# suicide with a gun, what woudl you do



## EMSDude54343 (Dec 15, 2011)

A discussion was started the other day after we took a suicide attempt with a handgun, to the head. The pt lived out in the boonies and was a 20 min response (give or take). Pt was an adult male, Agonal resp, unconscious. Handgun lying next to the pt. 
The closest Sheriff deputy was 15 min out behind the medic crew. Family was on scene with the pt, witnessed the incident. 
The medics decided to stage for law, which I don’t hold against them, crew discretion.  
But I know personally that I am comfortable and knowledgeable to secure the gun out of the way to be able to treat the pt and would enter the scene since the deputy had such a long ETA. 
What is everyone opinions’ on similar situations?


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## Handsome Robb (Dec 15, 2011)

Situation dependent. I usually go with my gut. My gut is usually right. If something doesn't feel right, I'm not going to play hero.


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## mycrofft (Dec 15, 2011)

*Been there done that.*

Except LE was there first each time.

Life over evidence. Are you sure the pt was the (self)shooter?(Safety issue).

Let me guess, turned pt over on back, airway went to hell, pt finished expiring. 

They can eliminate your traces from the scene, but not re-position the firearm, casings, blood and cranial matter, etc.


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## silver (Dec 15, 2011)

EMSDude54343 said:


> A discussion was started the other day after we took a suicide attempt with a handgun, to the head. The pt lived out in the boonies and was a 20 min response (give or take). Pt was an adult male, Agonal resp, unconscious. Handgun lying next to the pt.
> The closest Sheriff deputy was 15 min out behind the medic crew. Family was on scene with the pt, witnessed the incident.
> The medics decided to stage for law, which I don’t hold against them, crew discretion.
> But I know personally that I am comfortable and knowledgeable to secure the gun out of the way to be able to treat the pt and would enter the scene since the deputy had such a long ETA.
> What is everyone opinions’ on similar situations?



Question: how do you know that this was an attempted suicide verse an attempted homicide? Based on what the dispatch told you?

edt: mycrofft beat me.


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## JPINFV (Dec 15, 2011)

silver said:


> Question: how do you know that this was an attempted suicide verse an attempted homicide?



Isn't a suicide simply a one man homicide?


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## silver (Dec 15, 2011)

JPINFV said:


> Isn't a suicide simply a one man homicide?



their latin roots beg to differ.


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## JPINFV (Dec 15, 2011)

Is not homicide simply killing a human, which would make suicide a sub-category of homicide?


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## bigbaldguy (Dec 15, 2011)

Need more info. Did they walk in see the guy lying there with the gun next to him and go back out to stage, that would be kind of silly. On the other hand if all the info they had was that someone had been shot in the head that's different. Everyone now knows the guy was pretty much dead lying there but how would the crew know that originally? I assume someone phoned the call in to 911? Did the caller say the guy had agonal respirations? Even if the caller did describe the scene perfectly if the crew was out in the boonies I can't blame them for not believing it. I wouldn't have looked at this as a "am I comfortable dealing with a gun on scene" so much as a "am I comfortable dealing with distraught family members who claim dad just shot him self in the head but maybe his wife actually did it" kind of situation.


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## mycrofft (Dec 15, 2011)

*Suicides used to be treated like homicides under England's common law .*

Until the later half of the 20th century, if yo committee suicide in Massachusetts, the Commonwealth could claim your entire estate, turn your wife and kids out, if you committed suicide. That and insurance policies used to cause them to be covered up.


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## bigbaldguy (Dec 15, 2011)

mycrofft said:


> Until the later half of the 20th century, if yo committee suicide in Massachusetts, the Commonwealth could claim your entire estate, turn your wife and kids out, if you committed suicide.



Aren't they still technically considered homicides in some states. You'd have a hell of a time prosecuting though.

Sorry was too slow with this comment. Redundant. My bad.


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## JPINFV (Dec 15, 2011)

Homicide is not necessarily illegal. Murder, on the other hand. In fact there are numerous organizations where the entire purpose is to commit legal homicide. The so called pointy tip of the sphere.


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## usafmedic45 (Dec 15, 2011)

> pointy tip of the sphere



Me thinks you've been away from geometry for too long my friend. LOL


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## JPINFV (Dec 15, 2011)

Sphere, spear. Tomato, orange. Same difference.


