# Apparent suicide call...



## NJN (Sep 19, 2008)

Dispatched to an apparent suicide. On scene you find a male hanging by shoestring. You go to check for vitals and he is still warm, with no definitive signs of death.

Now the question, do you work a code or call them ME?


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## Hastings (Sep 19, 2008)

NJNewbie196 said:


> Dispatched to an apparent suicide. On scene you find a male hanging by shoestring. You go to check for vitals and he is still warm, with no definitive signs of death.
> 
> Now the question, do you work a code or call them ME?



Seriously?

...You work the Hell out of him.

Grab the knife out of your pocket and cut the guy down first, though.





...What were my vitals? What do you mean he has no definitive signs of death? Does he have a pulse? That's a nice start.

1. Assess scene.
2. Cut patient down, lower to floor.
3. Check ABCs.
4. If no breathing, bag, lots of O2. If no pulse, CPR. If either, move to 5.
5. EKG, shock if necessary. If not indicated, intubate.
6. Continue arrest scenario.

Also, since it's a shoe string (wow, strong shoe string), could be as simple as asphyxiation. Oxygen and intubation IMMEDIATELY. Try to assess timeframe by any bystanders. Cyanotic? 

There are two ways of dying from hanging, I believe. Breaking the neck on initial drop and asphyxiation. The former seems unlikely by shoe string. If intervention early, asphyxiation can be fixed. Get right on it.



Call the cops if they aren't already there though.


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## NJN (Sep 19, 2008)

No Pulse, but still warm.


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## Hastings (Sep 19, 2008)

NJNewbie196 said:


> No Pulse, but still warm.



There's no question. Not breathing, I assume? Cut him down and follow arrest protocols.

CPR, Assess Rhythm, Shock if indicated, Intubate, Drugs if indicated, Repeat for - in my opinion in a suicide of this type - for at least 45 minutes. This is not the type of call to give up in unless there are VERY definitive signs of death. In comparison to other suicide scenarios, this one has a significantly better chance. Especially if young.


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## NJN (Sep 19, 2008)

BTW this was taken from an episode of "Cops".


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## KEVD18 (Sep 19, 2008)

i'd have to work the arrest, but i wouldnt kill myself over it.(no pun intended)

follow the code algortihms, indicate during my entry notifications to the ed that this was a suicide and not be a bit suprised when they call it upon arrival.

heres where the wheels fall off of this call for me. they tried to kill themselves. i dont really have the capacity to pour my soul into someone who has no interest in their own life. i'll follow the book, but im not terribly concerned over the matter.


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## firecoins (Sep 19, 2008)

great! COPS.


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## Hastings (Sep 19, 2008)

NJNewbie196 said:


> BTW this was taken from an episode of "Cops".



Had a similar experience myself. Although in mine, there was an officer within the area when the patient attempted it. He was cut down within 1 minute and a half, and had no complaints other than a nasty mark and neck pain upon our arrival.

But yes, never ever declare a suicide by hanging an unworkable situation. In fact, most suicides should be worked, despite how hopeless they may appear. The only exception I can think of is the removal of the brain by gunshot. 

I will not work a drug overdose or hanging for less than 45 minutes unless the patient is in rigor. And clearly, that was not the case here. Work it. Work the Hell out of it.


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## Jon (Sep 19, 2008)

The discussion we had in Chat that precipitated this was: you arrive first and find someone "hanging out".

Do you cut them down, or leave them hanging.


My take - this is a non-issue. Usually, if they are found by family/roommates, the roommates cut them down and then we may, or may not work them.

Also... if I'm dispatched for an attempted suicide... I'm staging for PD to clear the scene.

If they have been cut down, and they aren't being worked - we either find obvious signs of death... or we will work it. If someone else started working it... then we usually continue, at least until we hit the point in the ALS algorithm to call it.

If they are still hanging by the time we get there... it is usually because they are VERY "obvious"... Us and/or the PD then contact the ME.


