How do you deal with suicide calls when you have experienced if firsthand?

DragonClaw

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I'm studying for my EMT course, and I have a question that's been bugging me (above). Not looking to create a "Boo Hoo" moment, but I still think it's an issue. Don't read on if you don't want moderate details of actual suicide.

To be honest, when I was in high school, my brother killed himself. Not much was said about it or explained. I still kind of blame my parents. It's still pretty unresolved. I ended up requesting the file from the responding police department, even the pictures. I looked at it all. But it still seems kind of surreal.

He had a lot of physiological issues of his own, but one day decided to jump off the dam. He broke his legs and managed to evade rescue (It had been like 25-30 minutes before they could even get a boat down there because of how low the bridge was. There were a couple of bystanders, but the closest woman didn't get too close in case he grabbed her and they both went over. The drop was over 200-250 feet.

I watched the interviews of the bystanders, one of the cops had them sit in the car and talk to the camera.

We did counseling and all of that. I couldn't take it seriously at that age, never really went back as an adult.

I had a kind of suicidal moment as my parents seemed to neglect me to take care of my siblings they thought were at risk for suicide (To be honest, they were, they just showed more outward signs. I went back to the rhythm of being that happy, annoying, chatty kid)

I started with cutting (as other kids did when stressed, but that turned out to be dumb and ineffective (surprise) I tried to kill myself with a bag (Halfheartedly.. kind of. I don't really know).

At that point, I realized I couldn't keep all that guilt eating at me. I swore on his grave that I'd never to kill myself again. (Sounds corny, but that kind of thing matters to me). I think I've gotten better to some degree, but it still heavily weighs on me.

How do you guys keep up with this? How do you respond to someone trying to kill themselves, standing at a bridge, someone who is actively trying (still writhing on a noose), or someone who purposely OD recently or even a dead body when it's too late? What about the family and friends, random bystanders?

Before this whole thing, I used to make and laugh at suicide jokes. I mean, it was whatever. Didn't affect me, didn't bother me, I didn't relate to it. Now, I only hope someone truly suicidal doesn't hear such comments and jokes, and I wish people would stop doing it.

I know this may or may not be the correct place, but considering my hopeful future employment, I thought it may be relevant. I hope I'd never have to respond to such a call, but that's naive to think it won't. While it concerns me, what bothers me more is every time I hear sirens, I realize I'm not trained enough or even in a job position to respond to a call, to be on that ambulance. Instead of mere wishing, I'm working toward that goal.

Just looking for some direction. It's probably a lot to go over, so I apologize if you've made it this far.
 

CCCSD

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You do the job that’s required. If you can’t, don’t put yourself into it. That’s a decision you have to make.
 

Akulahawk

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Really, this is a decision only you can make. You can do the job, accept that it's their decision, their emergency, not yours. You don't need to own their issues, no matter what they are. You only need to own yours. That's it. If you can't do that, then you need to find a way to not put yourself into the position where you have to confront those issues and any kind of first responder job or even ER job isn't going to give you much of an "out" from that. If you can't do that, these jobs will just eat at you.

It's truly your choice. None of us can make it for you. Take the time and put some deep thought into this. Whatever decision you come to, I'm sure it'll be the right one for you and I think most of us will applaud your decision, whatever it may be.
 

Peak

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You either get jaded to it or you struggle, you have to compartmentalize it.

Occasionally we all will see something that is especially awful, and there are counseling programs set up by most employers. You can't be in counseling from your work constantly though, it isn't healthy.

In the past ten years I can think of two cases that really shook me, one was a really bad NAT in the field and the other is a kid I had code on me in the PICU. Both made it through fine, but the first was the worst of humanity I've ever seen, and the other I let myself get too attached to the kid and family.

Adult that die, are SI, abuse each other, and so one don't really bother me. I sympathize with them, but when I go home I don't give it a second thought. You can't and be successful in EMS.

Some people can't handle it, and they need to leave EMS. People who invest themselves in every call are why we have so much depression, substance abuse, and suicide in EMS. The reality is we see thing humanity shouldn't.
 

mgr22

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Put aside the question about EMS for the moment. How are YOU doing? You sound like you're still very much affected by your brother's death. It must be terribly hard to handle something like that on your own.

Do you still try to hurt yourself, or even think about doing so?
 

DragonClaw

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@mgr22

Definately not. Absolutely not.

That was years ago, I came to the conclusion that self harm is dumb and not productive, killing one's self is a permanent solution to a temporary problem.

Yeah, it still gets me down, yeah I still have regrets about it.

One part that bothers me, is that when reading the reports, literally nobody tried to resuscitate him.

