Attempted Suicide Pts

Linuss

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So, speaking in only a transfer mentality, and not 911, how do you talk to your pts who have attempted suicide?

I've had atleast 1 a shift since I started my job. They always see... at peace. Not happy, but nice, if that makes sense.


I find it weird because I don't know what topics are ok to talk about, and what might be a trigger with them, and I don't want to just sit there in silence with them yapping away. Yea, I know, let them dictate the conversation, but it still leaves the question of what is a no go?
 
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Linuss

Linuss

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Example;

Was speaking to one and saw that her primary insurance provider was a cable company. Asked how she liked it there, and she said it was ok, but she missed working at the other cable company. Felt like an idiot for going there.
 

Sasha

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Definitely don't start out with the standard "So, how's life?"

Talk to them like they're people, not fragile little flowers. Talk about the weather, the game on TV, the president. Whatever they want to talk about.
 

Onceamedic

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I begin with my usual patient assessment, taking care of medical needs first. I then express sympathy and tell them that I am sorry they are hurting so badly. This usually evokes tears/gratitude for some understanding and non-judgment. I find out about their lives and what has pushed them to this point. Most are extremely grateful for the ear. I then tell them that suicide happens when the pressures to commit suicide are greater than the resources available to the individual to resist the impulse. We then discuss what they are doing (meds, therapy,etc.) and I try to suggest other tools they can add to there bag of tricks. I tell them that they have a challenging problem, but that there is hope - people heal and it won't always feel this bad.
The attempted suicides are among the most satisfying and personally fulfilling patients I run on.
 

Flight-LP

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I always remind them its "Up the road, not across the street"..................

In all seriousness though, just converse normally with them as previously stated. Do not try to be a shrink or their newest best friend. Just basic communication and preservation of their personal safety is quite sufficient.
 

Sasha

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I begin with my usual patient assessment, taking care of medical needs first. I then express sympathy and tell them that I am sorry they are hurting so badly. This usually evokes tears/gratitude for some understanding and non-judgment. I find out about their lives and what has pushed them to this point. Most are extremely grateful for the ear. I then tell them that suicide happens when the pressures to commit suicide are greater than the resources available to the individual to resist the impulse. We then discuss what they are doing (meds, therapy,etc.) and I try to suggest other tools they can add to there bag of tricks. I tell them that they have a challenging problem, but that there is hope - people heal and it won't always feel this bad.
The attempted suicides are among the most satisfying and personally fulfilling patients I run on.

I don't really think it's a paramedics place to try and play psych with them.
 

Mountain Res-Q

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I don't really think it's a paramedics place to try and play psych with them.

I agree. They obviously have a lot on their mind and don't really give a crap what we lowly Ambulance Drivers think. I know depression and when it hits you don't give a crap about anyone else, their feelings, or their opinions of you. You treat them like every other patient. Don't play therapist but don't be too afraid of saying the wrong thing. I think our perseption of them is the issue. They are just another patient with a medical issue. We can't fix the issue, all we can do is provided a safe ride. What do you talk about with every other transfer patient? Tryig to "fix" their problems is likely only to create problems. Let 'um sleep.
 
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Sapphyre

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Usually, I let them sleep, but, I'm night shift... If they want to talk, I let them dictate. It's only off limits if they don't want to go there. Never change the topic unless they seem to be getting agitated. And, yeah, I've noticed that most have a flat affect.
 

reaper

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I always remind them its "Up the road, not across the street"..................
In all seriousness though, just converse normally with them as previously stated. Do not try to be a shrink or their newest best friend. Just basic communication and preservation of their personal safety is quite sufficient.

That one is always a classic!:p
 

Burlyskink

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Im obviously not trained yet, but if I encountered that I like the posts above would just make small talk, and let them control the conversation.
 

FTRPO

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Why not try to play shrink or be there newest best friend. There is absolutely nothing wrong with asking them how they are feeling and what is bothering them. Also if you taking the time to do that and even pretend like your listening helps them get through it, then it was worth all your time considering it was just a short ride in the back of the ambulance. Who knows what will pop in their head the next time they are on the edge? Maybe you will. Everyone should be treated like they are your top priority and you have nothing better to do or think about. Take the time to make them feel like they are the most important person in the world, it could wind up making your day and theirs.
 

CAOX3

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Why not try to play shrink .

Why not? :wacko:

How about for starters we require one psychology class before your allowed to play shrink.

Maybe impersonating someone who just put this person on a 30 day timeout isn't such a good idea.

Maybe their just not suicidal but also homicidal.

Maybe I just let them direct the conversation since I dont have the slightest idea what going through their head at this point(since I decided to go on a bender in Mexico the semester of abnormal psychology) and dont particularly want to find out in a 5ft by 5ft box alone.

Just a few reasons.... Then again I havent been on a pscyh transfer in a long time.
 

Sasha

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Why not try to play shrink or be there newest best friend.

