CPG_The Suicidal Patient

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Clinical Practice Guidelines:Behavioural disturbances/The suicidal patientVersion October 2015

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42QUEENSLAND AMBULANCE SERVICE

The suicidal patient

Clinical features

Verbal clues may exist to which the paramedic

should be attentive:

Tomorrow, there wont be a tomorrow

Sometimes I think Id be better off dead

I talked to my family last night so everything

is taken care of

On recognising warning signs and verbal

clues the paramedic should definitively

determine suicidal intent by directly asking:

Do you want to kill yourself?

In Australia there were 2,535 deaths from suicide in 2012,

resulting in it ranking as the 14th leading cause of all deaths.

Three quarters (75%) of suicide were male, making suicide the

10th leading cause of death for males. Deaths due to suicide

occurred at a rate of 11 per 100,000 population in 2012.[1]

The most frequent method of suicide was hanging, strangulation

and suffocation. These methods are used in more than half (54.4%)

of all suicide deaths. Poisoning by drugs is used in 14.5% of

suicide deaths, followed by poisoning by other methods including

by alcohol and motor vehicle exhaust (8.5%). Methods using

firearms accounted for 6.8% of suicide deaths. The remaining

suicide deaths included deaths from drowning and jumping from

a high place, as well as other methods.

Warning signs of suicidal intent may include:

[2]

change in personality, behaviours,

sleep patterns and/or eating habits

loss of interest

worries and fears

drug or alcohol abuse

subtle or obvious suicidal statements

and plans finalising affairs.

Figure 2.2


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Risk assessment

Males account for over 75% of all suicides, with

younger age groups of both sexes comprising a

much higher proportion of total deaths than

compared with older age groups.[1]

Other factors that influence suicide risk are:

- psychiatric disorders[3]

- employment status

- occupation[4]

- past suicide attempt

- stressful life events

- drug and alcohol abuse

- access to lethal means

- recent marital separation divorce

- social isolation

IMPORTANT:No risk assessment can absolutely

exclude potential of a suicide attempt. Always becautious with decision-making when caring for

potentially suicidal patients.

Questions or assessing suicide risk in a patient

Means Is the method available?

Method Is there detailed knowledge of themethod and how lethal is it?

Plans Has a time, date and place beenestablished, or a plan rehearsed?

Intent Is there intent to carry throughthe plan and actually die?

Thoughts Anxious turmoil, worthless,hopeless, perturbation.

Supports Are there friends, family, a caseworker or a social network available?

History Have there been previous attempts,associated illnesses, or a familyhistory?

Impulsivity Is there a history of impulsivebehaviours?

Alcohol Is the patient affected by drugsor alcohol?


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Note: Officers are only to perform

procedures for which they have

received specific training and

authorisation by the QAS.

Consider:

Completion of an EEO

Mental state assessment

One officer should liaise

with the patient

Employ an empathetic,

non judgemental attitude

Does the patient haveany injury or require

clinical management?

Is it safe to proceed?

Y

N

Request urgent

QPS assistance

Emergency Examination Order[5]

This is an involuntary assessment order

that enables QAS to transport a patient

to an appropriate facility for further mental

health assessment.

This may be used to transport patients

against their will if there is significant

risk of harm to self or others.

For this order to be valid, the date

and time must be completed.

Communication with the receiving facility

is important, as patients under an EEO

may receive a higher triage category or be

moved to a secure part of the department. Manage as per:

Relevant CPGs

Transport to hospital(with appropriate mental

health resources)

Pre-notify as appropriate

N

Y

CPG: Paramedic Safety

CPG: Standard Cares

CPG_The Suicidal Patient

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