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## Hastings (Sep 19, 2008)

Jon said:


> The discussion we had in Chat that precipitated this was: you arrive first and find someone "hanging out".
> 
> Do you cut them down, or leave them hanging.
> 
> ...



There is absolutely no reason to leave them hanging. None at all. Cut the rope. The remaining hanging rope and the marks around the patient's neck are enough for the police and ME to put things together, and it's your absolute responsibility to work any patient that doesn't have ABSOLUTE signs of death.

Again, the only patient I've ever not worked was a woman we found lying on her bed next to a crack pipe and ball of crack cocaine. She was ice cold and in rigor. 

But warm and of suspected suicide? There's just no question. None at all. Cut them down IMMEDIATELY and get to work.


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## Ridryder911 (Sep 19, 2008)

Well since they are only hanging on by *threads*, it all depends upon on "how dead" they are. 

Never seen where there is any difference or differential in determining to work a suicide any differently than any other causative agent (except TSA Od's.) Dead is dead. 

If there is any sign of levity, and no pulse, I call it. It takes a while to blood to pool and as well all the other indicators of hypoxia, potential cervical injuries.. 

If I did call it, then yes I leave them hanging.. it is a crime scene. By cutting them down you destroyed the scene. 

The main thing about cutting them down, if you are going to work them, is to cut as near the tied end or through the loop if it is taught....*NEVER* cut through the knot!.. CSI will have your arse. Knots can be reviewed if they were self or by another person, etc. 

Remembering * all *deaths are homicide until proven otherwise.


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## mycrofft (Sep 19, 2008)

*"How dead". Miracle Max from Princess Bride?*

I say if he's hanging by a shoelace, pull the shoe all the way off and he'll just drop.Hanging upside down...how distressing.

One spring night a guy went into a little wooded lot (about seventy by seventy) in the middle of a heavily travelled intersection and hanged himself in a copse of boxelders and silver maples. No one knew he was there until road crews came to clean out the leaves in September. Thousands of cars driving by within two hundred feet every day. Uh, don't work THAT one!


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## reaper (Sep 19, 2008)

NJNewbie196 said:


> Dispatched to an apparent suicide. On scene you find a male hanging by shoestring. You go to check for vitals and he is still warm, with no definitive signs of death.
> 
> Now the question, do you work a code or call them ME?



Leave and come back later, You got there to quick!


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## firecoins (Sep 19, 2008)

Ridryder911 said:


> Well since they are only hanging on by *threads*, it all depends upon on "how dead" they are.
> .


Yes he could be partially dead. He clearly said "to blave" which we know means to bluff so clearly he  owed money.


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## mycrofft (Sep 20, 2008)

*But the mutton can't be too tender..little MLT sandwich there....*

Sportsfans, it's good to be alive.


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## SmokeyBear (Sep 20, 2008)

NJNewbie196 said:


> BTW this was taken from an episode of "Cops".




Never watched COPS and this may be off topic but, what happened in the episode? They didn't leave the poor slub hanging there did they?!  :blink:


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## NJN (Sep 20, 2008)

The PD were the ones who checked for the pulse. They left him hanging until the ME arrived. This happened late at night so no civilians were around to gawk.


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## Ridryder911 (Sep 20, 2008)

If you have determined not to work the victim, then its a crime scene and leave it alone. The body is not going anywhere or going to change in a few minutes it takes for the CSI and ME to arrive. It is no longer your job or position.


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## medic_chick87 (Sep 20, 2008)

firecoins said:


> Yes he could be partially dead. He clearly said "to blave" which we know means to bluff so clearly he  owed money.


Firecoins, you rock!
Love The Princess Bride


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## mikie (Sep 21, 2008)

I'd like to know how high he is hanging.  If you cut him loose, are you planing on catching him, or letting him hit the ground then having to board/collar him?


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## reaper (Sep 21, 2008)

If you are going to work him, He would be on a board already. Most hangings, if done right, already are MOI's for c-spine protection. 

