# Teen Suicide Attempt



## Kiley3706 (Jan 14, 2017)

If a 14 year old girl had slit her wrists, taken pills, and was going to jump off a bridge but cops showed up before she did, what kind of stuff would you do in the ambulance? What would you do if she wouldn't tell you what kind of pills she took? Would you do a full body exam to see if she has any other injuries she hasn't told you about? How would you check her body, just tell her to take her clothes off? If you did and you saw bruises on her body would you believe her if she said they were from sports or would you go tell one of the cops because you suspect someone abuses her?


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## DesertMedic66 (Jan 14, 2017)

What on earth kind of scenario is this? I'll bite anyway. 

Attempted suicide calls are calls where we stage away from the scene and will only be cleared in once the scene is secured by law enforcement. 

If she won't tell us what kind of pills she took and there are no pill bottles around then nothing. Hospital will draw lab work. 

If she did jump then yes I would be doing a full body exam and probably cut off her cloths. If she didn't jump then I may not do a full body exam unless I suspect something. 

If I saw bruises I would include it in my ePCR and inform the ED upon my arrival. Law enforcement will be doing a follow up at the hospital with this patient.


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## CALEMT (Jan 14, 2017)

DesertMedic66 said:


> What on earth kind of scenario is this?



I was thinking the same thing.


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## NomadicMedic (Jan 14, 2017)

This smells weird to me.


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## akflightmedic (Jan 14, 2017)

Very weird first post for sure....unsure if we are answering homework questions, feeding a family member info for legal recourse, or giving pointers on how best to kill oneself.


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## Kiley3706 (Jan 14, 2017)

Kiley3706 said:


> If a 14 year old girl had slit her wrists, taken pills, and was going to jump off a bridge but cops showed up before she did, what kind of stuff would you do in the ambulance? What would you do if she wouldn't tell you what kind of pills she took? Would you do a full body exam to see if she has any other injuries she hasn't told you about? How would you check her body, just tell her to take her clothes off? If you did and you saw bruises on her body would you believe her if she said they were from sports or would you go tell one of the cops because you suspect someone abuses her?


I'm asking these questions because I'm writing a story. I'm not sure what would happen so my story won't be very good if I just guessed what would happen. I'm not suicidal.


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## DesertMedic66 (Jan 14, 2017)

Most suicide attempts/successful suicides do not involve 3 different ways of doing it...


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## Kiley3706 (Jan 14, 2017)

DesertMedic66 said:


> Most suicide attempts/successful suicides do not involve 3 different ways of doing it...


I wouldn't know, I'm not suicidal. I don't know what goes on in their head. But maybe some people just really don't want to fail so they think if you do more than one way there is less of a chance you fail.


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## CALEMT (Jan 14, 2017)

You're writing a story on committing suicide? Must be some book...


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## Kiley3706 (Jan 14, 2017)

CALEMT said:


> You're writing a story on committing suicide? Must be some book...


No I'm writing a story about a girl who was about to commit suicide but before she jumped the cops showed up. About her life leading up to her wanting to kill herself. And then after she gets taken to the hospital how she gets better and sees the good in life again. About her finding reasons to live.


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## NysEms2117 (Jan 14, 2017)

you know, us ambulance folk have that tendency to change peoples lives around lickedy split


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## VentMonkey (Jan 14, 2017)

OP, you're better off joining a writers forum than asking a bunch EMS folk what they would do if...

Everyone approaches patients with their own spin for various reasons, and I doubt that the way the EMS personnel in your "book" assess her would have much bearing on her life-changing moment. That is, or course, unless the tech in the back was a master at "verbal judo" as this is arguably the strongest asset any public service agency provider can possess.

All the other stuff sounds irrelevant to your storyline, and as a non-medical person, I could care less if this isn't their turning point (i.e., again assuming the person in the back of the ambulance doesn't play a pivotal role in their decision-making). 

Notice what I said has absolutely nothing to do with what you see ambulance people do on TV, and in the movies, why? (whispers) Because that isn't what we do. Good luck on your book.


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## akflightmedic (Jan 14, 2017)

Maybe have an "angel" in the form of a paramedic named Clarence show her how the world would be if she were not in it. During the ride, this could be the treatment of choice. By the time they arrive at the ER she will have a better understanding of how much an impact she has had on the people in her life and how much more impact she will have in the future...surely she will recognize its a wonderful life and worth living.


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## Seirende (Jan 14, 2017)

Hi Kiley, welcome to the forum. I see that you're pretty young, so kudos for trying for accuracy.

Tbh, I would shy away from putting a lot of technical detail into a fictional story like this. If you're serious about getting stuff right, your best bet is to find someone to critique the material after you've written it. It's hard to answer vague questions in detail



Kiley3706 said:


> How would you check her body, just tell her to take her clothes off?



"Take your clothes off." <-- Not a sentence that you'll hear coming out of my mouth in this context. If I did need to expose any body areas, I would explain why it was necessary, then either cut the clothing or help her remove it.

As an aside, psychological care/therapeutic communication is going to be a significant concern here. That's a bit of a rabbit hole, but there's plenty of good reading material. Here, have an article for starters. http://www.emsreference.com/articles/article/ems-guide-depression-and-bipolar-disorder


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## Seirende (Jan 14, 2017)

akflightmedic said:


> Maybe have an "angel" in the form of a paramedic named Clarence show her how the world would be if she were not in it. During the ride, this could be the treatment of choice. By the time they arrive at the ER she will have a better understanding of how much an impact she has had on the people in her life and how much more impact she will have in the future...surely she will recognize its a wonderful life and worth living.



