1. Suicide Background and tips on handling calls from suicidal people
Silver Cross EMS 2011

2. The EMD may feel helpless talking to suicidal callers
The EMD may feel helpless talking to suicidal callers. There is no scripted protocol for how to handle these types of calls. The dispatcher likes to be in control of the situation so they can stay focused on their tasks. It can be quite frustrating and stressful, not knowing what to do or to say to the caller.

3. All suicidal callers should be taken seriously
All suicidal callers should be taken seriously. Regardless of the outcome, dealing with the suicidal caller is often very difficult. The obvious despair and hopelessness that leads a person to consider taking their life raises many highly charged emotions. There are many ways to provide help. Helping
someone begins with understanding the problem and trying to offer some solutions.

4. Common Misconceptions
People that talk about suicide, won’t really do it.
Not true. Almost all people that commit suicide have given some warning signs or clues. Don’t ignore them.
If a person is determined to kill themselves, nothing can stop them.
Not true. Most suicidal people do not want to die, they just want their pain to go away. Talking to them will help.
All suicidal people are crazy.
Not true. Suicidal people are often depressed and in a crisis but may not have any underlying mental illness .

5. Some Facts About Suicide
Suicide takes the lives of nearly 30,000 Americans every year. Many who attempt suicide never seek professional care. There are twice as many deaths due to suicide than HIV/AIDS. Between 1952 and 1995, suicide in young adults nearly tripled. Over half of all suicides occur in adult men, ages

6. Facts Continued
Suicide rates in the United States are highest in the spring. Over half of all suicides are completed with a firearm. Suicide rates among the elderly are highest for those who are divorced or widowed. In the month prior to their suicide, 75% of elderly persons had visited a physician.

7. More Facts
80% of people that seek treatment for depression are treated successfully. 15% of those who are clinically depressed die by suicide. There are an estimated 8 to 25 attempted suicides to 1 completion. The highest suicide rate is among men over 85 years old: 65 per 100,000 persons. 1 in 65,000 children ages 10 to 14 commit suicide each year.

8. Still More Facts
Suicide is the 11th leading cause of death in the U.S. (homicide is 15th). (CDC) Suicide is the 3rd leading cause of death for 15- to 24-year-old Americans. (CDC) It is estimated that there are at least 4.5 million survivors in this country. (AAS) An average of one person dies by suicide every 16.2 minutes. (CDC, AAS) There are four male suicides for every female suicide. (CDC, AAS)

9. Facts Conclusion
Research has shown medications and therapy to be effective suicide prevention. Suicide can be prevented through education and public awareness. There are three female suicide attempts for each male attempt. (CDC, AAS) According to the Violent Death Reporting System, in % of suicides also tested positive for at least one substance (alcohol, cocaine, heroin or marijuana). Illinois Region ranks 10.9 per 100,000 population in the national suicide rate. (AAS)

10. FAQs about Suicide Why do people commit suicide?
They are having intense feelings of helplessness and hopelessness and don’t see and other way out. Revenge may also be a motive.
Is it true that people attempt suicide as a cry for help?
Their attempt is often a method for getting others to recognize just how badly the individual is feeling.

11. FAQs about Suicide Does suicide run in families?
If someone in the family has committed suicide, other family members may be more tempted because that behavior has been modeled for them.
Do people ever attempt suicide to get attention?
Anyone that does attempt suicide for attention desperately needs it! It is tragic when a person feels the need to bargain with their life to have their problems taken seriously.

12. FAQs about Suicide
If a person attempts and fails, is it likely that they will try again?
A history of prior attempts should suggest the possibility of similar behavior in a subsequent crisis. They are less likely if they receive concerned help after an attempt.
Is it true that people who attempt to kill themselves really don’t want to die?
Most people want to live and die at the same time and are undecided right up until the moment of death.

13. FAQs about Suicide
Will a person that is deeply depressed always become suicidal?
Depression is a risk factor for suicide but not all depressed individuals become suicidal.
Does anyone ever impulsively attempt suicide and then become sorry for making such an attempt?
At the time of the attempt a person may find the emotional pain intolerable and make an impulsive decision, later regretting it.

14. FAQs about Suicide
Does drug or alcohol use increase the chance for suicide?
These substances can exaggerate the painful feelings to a point where the feelings are intolerable. In that state, a person might attempt suicide who otherwise would not go that far.
Is there a particular time of day that is more common for suicide attempts?
Young people tend to make attempts in the morning or around dinnertime, when they are more likely to be rescued.

15. IF THEY ARE TALKING TO YOU THEY ARE NOT COMMITTING THE ACT!
FAQs about Suicide
How does talking about a suicide prevent it?
Talking diffuses some of the intense feelings that a suicidal person may be feeling. It creates an environment of caring and helps to break through the loneliness the person is experiencing. Showing these individuals some real caring by listening and being supportive can make them feel life may be worth living.
IF THEY ARE TALKING TO YOU THEY ARE NOT COMMITTING THE ACT!