I for one would leave them be. Unless I witnessed them giving their last kick. They have probably been there a while.

Last one I worked, Family had him down and FD had started working him. His c2-c3 was like jello. He did it right. Used a cable and jumped from a tree!!


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## mikie (Sep 21, 2008)

reaper said:


> If you are going to work him, He would be on a board already. Most hangings, if done right, already are MOI's for c-spine protection.
> 
> I for one would leave them be. Unless I witnessed them giving their last kick. They have probably been there a while.
> 
> Last one I worked, Family had him down and FD had started working him. His c2-c3 was like jello. He did it right. Used a cable and jumped from a tree!!



good point, too early for me to be thinking.


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## FF894 (Sep 21, 2008)

SmokeyBear said:


> Never watched COPS and this may be off topic but, what happened in the episode? They didn't leave the poor slub hanging there did they?!  :blink:



You've never watched COPS?  Hasn't that show been on since like 1989???


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## emt_angel25 (Sep 21, 2008)

work it until you get him back or til your medcial direction tells you not to work it anymore.


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## mikie (Sep 21, 2008)

FF894 said:


> You've never watched COPS?  Hasn't that show been on since like 1989???



and no matter how recent I watch it, the things they place seem like they're from 1989.  I seldomly watch it, but when I do, I don't think I've ever seen anything past 1999.


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## traumateam1 (Sep 21, 2008)

First to answer the OPs question. I would work the code. Definitely. Call the MD if stated to (3 consecutive No Shock Orders, etc) but they don't meed MY criteria to call the ME at this point.

Now to deal with this COPS issue. 
I LOVE THAT SHOW! It has been a tradition I guess you could say, to watch it every Saturday. Just watched it last night and it was a new episode definitely after 1999


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## Ridryder911 (Sep 22, 2008)

In the real world, I doubt that most medics would even be called or allowed to examine the body (maybe one to declare death). Again, it is a crime scene.


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## BossyCow (Sep 22, 2008)

NJNewbie196 said:


> BTW this was taken from an episode of "Cops".



We had a similar incident many years back. The pt was not cut down because the responding EMS agency (not mine BTW) had just had a class on 'preserving a crime scene'. When ALS arrived and cut the guy down, he still had a rhthym. Had he been cut down sooner, possibly could have had a different outcome. 

We are taught by the medic who provided the ALS on the call, that our duty is first to the life of the pt, second is the preservation of the crime scene. Local Law Enforcement is in agreement on this one.


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## Melanie77 (Nov 12, 2008)

yeah u get ur knife out of ur pocket and cut him down.


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## SmokeyBear (Nov 13, 2008)

FF894 said:


> You've never watched COPS?  Hasn't that show been on since like 1989???



I don't own a tv :sad: Its not a "statement" of any kind, I just have never gotten around to getting one since the internet took off.  Dispatch has one and they watch all kinds of stuff--the other day when I was getting my keys etc. they were watching something called "_Dancing with the Stars._" I watched it for about 3 minutes and was glad that I don't have a tv :beerchug:

/sorry about the thread jack


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## SmokeyBear (Nov 13, 2008)

traumateam1 said:


> Now to deal with this COPS issue.
> I LOVE THAT SHOW! It has been a tradition I guess you could say, to watch it every Saturday. Just watched it last night and it was a new episode definitely after 1999



That sounds like a fun tradition  Here, a bunch of us get together and go hunting once or twice a year 

/again--sorry about the thread jack  :blush:


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## BossyCow (Nov 13, 2008)

I am also not a TV watcher. I do have a TV and use it occasionally to watch rented movies. I get three channels at least until next February. One is a low power local station, the other two are canadian.


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## firecoins (Nov 13, 2008)

BossyCow said:


> I am also not a TV watcher. I do have a TV and use it occasionally to watch rented movies. I get three channels at least until next February. One is a low power local station, the other two are canadian.



Well than.  You should get the 2 Canadian channels after February.


