FL teen commits suicide on webcam...

[WolfmanHarris]

Disclaimer: I'm not by any means an expert in psychological disorders. I have a seminar on suicide intervention under my belt, a schizophrenic great uncle and an undiagnosed bipolar mother (my opinion on her). I've had my share of exposure to mental health outside of EMS (no not myself).

Mental health is the least understood, one of the most underfunded, overlooked and worst treated facets of medicine in the world and I feel that Emergency Medicine is probably worse than most at dealing with it, especially given our unique position between EMS and the ED to intervene early and direct the person to the most appropriate definitive care.

The fault is not entirely on our shoulders. As you said, those who use suicide as a tool to manipulate people make it difficult to differentiate between those who are seriously seeking to end there own life and those who aren't and even more difficult to maintain compassionate throughout. It's understandable to resent the manipulation by a patient and to feel jaded as a result and that is likely why we get so fed up with a lot of the suicide calls.

But here's the thing. It doesn't matter if they're serious or not. In most cases, someone who is contemplating harming themselves or ending their own life, they are sick and need help. My take on suicide is similar to my take on chest pain. I may not know for sure that the patient presenting with chest pain is having an MI, but I assume ischemic CP until able to rule it out. The same should happen with suicide, assume the person is so ill that they need care and right away. If they are threatening suicide as a cry for help or for attention; they are ill too. In a different way, but like angina to an MI our initial first line treatment shouldn't change.

The pain someone feels when they are so depressed they are considering suicide cannot be treated with nitro or oxygen or anything we have in the back of the ambulance, but it can be made much worse with indifference or worse, disdain. The definitive pre-hospital treatment for is a compassionate ear, a lack of judgement ("selfish" is a judgement) and patience as well as advocating for your patient. They need to know that someone cares and you as the pre-hospital care provider need to help them gain access to this care.

Here are some things to consider. If the patient is competent and refuses treatment, don't leave it at that. If the hospital is not the right place for them, than give them information they can use. Crisis lines, social services, mental health clinics, are all good alternatives. Beware of the refusal that seems suddenly content or at peace; this can be an ominous sign that they have decided on their plan and are ready to carry through with it. They shouldn't just be signed off if possible. One technique that works sometimes is to have them promise not to harm themselves for 24, 48, whatever hours. I don't know why but apparently these verbal contracts work well. They can then call 911 again at the end of this period if they still don't feel "well" and from their you can try again to get them to proper care. (Ya it means another psych call, but if you don't understand why it's necessary please refer to above and start again.)

If you believe they are an imminent threat to themselves (or others) you must of course follow your protocol AND treat it seriously. They have a life threatening condition.

Failure to follow the above recommendations and to maintain your compassion may result in you signing off your "BS suicide call" and returning in an hour to their dead body and the human tragedy that leaves behind.

Like I said, I'm not an expert in mental health. The above is a mixture of my own reading, a seminar, schooling and my own thoughts on mental health from my limited, non-professional experience.

- Matt

[paramedicmike]

I have been watching all of your comments since my post and im well aware of the emotions held within them. Now i will not apologize for what has been said cuz im truly not sorry about it...

That's most unfortunate, really.

My motto has always been "Show me a person who TRULY needs EMS, and I will show you TRUE compassion towards that patient." I dont believe in shelling out compassion to those who dont need/deserve it. By doing that, all your doing is inhibiting those patients to continue to abuse the 911 system.

So who's system is used to determine who truly needs EMS? Your arbitrarily assembled criteria? Do you have a set of benchmarks that you carry in your pocket and tick off like a check list for every patient you encounter to see if they are *truly* deserving of your compassion?

What's more, you didn't sign up for this job to pick and choose what patients you treat. As such, you don't get to choose which patients to whom you show compassion. If you're willing to discriminate based on what you believe to be truly deserving of your "compassion" then you're already wrong.

Why do you feel it's neccessary to show compassion to a person that wants to commit such a selfish act?

Mobey referenced this thread. It might do you good to read through it.

...but does the patient really deserve to have their hand held and told eeverything will be ok? Why not try a different aproach and inform them of all the consequences and suffering they will cause, should they follow through? Now i do understand that these people do have some wiring problems in their head, for whatever reason it may be, but that does not mean that you cant reason with them without kissing their ass.

I think you need to go take several psychology classes including abnormal psych. It's plainly obvious that you have NO clue what you're dealing with. Unfortunately, that ignorance is hurting more than just you.

The discussion offered by posts before this one do a fair job at describing why you need to change your attitude. The thread Mobey referenced does as well. For what it's worth, a comment was made in another thread recently that we here in the forums seldom see such widespread agreement on a particular issue (like has been seen in the overwhelmingly negative responses to your posts). If we all agree on something there's probably something to it and it might work to your benefit to do some research and consider that you're wrong.

