People at risk for suicide are being seen in health care settings. But often no one asks or intervenes. Comprehensive approaches to suicide care are needed in healthcare because many people who are actually receiving health care are dying from suicide. In the month before their death by suicide, about half saw a general practitioner. And 30% saw a mental health professional. Many were seen in emergency departments shortly before their deaths as well. Health care professionals often fail to ask about suicide risk either because they were never trained to, don’t know how to recognize suicide warning signs or risk factors, don’t know what to do if someone is at risk for suicide, or believe erroneously that the person at risk would just tell them if they were feeling this way. If we could improve suicide identification and care in primary care settings, where most people receive their care, or in emergency departments, where most people go when they are feeling suicidal, we would have the potential to save lives.
• Can be anything- complex on emotional status
and prior well-being
• One event or several events over a career
• Death- especially unexpected
• You know the patient
• Multiple fatalities
• Children-senseless tragedy
• The negative change in our practice
• End of career issues
• Sleep deprivation- all in lifestyle
How big is the problem?
• 57 suicides in fire/ems in 2013 and again in
2014- we know this is under-reported
• JEMS Survey- 36% had thoughts 6%
• Depression, helplessness, suicidal thoughts
are much more common.
– Stop signing up for call
– Personality changes
– Become unsure of skills on calls
– Feel inadequate
Some will look to substances to mask
• Addiction is on the rise in America and
fire/EMS is not immune
• Punishment for addiction, especially with
drugs remains strong in our culture
• Addicts need help, not felonies, loss of job or
• Alcohol most common in Fire Service
In the month before their death by suicide:
•Half saw a general practitioner
•30% saw a mental health professional
In the 60 days before their death by suicide:
•10% were seen in an emergency department
People At Risk For Suicide Are Falling
Through the Cracks in Our Health Care
You may be the person to identify the
risk of suicide or self harm
• Talking about death
• Getting life in order-will, visiting family etc.
• Sudden calm demeanor
• Increased use of drugs or alcohol.
• Buying a firearm
Some will become angry
• Bully others to hide the pain
• Behave this way to cover own feelings of
• Constant complaining and anger on the job
• Hating to come to work
What to do?
• Do not leave person alone- get family and
other friends involved
• Get friend to a doctor- ER if necessary
• Make effort to remove medications and
weapons from the home
• Non-judgmental, loving, caring, genuine.
• Crisis intervention
• Suicide prevention help line
Some reach for substances
• Alcohol by far the most common
• Some will become addicted to opioids
– By initial prescribed medications
– By using and diverting to cover emotional pain
What should we do when something
• Open lines of communication encouraged
• It is not a weakness to be human
• Allow and encourage fellow members to be
open with struggles without fear of
• Have a plan in place to implement when a
member needs help
• Be vigilant- act on suspicion.
• Should be done ASAP after event. Should be
within 72 hours for sure. 24 hrs optimal.
• Needs to be done by trained individuals.
• 63% of EMS surveyed say this helps
• Your service should arrange to have an
Employee Assistance Program in place.
• This is for those continuing to struggle after
CIDS. 58% say this is helpful.
Florian Program at Rosecrans
• Started by Chicago FD Batallion Chief
• Specific in-patient program for Fire or EMS
personnel dealing with PTSD, suicidal
thoughts, addiction etc due to stress of the
• In-patient stay. In Rockford, so close.
My personal take after 40 years
• We respond to situations routinely that are
painful and make no sense
• We live in a fallen/broken world
• Humans are wonderful and beautiful creations
that mess up constantly.
• Evil is alive and well in the world
• The further we exclude God from our society
and personal lives, the worse things will be
• What we do takes a special skill set.
• We were created to do this job.
• It is a PRIVILEGE to care for others at their
worst possible moments.
• We have wonderful opportunity to help and
change the world one patient at a time.
• This task is increasingly difficult-we must take
care of our own.