Emboldening Gatekeepers

As a paramedic firefighter with more than 32 years of EMS experience, Wayne Zygowicz has dealt with a lot of things in his career. But it was an incident that happened at his Littleton, Colo., fire station that led him to look at life–and death–with a new perspective.

In 2007, Littleton Fire and Rescue (LFR) responded to a call at the home of an elderly gentleman who’d been suffering from depression. He had tried to take his own life using carbon monoxide in his home. Paramedics resuscitated and treated the man, who was subsequently sent to a mental rehabilitation facility. Five months later, the man returned to a Littleton firehouse with a gun, but he found the station house empty because everyone was out on a call.

“He shot and killed himself on the front lawn of the firehouse, at the same time as a grade school was letting out down the street,” said Zygowicz, who is division chief for LFR and sits on the editorial board of JEMS. “We don’t know if it was a homicide attempt or a suicide.” The event rattled everyone working at the fire station.

At the time, Zygowicz had been attending an Executive Fire Officer program, the equivalent of a four-year master’s level program, at the National Fire Academy. The program required Zygowicz to write four thesis papers over four years.

“That significant event peaked my interest in suicide,” he said. He decided to devote one of his thesis papers to investigating and writing about suicide, as it pertains to EMS.

“I started to think back to all the suicides that I’ve gone on over the years. I did some research through the CDC (Centers for Disease Control and Prevention) and found out that Colorado was No. 6 in the nation for suicide,” Zygowicz said. “In all of those years of responding to suicide-related calls, I had no idea that Colorado had such high rates of suicide, especially in this beautiful state that I live in.”

Wayne Zygowicz's research paper creates the open dialogue about suicide EMS has needed

Zygowicz investigated further and discovered gaps in the National Suicide Prevention plan issued by the surgeon general’s office at the U.S. Department of Health and Human Services.

“The National Plan called for “˜gatekeepers’ in society, such as police, fire, clergy, and people who interact with the public on a daily basis, is to be trained in suicide prevention and education. Gatekeepers should be trained to identify people who have mental health issues and may be at high risk for potential suicide,” said Zygowicz. “In 30 years, I have never had any education on suicide prevention. I went to the closest textbook I had on paramedicine and found a page and a half on suicide. Yet the fire department was responding to these suicide calls with no education or training on how to handle them. That’s what motivated me to write this paper.”

In October 2014, the CDC released a report underscoring that the rate for the top 10 leading causes of death had all decreased–except suicide. The national suicide rate, the report said, rose 2% in 2012.

As Zygowicz was researching and writing his paper, he was met with some resistance in discussing the topic of suicide. “I interviewed a lot of people before I started this paper. I was told that it was not a topic I would want to write about because people don’t want to talk about it. But the more people told me not to talk about it, the more I wanted to talk about it,” he said. “It made me want to dig my heels in that much more and work to make a difference.” 

His widespread interviews revealed that many of the agencies and people involved in the awareness and prevention of suicide aren’t necessarily working in a cohesive manner. “I found the national suicide effort is actually fractured,” Zygowicz said. “Many are doing their own thing. Through the National Suicide Prevention strategy, we should all be working together and that’s not happening.”

After interviewing local and national firefighters and police officers, Zygowicz also found a lack of awareness about suicide prevention at every level. “There is a very big disconnect around what should be happening down at the field level for people actually taking care of those who are attempting suicide and dealing with family members,” he said.

Zygowicz talked with a seasoned Littleton paramedic captain, who told him, “Every time we have to respond to a suicide, every time we have to see the trauma and grief a family goes through, it puts a little nick, a little black mark on our soul.” Zygowicz included the comment in his paper.

Once he completed the research paper, Zygowicz made it his mission to disseminate the information wherever, and to whomever, he could. The paper contains all of the research information, a training class on suicide for first responders, standard operating procedures for responding to suicidal crisis and resource brochures to leave at the scene. He hopes the information will be used to prevent inactivity by untrained first responders at suicide scenes. “I call it “˜The Look,’ where first responders stand around with their hands in their pockets not knowing what to say or do,” Zygowicz said. “It’s awkward because we haven’t been educated in dealing with these situations.”

He’s presented his suicide training program across the country and did the presentation at the 2013 EMS Today Conference and Exposition. He found it ironic that he was scheduled last on the conference’s list of presentations–Saturday afternoon. “I wasn’t expecting to have a keynote presentation, but how many people are going to be around on the last day of the last session on a Saturday afternoon?” Zygowicz said.

He told the audio-visual person not to bother with the auditorium electronics, since he only expected a few people to show up. “I told them I wouldn’t need a microphone because I’d just sit down and talk with the five or six people that would show up,” he said. A few hundred people came to the presentation. “It shocked me,” he said.

A neighboring Colorado fire department had two fellow firefighters commit suicide within a year of each other. Zygowicz offered his paper to the chief in hopes their firefighters might better understand this complex problem. “How could this have happened? How could we miss the signs in our brothers and sisters, who we work and live with 110 days a year, 24 hours a day?” Zygowicz said. “How could we miss those subtle calls for help in our own brothers and sisters?”

Part of the answer to those questions is the stigma mental health disorders still embody, especially in fields where perceptions of strength run deep. “If you’re a firefighter and have a heart attack, your brothers and sisters rally around you,” Zygowicz said. “But if you are identified as having a mental health issue or substance abuse issue, they don’t embrace you. They mostly push away from you.”

Zygowicz also highlights the lack of money to support mental health treatment as another obstacle in bringing awareness of suicide out from the shadows. “Mental health doesn’t pay well. Denver has one of the highest rates of suicide in the country, and we have one of the lowest rates of paying for mental health treatment,” he said.

Despite these obstacles, Zygowicz emphasizes that suicide is treatable, but prehospital providers must first recognize the signs in their patients–and their colleagues–and then take action.

“It’s my mission to talk about a subject that no one wants to talk about that affects our firefighters on a weekly basis,” he said. “We deal with a lot of suicides here in Colorado. Many of these folks could be treated for their depression and substance abuse and may never end up taking their own life. We have to start talking about this issue and try harder to stop these unnecessary and untimely deaths.”

As an example, Zygowicz highlights actor Robin Williams’ recent suicide. “He was a very talented man who had many things going for him. The idea that he could take his own life is almost beyond comprehension,” he said. “I want to send out this paper, and get the word out to as many people as possible, to prevent these kinds of needless deaths. We could do so much more in this field.”

View all of the 2014 EMS 10 Innovators here.

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