-be safe

[Ridryder 911]

I have been watching all of your comments since my post and im well aware of the emotions held within them. Now i will not apologize for what has been said cuz im truly not sorry about it, however, most of you are right in the fact that it could have been worded better to say the least. My motto has always been "Show me a person who TRULY needs EMS, and I will show you TRUE compassion towards that patient." I dont believe in shelling out compassion to those who dont need/deserve it. By doing that, all your doing is inhibiting those patients to continue to abuse the 911 system.

Having stated that, I am here because I do want input on a question I have in regards to the whole suicide thing:

Why do you feel it's necessary to show compassion to a person that wants to commit such a selfish act? Now, im serious on this question, as it's very obvious that all of you dont share my ideas. I do agree that the family should be shown compassion, especially if the victim actually follows through with their intent, but does the patient really deserve to have their hand held and told eeverything will be ok? Why not try a different aproach and inform them of all the consequences and suffering they will cause, should they follow through? Now i do understand that these people do have some wiring problems in their head, for whatever reason it may be, but that does not mean that you cant reason with them without kissing their ass.

Please feel free to input, as I'm looking to see what others' perspectives are.

Ever hear the phrase .. You are there for them; not that they are there for you? Really, what pompous attitude. It's not like you spent ten years post graduate studies to get where your at or your in such a demand that your absences would be missed more than thirty minutes. Hello!... You work in a ambulance. Let's get re grounded huh?

Do you have the same feelings for a person with an AMI ? Do you have such apathetic & judgemental attitude that they should had exercise more often, ate a better diet? Even in regards to fallen co-workers. You know really there is NO such thing as an accident, they all can be prevented. They should had known and do better... right?

Its obvious you have no formal knowledge or education in mental health. Definitely lacking in the understanding of those with psychological depression. I have seen many that took their life because there was not a clear option. Sure, its easy for one to judge if things and their current situation are going great. Again mental illness alike physical illnesses does not always allow the patient to make rationale decisions. They cannot rationalize what might occur, if they could they would be able to handle stresses. Unfortunately, it is not they do see the light in the end of the tunnel; rather they cannot even see the tunnel. Have you ever seen an AMI patient in denial or the hypoglycemic with altered mental status, should we criticize them as well for their actions that occurred during their illness?

It would be wishful to see those that practice in EMS have at least one year of psychological education with clinical sites. Almost every patient we attend to is in some form of psychological imbalance at the time, r/t pain, fright, etc.. How many are really themselves?

R/r 911

[VentMedic]

After reading cynical_as_hell's post on the thread; "Stupid 911 calls clog system, put safety at risk", even I who enjoys jumping in as a patient advocate, found this person's post "too over the edge" to be worthy of a response. It is quite possible to even read some things into this person's posts that are a disturbing glimpse into his/her psyche. Unfortunately or fortunately, on anonymous forums we may never know a person's reasons for posting the things they do or what is actually going through their minds.

The human psyche is very complex. For this reason I am not a fan of CISD. No two people in that room will have the same past and present baggage or interpret/process situations the same way. No two suicide attempts or actual suicides will be the same except for maybe the method.

This month (November) has also been the 30th anniversary of Jonestown. That is one event in history that hit close to home for many and one can't help but wonder what happens in the minds of those that can fall for something like this that had such a tragic ending.

[cynical_as_hell]

i must say, this particular group of people are a damned if you, damned if you don't attitude. And dont think for one second that im the only one that feels that way. I was serious in my last post about getting input for the fact that you all dont agree with me, but nowhere i there does it say "Please go ahead and continue to bash me for not thinking like you" You may not agree with how i think, and im not asking you to, but at least i was willing to hear all of yours perspective, and i havent bad mouthed you for it. in some areas, i do agree with you guys, but in others, i dont.

As far as the who am i to judge who gets compassion and who doesnt.....answer me this? Are you going to show the same amount of compassion on some frequent flyer that calls you every shift at the same time and always has the same complaint? can you sit there and say that you would show them the same amount of compassion as you perhaps did the first time you met them?

I do understand that although every call may not be life threatening it may very well require a 911 response. For example, someone that is ALOC because their sugar is a little lower than normal, is not an emergency. And it is something that most of the time we can fix before getting to the hospital.

I personally believe that all of you put EMS and your positions within it on a peda-stool

Everyone in EMS can be replaced and we are no different than those who will come after us and take our place

[chbare]

i must say, this particular group of people are a damned if you, damned if you don't attitude. And dont think for one second that im the only one that feels that way. I was serious in my last post about getting input for the fact that you all dont agree with me, but nowhere i there does it say "Please go ahead and continue to bash me for not thinking like you" You may not agree with how i think, and im not asking you to, but at least i was willing to hear all of yours perspective, and i havent bad mouthed you for it. in some areas, i do agree with you guys, but in others, i dont.