16. Risk Factors & Warning Signs for Suicide
Significant changes in: • Relationships • Well‐being of self or family member • Body image • Job, school, university, house, locality • Financial situation • Environment Significant losses: • Death of a loved one • Loss of a valued relationship • Loss of self esteem or personal expectations • Loss of employment Abuse including: • Physical • Emotional/Psychological • Sexual • Substance • Neglect • Withdrawing from friends and family, lack of communication or isolation • Depression
Signs of depression include: • Loss of interest in usual activities • Showing signs of sadness, hopelessness, irritability or helplessness • Changes in appetite, weight, behavior, level of activity or sleep patterns • Loss of energy and difficulty concentrating • Making negative comments about self • Recurring suicidal thoughts or fantasies • Sudden change from extreme depression to being `at peace' (may indicate that they have decided to attempt suicide) • Talking, Writing or Hinting about suicide • Previous attempts • Feelings of worthlessness and guilt, • Purposefully putting personal affairs in order: • Giving away possessions • Sudden intense interest in personal wills or life insurance • `Clearing the air' over personal incidents from the past

17. Suicide
Depression is the most significant factor that contributes to suicide.
It is a common misconception that people who threaten suicide never commit it.
Suicide is a cry for help.
Someone is in a crisis that he or she cannot handle alone.

18. TO BE OR NOT TO BE?
If a person is stating they are suicidal, has formed a lethal plan and has the means to carry it out immediately, they would be considered more likely to attempt.

19. How you can make a differenceDO
Be a GOOD LISTENER
Be DIRECT and talk openly
Show that you CARE
Get them HELP
DON’T
MINIMIZE their feelings
Make moral JUDGEMENTS
ABANDON them
IGNORE the problem

20. Tips for Handling The Suicidal Caller
Be yourself.
There are no “right words” to say. Your voice and manner are more important. Show them that you care.
LISTEN! Let them vent and unload their feelings. Talking will give them relief and a feeling of being understood.
Be empathetic.
Non-judgmental
Patient, calm
Take them seriously and keep them on the line.
Avoid arguments, belittling, problem solving or advice giving.

21. Tips for Handling The Suicidal Caller
Try to establish a bond with the caller
Let them know that you are there to help
Try to identify areas of commonality with the caller
Keep them talking
Take notes
Reassure them and focus on positive alternatives
Their problems are very real but temporary. Suicide is a permanent solution.
Avoid sensitive topics or things that set the caller off.

22. Tips for Handling The Suicidal Caller
Avoid statements that are condescending:
“You have everything to live for”
“I know how you feel”
“There’s light at the end of the tunnel”
Avoid statements that will make the caller feel guilty:
“Think of how your family will feel”
“You will make everyone feel sad”

23. EMDPRS for Suicide Attempts
Key Questions: 1. What is the patient’s location? Phone number? 2. What is the suicide mechanism? How? If drugs, go to OVERDOSE protocol 3. Are there weapons involved? Available? 4. Where is the patient now? 5. Is the patient breathing? YES? Monitor breathing until help arrives If difficulty in breathing, go to DIB protocol NO? Go to ARREST protocol per age 6. What is the history of the incident?
Pre-Arrival Instructions: 1.Send law enforcement to secure the scene 2. Attempt to calm the patient 3. Remove dangerous objects, if safe to do, including weapons 4. If caller is also patient, attempt to maintain phone contact. Be careful not to agitate patient. 5. Call back if patient’s condition worsens prior to the arrival of medical personnel 6.In case of suicide attempt by hanging, to release patient, cut ligature above the knot

24. EMDPRS for Suicide Attempts
ADDITIONAL INFORMATION
INQUIRE OF CALLER
1.Does the patient have a history of mental problems?
2. Is the patient under psychiatric care or counseling?
3. Any previous overdoses or suicide attempts?
USEFUL INFORMATION
IN DEALING WITH SUICIDAL CALLERS:
1. Remain calm 2. Instruct caller to stay on line
3. Avoid putting caller on hold
4. Avoid lying to caller
5. Dispatcher who answers call should create a
psychological bond with caller
6. Create an environment of trust

25. EMDPRS for Suicide Attempts
If the victim has ingested drugs/poisons or has injuries, refer to the proper protocol for additional pre-arrival instructions.

26. Resources
Will County Crisis Line AAOS Emergency Care and Transportation of the Sick and Injured 10th Edition CDC website SAVE (Suicide Awareness Voices of Education) website American Association of Suicidology website Will County (Region 7) EMDPRS