from the suicide at„Littleton’s Station 13. Two strategic lessons learned from this unfortunate incident are the importance of suicide awareness programs for first responders and the significance of community based suicide prevention programs. Communities must work together to prevent future tragedies by reducing these needless deaths. For further information and educational resources on suicide and suicide prevention check out the following references: