Attempted Suicide

[WolfmanHarris]

What do you think about running in L&S with caustic ingestion pts? It seems like most of the damage would be done rather quickly with Drano, but what about other chemicals? Any treatments the hospital could do that you can't in the field (protocols allowing of course)?

To me this (being draino or similar ingestion) fits criteria for an L&S return. The upper airway trauma may be complete at this point, but unless the agent has been removed and the remainder neutralized we can't rule out further damage along the GI tract. Not to mention I'd worry about metabolic concerns, renal and hepatic damage/failure, potential aspiration/inhalation and respiratory damage. This to me is a profound multisystem insult that needs definitive, specialized care. As the only person in the back (with maybe a First Responder FF tagging along) I don't imagine I'd be able to get too far from the airway which means one of the best things the hospital can provide is enough expert staff to manage each potential issue.

[Richard B the EMT]

Isn't is almost always "had a fight with gf"? Sad really. Permanent solution to a temporary problem.

Nope. I've transported numerous patients had a fight with the BF and attempted suicide, usually different types of pill ingestion.

From 1973, don't recall if I transported any caustic agent ingestion patients, but have done numerous pill ingestion, and/or vehicular incidents and "Jumper down" calls related to fights with the "significant other", or the parents.

[firedoc5]

I can just hear a few dispatcher buddies of mine talking to suicide callers. They'd start argueing with them when they said that they just took pills or drank something or whatever. The first thing they would say would be, "No, you're not trying to kill yourself. You just want attention. If you were going to kill yourself you wouldn't have called." And if someone else called for the "suicidal" person, they'd just give them instructions to be more attentive to them and give them all the attention in the world. Of course Terry and Roy, the dispatchers, wouldn't have actually done it, but I could just hear them now.

[Jeepluv77]

I know it may seem inane when people threaten suicide or attempt suicide, and yes it's a cry for attention, but it's also a cry for help. Most of the time these people have already tried to talk to people about what's bothering them, and in this "me" society no one has taken the time to listen. They need to be directed to a professional counselor and it would be best if those closest to them, be it friends or family, would attend at least one session with them. A lot of times they simply cannot articulate the extent of their pain(and yes, even problems you see as minor can be very significant to someone else) and that's where a professional can help. Also, sometimes they are just very selfish and needy and want all eyes on them all the time. Again, a professional can help. They will see this if it is the case and can help the patient come to realize it and to work on it. Either way even these attempts, cries for help, need to be taken seriously. Otherwise, a lot of them can/will turn into an actual suicide one day. And some of them aren't cries for help, but actual serious attempts that were accidentally walked in on. If a parent/spouse/sibling/friend/etc hadn't come in unexpectedly, you would be calling a coroner for more of them than you might think.

[emti2008]

Last year during my clinical rotation we picked up a woman on the side of the road, her husband had died and she had taken 2 packages of cold medicine and a thing of store brand Accetominophen (sp?) She was only responsive to pain and had extremely high BP. I don't know if she made it, I don't think they found her quick enough, the meds had already been released into her bloodstream. The same week we had a 15 year old put a shotgun in his mouth, because of a gf breakup. It's so sad that ppl think they will make things all better, No girl or guy is worth me taking my own life.

[joesph]

These type of calls are tough because they are a contradiction to our job description. But it is somewhat easier after you realize that most of these victims are suffering from depression, a mental illness. I am sure that many will argue that point but it holds true in most cases. This being the case I think they need to be dealt with the same as any other patient (with obvious exceptions). It is still frustrating to get a call like this and I often get the desire to slap them along side the head and tell them not to be a dumb ass, But if I cant do that to DUI's I will refrain on the rest as well.

Edited April 12, 2009 by joesph

[Flasurfbum]

Something that is completely misunderstood, and often neglected is mental health.

Sure, you will get the 16 year old who scratches his/her wrists for attention when they don't get their way.

But how about some of the other people out there?

The ones that have undergone severe emotional trauma, and tried to bury it, and move past it?

Everyone deals with trauma, be it mental or physical, in different ways.

There is a stigma attached to depression, anxiety, bipolar, manic depressives and the like.

Often times, those suffering do so in silence. What we see is a cry for help.

DON'T WRITE THEM OFF BECAUSE YOU DON'T UNDERSTAND

Be an advocate for them. Ensure that the ER does not throw them in triage. Talk to them. Let them know that they have someone to talk to, and not be judged.

If you couldn't tell, this is a subject that I am painfully familiar with.

[NOMedic119]

had a guy who drank a whole bottle of deep woods off bug repellent. The smell was sooo bad i couldn't understand how he was able to guzzle that entire bottle. Don't know what happened to the guy but i can imagine it didn't end all that great.

[WolfmanHarris]

Something that is completely misunderstood, and often neglected is mental health.

Sure, you will get the 16 year old who scratches his/her wrists for attention when they don't get their way.

But how about some of the other people out there?

The ones that have undergone severe emotional trauma, and tried to bury it, and move past it?

Everyone deals with trauma, be it mental or physical, in different ways.

There is a stigma attached to depression, anxiety, bipolar, manic depressives and the like.

Often times, those suffering do so in silence. What we see is a cry for help.

DON'T WRITE THEM OFF BECAUSE YOU DON'T UNDERSTAND

Be an advocate for them. Ensure that the ER does not throw them in triage. Talk to them. Let them know that they have someone to talk to, and not be judged.

If you couldn't tell, this is a subject that I am painfully familiar with.

Excellent point. I know in two years I have received less than 10 hours of class time on psychological conditions (not counting the required full course on psychology). Does that sound like enough to provide any sort of worthwhile assessment other than competency to refuse?

I think part of the problem with psychological calls is that they feed into our own jadedness quite well because on a cursory glance they seem to fit better with our other BS calls and there's little we can do intervention wise for them unless they're an immeninent threat and we call the cops.

EMS is far too often at the sharp end of our abysmal mental health system and with our current education and provider model, is woefully equipped to deal with it. Community Referral by EMS (CREMS) is a start, but these programs need to develop more so that we can get patients the help they need when a trip to the ER isn't it.

Additional time spent on psychology during our educations is not the answer as while they will better prepare medics, they will not suddenly turn us into competent social workers, let alone psychologists. We do however need enough education in abnormal psychology to know how much we don't know. Maybe then we (EMS collectively) will treat our mental health patients better.

[Jeepluv77]

I, too, think that training for psychiatic disorders is sorely lacking. Here, paramedics are required to make only one 8 hour clinical rotation in a psyciatric ward. That's not nearly enough time to fully grasp what happens to a patient during a psychiatric crisis. Suicide attempts can be triggered by a lot of different things and is not only because of a fight with a significant other. They feel trapped in a situation they can't handle(ever heard of the abused wife that can't leave?), drug/alcohol problems, feelings of inadequacy, a general hopelessness about their lives, etc. I really feel that all healthcare workers, not just emergency responders, should recieve training in the early warning signs of serious depression/psyciatic issues. Aren't we supposed to be advocates for our patients? A lot of people comtemplating suicide never ask for help because at that point they no longer believe that help is available or simply are afraid they will be jugded for their feelings. You never know if you might be that one person that reaches out and renews someone's faith in life and, more importantly oftentimes, in humanity. Or, at the very least, sets them on the track towards finding it. No one comes into this world severely depressed. Something gets them there and if it's noticed in time something might just be able to bring them back.