When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals

Abstract

The suicide of a patient can be a disturbing experience for health professionals. According to literature, a patient suicide is a professional hazard in the path of prehospital emergency professionals. In the emergency context, several factors pointed out in literature as predictors of increased emotional impact and more severe traumatic reactions are present. However, the impact of patient suicide on prehospital emergency professionals is still an understudied subject. The aim of this study was to better understand the impact and emotional reactions of prehospital emergency professionals facing a patient suicide, using a qualitative approach. Semi-structured interviews were conducted with 19 prehospital professionals. Fourteen narratives about a patient suicide experience were obtained. Three main categories emerged from the process of content analyses: (1) emotional impact and related factors; (2) perceptions of impact; (3) emergency context and professional growing. Death by suicide in the prehospital emergency context had a considerable emotional impact on these professionals. Several participants described intrusive thoughts and images as a consequence of attending to the death scene. Regarding the perception of impact, there seemed to exist a variation between the levels of exposed to and affected by suicide. There are specific features of the prehospital emergency context that emerged in the narratives of participants as factors which increased the patient suicide impact, namely attending the death scene, encountering the family or other survivors, and managing the feeling of responsibility for not arriving in time of the rescue. The narratives of prehospital professionals also indicated some negative effects on their professional practice, such as doubts about their competence, training, and limits to liability. The death of a patient by suicide in the prehospital emergency context can be a difficult experience, marked with an intense emotional impact. Nevertheless, it can have some positive effects, such as professional growth and increased awareness for the phenomenon. Specific training appears to be fundamental to promote professional growth and to overcome the negative emotional impact.

Paramedic experiences of providing care in Wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

“… 34 Indeed, Rothes et al (2020) reported such professional growth and increased awareness in paramedics following their experiences with patients who died by suicide, but this relied on supportive cultures, training and preparation to overcome the negative emotional impact. 35 Once again, tragic and costly choices may be required to invest resources and mental energies in these issues.…”

“…It should however be recognised that such growth relies on supportive cultures, training and preparation to overcome the negative emotional impact. 35 Future preparation for pandemics should therefore consider the findings of this study and focus on such issues in planning.…”

Hangings attended by ambulance clinicians in the North East of England

“…Two recent articles have provided some early evidence relating to the impact that attending suicides, such as hangings, has on EMS clinicians, including the lasting emotional impact and the desire for better training, as well as a recognition of the impact on bystanders and family members ( Nelson et al, 2020 ; Rothes et al, 2020 ).…”

Editorial: Emergency in Psychiatry—The Various Facets of Behavioral Emergencies, Crises, and Suicidality

“…Not only social workers, relatives and teachers can be stunned, overwhelmed and helpless in these situations but also health care professionals are. Social workers and emergency service providers dealing with these highly stressful situations may themselves be traumatized by this confrontation and may suffer significant psychological damage ( 1 – 3 ). In adult as well as in child and adolescent mental health emergencies, self-mutilating and suicidal behavior are within the most frequent challenges as documented in the analyses of Franzen et al and Slankamenac et al within this issue.…”