I'm not angry about that, I'm sure it was a tough call for everyone. I'm just trying to make sense of something I don't have all the details of. Like I said, highly unresolved.

I get moderately stressed, but no, self harm is long off the menu.
 

mgr22

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Glad to hear that, Sarah. So let me just add a positive spin to the other worthwhile feedback you've gotten: The tragedy you experienced may help you become a better caregiver.

I used to ride with an EMT who had a seizure disorder. No matter how much I learned in paramedic school about seizures, I was never going to know as much as her about patients with that disease. Same thing with another partner who was an asthmatic. I knew the physiology and pharmacology, but consulted those with personal experience whenever possible.

You might find yourself on a call where you can relate to a presenting problem better than anyone else present. That's not the only reason to get into EMS, and you'd still face lots of challenges, but don't underestimate the value of your first-hand experience.
 

DragonClaw

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I know I have to put a lot of thought into it, as I have been. I mean, being a first responder is no joke. If you're not all right, all there, you get people killed.

I'm not all doom and gloom, but I do recognize this as a possible issue. I mean, even if I think it's all resolved, if I go out on a call, there's no promise how things will go. There's a lot of factors I don't have control over.

And yeah, talk about checking the empathy box on that one. I only hope that I can help people with it. Otherwise, it seems undue.

I'm not the kind of person to freak out in the middle of something stressful, I can keep calm and do whatever task is required. I am just not content working a job when (Yeah, sounds kind of hero complex or something) I could be out there saving people. Or based on my ride alongs, be a spacious taxi for people who've had ongoing issues for months, but only now think it's 9-1-1 worthy.

Hung out at the rodeo in case someone got hurt.Though the cowboys apparently hate being treated by EMS staff (Does the term EMT include paramedics?) and we just hung back unless asked, they have their own medical staff. There was a patient transport. There was a call of a suicidal guy, the husband freaked out and (I guess?) tried to shoot himself, the wife wrestled with the gun, it went of. No injuries, but it did get me thinking. We were a couple blocks away, heard it on the radio, cops hadn't secured the scene yet. But I guess another unit took the call, or they settled it.

Like most others, I get false notions from TV and such, but I try to dissuade that, as most professionals scoff at it.
 

StCEMT

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I do my job. Some people want to talk, and if they do I'll listen. Some people don't want to, and that is fine too. I explain what the process is, any local resources I may know of, and encourage them to use them. I try to get them to what I believe is the best place for them and everything else in between you figure out as you go based off of your patient.

When it comes to dealing with the death side of it? It isn't my burden to carry. I have no emotional investment in them and I don't want to. I will do my absolute best to give the best care I can, provide an avenue for the most resources I can, and do whatever I can for the patient (I genuinely want to see people get what they need), but if I am arriving to someone who is already dead then it is what it is. At that point my focus shifts to trying to support family and help them through the process. Our interactions with family matters and that isn't a moment I want to leave a bad impression that would make that moment any harder.

Perspective is important with any fatality call, not just suicides. We rarely "save" people. There are a lot of situations we can't change no matter how much we do and that isn't a poor reflection on us. It's life. And honestly, it's not even bad. Sometimes, death is the better result. I didn't want to get back the stage 4 cancer patient who didn't have a DNR ready. I've watched people I loved die from cancer, I wouldn't wish to prolong it for my patient. Death is natural and doesn't have to be a bad thing, but culturally we aren't that open to it or about it.

If this is the path you want to go down, you need a realistic outlook on patient outcomes and what you can actually effect. Don't try to carry the emotional burden of your patient. Help their situation by being good at your job and advocate for them (and the family). If you do everything you can, then go home knowing they had the best chance you could offer and don't dwell on it.

That being said....have outlets. I fully believe that even the people who can have streaks of multiple patient deaths and truly be perfectly fine all have one call out there in the universe that will get to them. Whatever and whoever it is for you, have them available.
 

DrParasite

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If the sounds of siren, or the sight of flashing lights cripples you to the point of being able to function as an EMS providers, than this job isn't for you.

You will NEVER be ready for everything; I don't care how long you have been doing this job; you will go on the call and ask the patient "so how did you do that to yourself" or "hmm, I'm not sure what to do, so I'm going to have to call someone more educated than me." That doesn't mean you are a poorly trained provider, but you also need to recognized your limitations. Even the salty veteran will have a call where he or she says to him or herself "hey, that's a new one."