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## SmokeyBear (Nov 14, 2008)

BossyCow said:


> I am also not a TV watcher. I do have a TV and use it occasionally to watch rented movies. I get three channels at least until next February. One is a low power local station, the other two are canadian.



I don't blame you for not getting cable. If anything it's *ridiculously* expensive.


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## Jon (Nov 14, 2008)

I enjoy watching COPS... and I keep watching for the old Philly episodes (because an old boss of mine was in those episodes).

COPS is just good fun... but like the old Paramedics show - they almost never show the BS calls... just the "fun" stuff.

I volunteer on Saturday nights, so we usually have COPS on on the TV in the kitchen when we eat dinner.


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## BossyCow (Nov 14, 2008)

SmokeyBear said:


> I don't blame you for not getting cable. If anything it's *ridiculously* expensive.



Yeah.. the idea of paying $49 a month so I can watch more TV is ludicrous. Cable isn't available in my area so its satellite or nothing. I've heard that Canada will continue with analog for another year. After that, gone!


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## aandjmayne (Nov 14, 2008)

Okay.. this has gone in a completely different direction.. so what happened on the show??? :wacko:


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## Jon (Nov 14, 2008)

Well... I'm not going to leave you hanging 

They left him hanging...

and called the ME.


We were in Chat when the show was on, and we were talking about it.


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## SmokeyBear (Nov 14, 2008)

BossyCow said:


> Yeah.. the idea of paying $49 a month so I can watch more TV is ludicrous. Cable isn't available in my area so its satellite or nothing. I've heard that Canada will continue with analog for another year. After that, gone!



Agree 100% -- theres absolutely no point in paying that much. If you think THATS bad--my brother pays over 130 per month with only a couple of x-tras. Funny thing is, hes not even home all that much (works 2 jobs) :sad:



aandjmayne said:


> Okay.. this has gone in a completely different direction.. so what happened on the show??? :wacko:



Sorry about the threadjack :blush: 
Its hard not to chit-chat with ones fellow brethren


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## aandjmayne (Nov 14, 2008)

It's totally understandable.. I just didnt want to be left hanging.. lol


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## aandjmayne (Nov 14, 2008)

besides.. cable is really expensive.. I agree on that one.. Its a shame that those of us who dont have the money, much less time, are going to have to pay more after February just to watch TV....... ridiculous.. Bills go up and salary stays the same.. B.S. I say a whole bunch of B.S.:wacko:


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## ttoude (Nov 30, 2008)

Assess the scene get guards to protect the entrance to the cell. 
check for state approved signs of death, 
Cut inmate down at CENTER of ligature between nots
if no livitaty etc , Cpr protocols,  arouse, chk breath and sounds, two rescue breaths, then chest compressions etc, 
Contact Mcep for approval to discontinue and pronounce if no response
HEAVY documentation and guard interview

I'm new to ems but I did 2 years clinical autopsy and 3 years criminal autopsy. It would be very easy to become complisate in this death. Also at that point if negligence is proved by an angry family member, it becomes a very sticky homicide. Usually resulting in correction officer firings either way.

The inmate autopsy is very intensive including a neck to ankle "fillet" to look for any signs of foul play. Inmates "hang" themselves all the time, from what I saw of all "suicides" it was about 30% suspicious, 30% homicide, 30% actual suicide. 

Most swingers use a bed post or chair. It doesnt have to be high it only has to occlude the carotids


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## Sasha (Nov 30, 2008)

ttoude said:


> Assess the scene get guards to protect the entrance to the cell.
> check for state approved signs of death,
> Cut inmate down at CENTER of ligature between nots
> if no livitaty etc , Cpr protocols,  arouse, chk breath and sounds, two rescue breaths, then chest compressions etc,
> ...




30 30 30, that's only 90. What are the other 10%?


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## ttoude (Nov 30, 2008)

Sasha said:


> 30 30 30, that's only 90. What are the other 10%?



Sorry 33 1/3 (33.33333)


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