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## Akulahawk (Dec 15, 2011)

Been there, done that too. Patient shot himself in the head with a small caliber handgun. His breathing was OK in this case. Unfortunately for him, he basically missed his cranial vault and effectively blinded himself. 

Follow your gut. Life > evidence. Enter and exit with as little disturbance to the scene as possible. Document as exactly as you can how you found the patient and where. Document how you moved the patient so that the crime scene folks can figure out where everything was. Do not move anything you do not have to. 

And remember, you're not the investigator... Document the injuries you find. Your job isn't to determine if the patient attempted suicide or if someone attempted homicide upon that person... that's the job of Law Enforcement. 

And homicide is not always a crime. Murder and manslaughter are crimes. Homicide is simply the killing of one person by another...


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## usafmedic45 (Dec 15, 2011)

I would have sat back until the cops got there.  If it's a GSW to the head, the patient is probably better off dead anyhow so a "slow code" in the name of scene safety is welcomed in my book.



> And remember, you're not the investigator... Document the injuries you find. Your job isn't to determine if the patient attempted suicide or if someone attempted homicide upon that person... that's the job of Law Enforcement.



Actually, it they die, it's the responsibility of the coroner or medical examiner.  The cops don't get to make that call.  They try to- and nothing pisses them off more than telling them to slow their roll- but it's not their jurisdiction to do so.

Also, rule #1: don't touch or move the body if the patient is obviously dead.  Thank you.  

Sincerely,

Your friendly neighborhood former deputy coroner


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## DesertMedic66 (Dec 15, 2011)

Anytime I hear gun or stabbing or GSW or assult I am staging. Dispatch will already told us to stage before hand. 

Just because someone said suicide doesn't mean it is a suicide. Everyone is out to get me h34r:


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## Akulahawk (Dec 15, 2011)

usafmedic45 said:


> I would have sat back until the cops got there.  If it's a GSW to the head, the patient is probably better off dead anyhow so a "slow code" in the name of scene safety is welcomed in my book.
> 
> 
> 
> ...


If the patient is obviously dead, I'm going to simply let them be... because there is nothing I can do that is going to benefit anyone. And rule #1 is followed quite nicely when you go in to the scene, determine that the patient is obviously dead and leave. 

Oh, if the cause of death is homicide, not suicide, it's not going to be the Coroner/ME's Office that is going to be investigating the case to determine who caused the death and if it is murder or not. That's why there's these LE folks known as Homicide Detectives... They do that. But you knew that already.


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## usafmedic45 (Dec 15, 2011)

> Oh, if the cause of death is homicide, not suicide, it's not going to be the Coroner/ME's Office that is going to be investigating the case to determine who caused the death and if it is murder or not. That's why there's these LE folks known as Homicide Detectives... They do that. But you knew that already.



Right, I was just pointing out that the call gets to be made by the coroner or ME.  I've ruined many a cop's day by pointing out that what they thought was a homicide was suicide, accident or natural causes.


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## Akulahawk (Dec 15, 2011)

usafmedic45 said:


> Right, I was just pointing out that the call gets to be made by the coroner or ME.*  I've ruined many a cop's day by pointing out that what they thought was a homicide was suicide, accident or natural causes.*


Bummer for them...


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## EMSDude54343 (Dec 15, 2011)

In this case, I was the call-taker. The situation was witnessed, by the wife and teenage daughter. The daughter was the caller, she adv that the mother and pt came home from the store and the father was visibly upset, walked straight to the bedroom took out his handgun and shot himself in the head. All before the mother was even in the door, and the daughter who was home when the pt walked in, didn’t even have time to say hello to him. 
The wife and daughter immediately went to see what happened in the bedroom, and found the pt on the floor, the mother collapsed and the daughter dialed 911. 
After getting through the whole address and exactly what happened we went through Pro-QA and started to attempt CPR over the phone and the daughter had to actually pull her hysterical mother off her dad to attempt CPR, and we were able to calm the mother down enough over the phone to get her to assist in CPR. 
All information of what happened was relayed to the crews responding and they were told to use their discretion upon staging and the status of LEO and their ETA. The crews decided to stage, and I don’t blame them, to each their own.
Knowing all that info, and if I was on the truck I would have continued in. Had there been less info, or if the pt was found that way or the situation wasn't witnessed, I would stage.
I was just wondering what everyone else would have done given this situation.


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## firetender (Dec 15, 2011)

EMSDude54343 said:


> A discussion was started the other day after we took a suicide attempt with a handgun, to the head.