One thing you said, how no one tried to resuscitate your brother; I will say this: sometimes people are beyond the care of EMS. if many cases of blunt trauma, there is nothing EMS can do, so if the patient is dead, they are left in the care of LEO for the investigation. idk if that was the case with your brother, but it's possible after a 200 ft fall.
How do you guys keep up with this? How do you respond to someone trying to kill themselves, standing at a bridge, someone who is actively trying (still writhing on a noose), or someone who purposely OD recently or even a dead body when it's too late? What about the family and friends, random bystanders?
You can always stage for PD, however I'm really bad at this, especially when my safety isn't at risk.

If someone is writhing in the noose, I would recommend you do two things: push the chair under their feet, and then cut them down. if they are no longer responding, cut them down and start CPR.

If they purposely OD, give them narcan if they used opiods, and if now, support their ABCs until you get them to the hospital.

If the person is cold and dead, cover them in a sheet and turn the scene over to PD for the investigation.

If they want to jump off the bridge, do what you can to stop them, but don't them them take you with them.

I've dealt with more suicidal patients in my career than I can recall; most wanted to harm themselves, and not others. The other thing I will tell you is if someone wants to kill themselves, they will find a way, and nothing you or I can do will prevent it. We can tackle them, tie them down, send them to a psych hospital, but if they want to kill themselves, it's going to happen. might not happen today, or tomorrow but it will happen. We, as healthcare providers, can try to change their mind, but we all have free will and make our own choices.

Some EMS providers are less mentally broken than others, especially after what we have seen. make no mistake, this job will wear on you, and you will likely see some messed up stuff.

Let me close on this: in the county I grew up in, about 20 years ago, a young kid jumped off a the victory bridge, into the raritan river (where 80 people had jumped off of prior to 2014, with 22 fatalities). This kid was pulled out of river alive, and promptly flipped off the paramedic, before being taken to the helicopter. Fast forward 20 years, said kid has completed his masters, is an EMT instructor, and occasionally works with the paramedic who helped him out of the river, and quite honestly, was one of my favorite partners to work with. He got on the right meds, and he's an awesome person today. He doesn't let his past prevent him from functioning in the present, and if you can do the same thing, than there is no reason you can't have a successful EMS career.
 

DragonClaw

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I think you misunderstand. Maybe I'm not clear. I WANT to go out and help, the lights and sirens "call" me. They just remind me of the goal I'm working toward.

I'm not stupid to think my life hasn't changed my outlook or preferences for careers, etc, so I would like a few things addressed such as this. Mentally try and prep myself as best as I can.

I know I can do the course, I guess I'm just trying to figure out all of the how.
 

StCEMT

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Starts with signing up for the course then completing it. Your first steps really are that simple.
 

Akulahawk

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I think you misunderstand. Maybe I'm not clear. I WANT to go out and help, the lights and sirens "call" me. They just remind me of the goal I'm working toward.

I'm not stupid to think my life hasn't changed my outlook or preferences for careers, etc, so I would like a few things addressed such as this. Mentally try and prep myself as best as I can.

I know I can do the course, I guess I'm just trying to figure out all of the how.
Starts with signing up for the course then completing it. Your first steps really are that simple.
The journey of 1,000 miles starts with the first step. The decision to take that first step is the hardest for once you take that step, the next one becomes easier to take.
 

j2021

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I'm glad you are studying. I know it is hard, but this is your choice you are making. You have to be there for others. It is your job, whilst taking care of yourself. However, you cannot let your feelings get in the way. You do what you applied for.
You will never know what people will do, unless they state so. You are not in their head; cannot see their mind.
But as soon as the call is over, attempt to debrief. It has helped me a lot, as others. Otherwise, have good support, find things you can do in a positive way that will help you cope.
Remember, "why did I apply for this? Why is this my calling? How can I use my experience to better help or support others?"
I am not saying it is easy at all, but you have to learn to shake off the last call, and be able to work your way through the day, performing as good as on your best days, even on your worst. Then you go home. This job may or may not weigh on you. It all depends upon if you're prone to stress, PTSD, coping mechanisms, and similar.
For now, if I was in your position, I'd have a goal of taking care of myself first, and finding a stable support system, bettering yourself for situations in you find yourself upset, or triggered by calls or even daily life situations. Then, assessing yourself, and see if EMS is really for you.
Only you know you. I can only provide my thoughts.
 

Seirende

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No one in my family has died by suicide, but some have come close, so I'm a little sensitive in this area as well. From experience, therapy helps. I've only had one call for a completed suicide and it really bothered me for about a week, but I talked about it with friends, made a counseling appointment, and processed it effectively. Having a relationship with a therapist to start with is good so that when something comes up you can just go in and you don't have to start from scratch. Plus it's good for just life stuff.
 
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