Every time a siren wails...


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## Kiley3706 (Jan 14, 2017)

I don't want to talk about it I'm just writing this cause I feel like a complete ******* and it's going to bother me the entire rest of the night. I lied about the whole story. I'm not writing a story.


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## DesertMedic66 (Jan 14, 2017)

Please call the suicide hotline: 1-800-273-8255


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## Kiley3706 (Jan 14, 2017)

DesertMedic66 said:


> Please call the suicide hotline: 1-800-273-8255


I'm not calling a hotline.


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## CALEMT (Jan 14, 2017)

Maybe @Chimpie should close this thread right quick.


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## SpecialK (Jan 14, 2017)

A great opportunity to timely remind us:

1.  Attempted suicide, threatened suicide, and self-harm are *NOT *the same thing and should *NOT *be treated the same!
2.  These scenarios do *NOT *routinely need the police, and the police are often more harm than good!
3.  Transport to ED is *NOT *routinely required unless no other option is available.


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## NomadicMedic (Jan 14, 2017)

Another example of how medicine differs between the continents.

What may be acceptable and status quo in NZ is not in the US and a reminder that you should always follow your local protocols.

In many places in the US, the first point of entry for acute mental heath incidents is, in fact, the local ED, as they can usually direct  the patient down the correct pathway and call mental heath practitioners and social services into play.

While it's far from perfect, any ACUTE mental health crisis should be seen at an ED.


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## Jim37F (Jan 14, 2017)

Attempted suicide here is an automatic trip to the ER via ambulance. We have no say, pt has no say, in the eyes of the law here "Danger to Self" means you no longer have the right to refuse transport, and PD will get involved if needed to ensure you go.

To the OP, the scenario you presented is a rather bizarre situation, it is not something we see everyday. In fact, if I ran the call as you described, it'd probably become a "war story" due to its uniqueness. Add to that the stigma that exists with suicide and mental health in general, and the fact that most of us are woefully under educated and trained in these matters may help explain  why a lot of the responses here are more along the lines of "dafuq?"  vs a detailed step by step  account of what we may do. This isn't a straight forward trauma or chest pain call or whatever, instead this is a highly complex case that doesn't really have a straight forward answer.


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## StCEMT (Jan 14, 2017)

Kiley3706 said:


> I'm not calling a hotline.


If this isn't what you want, the general principle of what Desert suggested is still a good idea.


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## SpecialK (Jan 15, 2017)

Of course I can't say what happens elsewhere, but in general, there's a lot of myth and misnomer about this sort of thing:  This is an increasing area of work and it an area very poorly understood by ambulance personnel; and historically has been very poorly taught.

As a contrasting example, our framework is:

1) Prevent suicide if it is imminent or an attempt is in progress - this is very rare, 
2) Assess pt for injuries or poisoning requiring immediate treatment and/or referral,
3) Differentiate between a) attempted suicide, b) a genuine and significant threat to commit suicide, or c) self-harm
4) If (a) or (b) above are present then arrange a psychiatric assessment for the patient.

The _*key *_factor in determining if either a "suicide attempt" or "genuine and significant threat to commit suicide" is present is by answering the question "did the patient intend to die?".  The answer is most often "no" but sometimes it is "yes"; for example, somebody who drank (or attempted to drink) a bottle of dishwashing liquid or some other less-than-lethal substance but clearly articulated (either to ambulance personnel or somebody else present or who they were in contact with) that this was with the intention of dying has made not only a significant and genuine threat, but has also seriously attempted suicide.  In contrast, somebody who, in the "crux of the moment" just said "oh bugger you, maybe I should go off myself" and then nothing further is said did not.  

Patients who have made a genuine and significant threat to commit suicide, or whom have attempted to commit suicide, require a psychiatric assessment.  Locally, this is done by our area community mental health people.  They can see patients in the community so transport to ED is not routinely required unless there is absolutely no other reasonable option available; i.e. nobody can stay with the patient until they arrive (they often take one to three hours, or will visit in the morning).  These assessments are much more detailed than what ambulance personnel can perform.

Patients with only self harm are not routinely referred for an assessment and are referred to their GP.

The Police are not routinely required because they don't have any special powers to assist.  They cannot arrest people who've not broken the law.  If police restrain somebody to assist ambulance personnel, technically that person has been arrested and as they have not committed a crime, that is illegal and the person can (and several have) successfully prosecuted the police for false arrest.  They are only involved if there is significant danger to other persons.

This might be wildly different to how you do your thing, and it would be a shame if that is the case.  I've dealt with enough of these patients to know routinely transporting them, or routinely involving the police, is not the best thing; it's the last bloody thing they want.  It often just ends up making the situation worse.


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## Chimpie (Jan 15, 2017)

Kiley3706 said:


> I don't want to talk about it I'm just writing this cause I feel like a complete ******* and it's going to bother me the entire rest of the night. I lied about the whole story. I'm not writing a story.





DesertMedic66 said:


> *Please call the suicide hotline: 1-800-273-8255*





Kiley3706 said:


> I'm not calling a hotline.



Since @Kiley3706 has not been upfront about the purpose of this thread, I'm going to close it.


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