 
So you brought a guy to the bathroom who tried to shoot himself with a gun?

(I'm sorry, I couldn't resist!)

It wasn't an attempt, it was successful and since it was witnessed, I would imagine it would be appropriate to secure the firearm without damaging it as evidence, meaning, get it out of the reach of the distraught relatives because, after all, THEY are your patients.


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## EMSDude54343 (Dec 15, 2011)

firetender said:


> So you brought a guy to the bathroom who tried to shoot himself with a gun?
> 
> (I'm sorry, I couldn't resist!)
> 
> It wasn't an attempt, it was successful and since it was witnessed, I would imagine it would be appropriate to secure the firearm without damaging it as evidence, meaning, get it out of the reach of the distraught *relatives because, after all, THEY are your patients*.



And thats the main reason why I wouldnt want to stage. To show the family that somone is there, to try and help, instead of having to wait almost 45 min for crew arrival. Pt was DOA, out of the 15 or so suicide attemps I've taken, he was actually the only one that was pronounced on scene, all the rest were either coded and transported by gound, or were stable enough to fly out.


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## EMSDude54343 (Dec 15, 2011)

firetender said:


> So you brought a guy to the bathroom who tried to shoot himself with a gun?
> 
> (I'm sorry, I couldn't resist!)



LMAO!! :rofl: Took me a sec, but i guess i should have re-read that line... LOL 
But hey , drag him the the bathroom, put him in the bathtub before he really starts beleeding out, and he can just bleed in the tub, less to clean up, less carpet to replace....


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## Cawolf86 (Dec 15, 2011)

I prefer to stage for any shootings or stabbings. I will enter after PD. I have been burned by dispatch and sent into an unsafe scene. In this case I would stage. It should be staging per EMD anyways.


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## usafmedic45 (Dec 15, 2011)

> And thats the main reason why I wouldnt want to stage. To show the family that somone is there, to try and help, instead of having to wait almost 45 min for crew arrival. Pt was DOA, out of the 15 or so suicide attemps I've taken, he was actually the only one that was pronounced on scene, all the rest were either coded and transported by gound, or were stable enough to fly out



Yeah, but until the cops are there and secure it you don't know for sure if they are victims or not.  Better safe than sorry.  They are already traumatized by the guy painting the walls with his brains and calvarium....a couple more minutes isn't going to make a big difference.


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## systemet (Dec 15, 2011)

I think usafmedic is probably right here.

I will say that on several occasions I have entered the scene for these calls without the cops, because the information from dispatch has been reassuring, e.g. parents upstairs found son unresponsive after self inflicted long weapon wound to the head, wife found elderly husband with transoccipital wound in garage, etc.

But these have been unnecessary risks on both occasions.  We tend to give ourselves a little too much importance in these situations.  If you've just witnessed your teenage son, or your husband of 50 years kill themselves, or the immediate result of this, that your biggest problem.  While a delayed EMS response might add to the agony a little, and it might be something the family choose to fixate upon, it's not even remotely close to the primary problem in this situation.  The aftermath of this decision might not be nice when you arrive, but, then again, they may reasonably accept the police responding first (especially if PD response is rapid), and, if they don't, responding to a suicide call isn't about the emergency responders feeling loved and cherish.  If we have to absorb a little bit of someone else's anger, at least it's for a good reason.


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## mycrofft (Dec 15, 2011)

*Had a classmate survive a small caliber auto-lobotomy.*

And this has been observed many times, according to something I read in the Seventies (Schneidman and Farberow?)  and EMS I've worked with since. A small caliber through and through to the temple, if survived, can actually rehabilitate quite well considering, and are very unlikely to attempt suicide again. My classmate resumed and finished high school and went on to college.

Nursed a recovering failed murder-suicide (part one worked, part two sent the .357 through his hard pallet, right orbit and sinuses), who was doing pretty ok (lost the eye, couldn't speak, cognitive changes) until we found the nickel-sized melanoma on his back.
 Hard to make a blanket judgement, but scene safety trumps heroics.


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## bw2529 (Dec 16, 2011)

As someone new to this, I'm going to err on the side of my safety and my crew's safety, and stage. Also, I believe PD here can pronounce if there are obvious signs of injuries incompatible with life... so they may cancel us. I would not actually be the one making the call though, that would be left up to the crew chief (not me).


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