Because you are not trained, or paid to be the shrink?
 

Melclin

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Yeah I'm not sure that playing shrink is the best of ideas. But it depends what you mean.

A older bloke I know with Bi-Polar told me once (I'm somewhat involved in the 'mental health community') of when he was being transported for cardiac surgery to another hospital. The transport officer said, "Oh you're bipolar? You're not ganna do no crazy :censored::censored::censored::censored: or nothin' on me are ya?"

Clearly that's inappropriate. But I think if you're the right kind of person you can get a feel for their particular type of crazy and act accordingly. Sometimes this might be mean saying things like, "Yeah I knew a guy with schizophrenia, nice bloke, had a real tough time though. Got on this new drug and he's doing really well now". You know, kinda sharing stories..identifying a little. Other times it might mean shutting up and sitting in silence or just letting them talk their heads of.

There's no one topic of conversation that's best for all psych patients, taking your cue from them is the best way to go. Most importantly, don't treat them to much like they're fragile. What they're going through is worse than anything you can say and treating them like delicate china is just patronizing. You get real sick of that as a psych patient.
 

Mountain Res-Q

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Why not try to play shrink or be there newest best friend.

Because you are not a shrink or their new best friend. What good does pretending and playcating suicidal folks do for them? We provide Basic or Advacned Life Support, not long term psychiatric care. You can do far more harm than good. Talk to them, yes. You can even ask them how they feel or how they are doing in many cases, but to try to get too psycological wiht them is usually a disservice to them and the professionals that will be making their mental care their top priority. Our priority in this case is to transport them safely and to care for any physical health issues.

Leave the mental health care to the mental health professionals, just as they should leave the emergency medical care to to emergency services professionals.
 
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triemal04

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How about for starters we require one psychology class before your allowed to play shrink.
I took several psych classes and I still won't go near that route. Treat them like you would any other pt; after your assessment and treatments (if any) are done and the pt is willing, talk with them. That doesn't mean about what they did and why, but simply chat with them. It doesn't take that much effort and can make for a more pleasant ride. The flip side is that if the pt is not willing, then don't keep trying to engage them; if they want to keep quiet, let them. Just like everyone else that ends up in the ambulance.
 

Onceamedic

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I do not believe I am playing shrink or becoming a new best friend. I am a health care professional. My uniform and the fact that I am the person there gives me a status in the patient's eyes (whether that's justified or not is another discussion). This gives me an opportunity for a teaching moment. This is a chance to make a positive impact in someone's life, and quite frankly, it is the reason I do this job.
It does not require a degree in psychiatry to ask common sense questions that paint a detailed clinical picture. Do you hesitate to get details of a patient's physical condition because you are not an MD?
Psychiatric and emotional/social issues are an ever increasing issue that presents itself to us. When I take a medical patient to the ED, I am pretty confident that they will receive standard of care. The social support network here is not well developed. I make sure to impart the information I uncover during the transport to ED RNs because I am pretty sure I am the only person that patient encounters in this crisis to ask those questions. The information is always received well by RNs because they are often frustrated by these types of calls. It makes a big difference in where these patients are referred to and how they are treated after I drop them off.
 

Mountain Res-Q

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Psychiatric and emotional/social issues are an ever increasing issue that presents itself to us.

In that case we as EMSers need to have psycology course made mandatory to be in EMS. If we try to get too psycolgical then what we end up being is a Teen Help Hotline. These people have already tried to commit suicide and they nothing we can do is gonna provide meaningful help. Hell, do most of us have any real clue on what it feels like to be pushed to that level. Sure we all have problems, stresses, and "depression days", but how can we really hope to provide any meaningful help without an deeper understanding of the underlying psycological and chemical issues? Even PSYCOLICAL PROFFESSIONALS will admit that they have low success rates in managing the underlying condtions that prompts people to want to make a LEGIT attempt to take thier own lives. Are we gonna have any meanigful impact with our lack of psycological traing and the short transfer time we will have with them. I still say that if we try to play shrink we might be able to do some good 10% of the time, but the chances of doing more harm than good is a risk we should not be taking without the training and standing protocols that I have yet to see in any EMS training program or Scope of Practice.
 
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triemal04

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Passing on info about support groups or available options is one thing (and appropriate if the info is accurate), it's when you start getting into telling them how they can fix their problem and why it happened that issues come up. Healthcare professional or not, nobody here is a mental healthcare professional. There is a difference. Just as you probably wouldn't want a psychologist treating someone with a chronic medical condition, having a paramedic try and treat someone with what may be a chronic mental problem (or just a sentinel event) is about the same. As in not the best idea.

Without a hell of a lot more education and practice in treating/interacting with people with depression, schizophrenia, suicidal tendencies and the like, it's a bad idea to start getting to involved in people who have just tried to kill themselves. Talk with them, by all means, just doing that can make quite a few feel better for at least awhile, but going to in depth...bad idea without knowing what you are doing.
 

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