As far as the who am i to judge who gets compassion and who doesnt.....answer me this? Are you going to show the same amount of compassion on some frequent flyer that calls you every shift at the same time and always has the same complaint? can you sit there and say that you would show them the same amount of compassion as you perhaps did the first time you met them?

I do understand that although every call may not be life threatening it may very well require a 911 response. For example, someone that is ALOC because their sugar is a little lower than normal, is not an emergency. And it is something that most of the time we can fix before getting to the hospital.

I personally believe that all of you put EMS and your positions within it on a peda-stool

Everyone in EMS can be replaced and we are no different than those who will come after us and take our place

I can "think" whatever I want about these people; however, it is my job to "show compassion" to patients regardless of what I may think.

Regarding the sugar comment: This is what separates a protocol monkey from a true provider. Why is the sugar low? What is going on with this patient? What additional assessments must be completed? Are there other interventions that can help and perhaps opportunities to educate our patients about their conditions? Are adequate support systems and access to ongoing care in place after the patient leaves our service? Can we introduce a customized plan of care that can prevent this from occurring in the future?

You see, we can fix the number; however, what about the actual cause of the low number? I hope somebody gets where I am going with this?

Take care,

chbare.

[Eydawn]

While you may not FEEL compassion for every patient you encounter, you MUST display a semblance of it to your patients. You're not there to be a robot to take vitals and drive them to the hospital, unless they're the sweet old lady that everyone loves seeing even when they're sick. If you can't fake it then don't tech that patient. You are there to provide the best possible care regardless of who your patient is, remember? So how is it NOT unfair to show compassion and provide an extra level of comfort to one group, but exclude another from that just because you don't like their modus operandi?

Cynical, the reason some people are reacting so strongly is that they've had *lots* of study of psychology. You might have a good natural feel for how the human psyche works, but until you really study it, I don't think it's correct to hang on to any opinion you have about mental illness-- good or bad. You don't realize just how complex something like a suicidal ideation is until you read the multiple analyses by decades of psychiatric care professionals...

The action of suicide is selfish. No argument. It damages families, friends... and can trigger others to follow suit. The process of becoming so lost that one sees no other option is not a selfish process, it is a process of illness. Killing the self is something innately abhorrent to logical thought; therefore, to reach that point, your thoughts have to change to the point where it is no longer abhorrent. Can you even *begin* to imagine how F*cked up that must feel? What those thought processes could be like? Not to mention that depression is an isolating disease... the guilt felt by people reaching out often outweighs the potential guilt they see in just removing themselves from existence. How more isolated can one get inside one's head? Can someone really be blamed for that, logically, when looked at from that perspective?

You've seen how much we push for educated providers in order to best serve our patients and provide the most complete care we can. You've seen people get jumped on for thinking that medicine is seat of your pants, that background education doesn't matter. Here's the thing... by dismissing suicide and the inherent mental illness that goes along with it as simply "selfish" and not "worth compassion" you're expressing the same type of attitude, only in the field of mental health instead of straight paramedicine. Do the reactions make more sense, looking at it that way?

If we are all the same, and no different than any who may come, then what is the point of trying at all? We are all different, and should use our strengths to advocate for our patients to the fullest extent of our ability, even though we only be lowly pre-hospital medical providers. No one is putting EMS on the pedestal; we're fighting to get it into the same damn gymnasium as other previously lowly-regarded sectors of medical care now inhabit.

Strong opinion is good. Phrasing is everything. That's the lesson I've learned recently.

With utmost respect,

Wendy

CO EMT-B

[spenac]

we are no different than those who will come after us and take our place

Perhaps you need to leave the profession now so the patients can get the care they deserve from the person that replaces you. I hope those that replace us are more educated and actual medical professionals.

I tried to give you the benefit of the doubt but you just showed extreme ignorance in your comments about the diabetic with low blood glucose levels.

I really hope you are in real life way different than you come off as in the forums.

[WolfmanHarris]

Regarding EMS and our positions being put on a pedestal I think you've missed the point of the largest theme that runs through these boards. The current system sucks and puts out ill-prepared providers with limited skills and less knowledge to go with it. I won't harp on this one further than that. EMS being no different generation to generation is the problem. So the goal on many here is to spread the word and in my view grab every provider by the boot straps and try to drag them kicking and screaming to their full potential. Not nicely, not with a hand hold and with no apologies. I'm not one for the former, I get my ass kicked and my brain wracked in every scenario or debate I come across. But each time I come back a bit smarter and a bit less timid to jump in and get bopped in the nose. For someone who is by your own admission naturally blunt and unapologetic, I'd figure you would be comfortable with this environment. I honestly believe if you were to check your ego and try hard not to take it personally you would learn a lot.

Regarding suicide and you're seeking answers and input. Please return to my previous post. If you have specific questions comments or issues with that I'd be glad to debate and discuss.

[Michael]

I dont believe in shelling out compassion to those who dont need/deserve it.

Cynical, do you deserve compassion?