First Aid for Attempted Suicide

Article by Sarah Gehrke, MSN, RN.  Reprinted with permission from https://pacificmedicalacls.com.

Suicide touches all ages and incomes; all racial, ethnic, and religious groups; and in all parts of the country. It is a leading cause of death in the US.

• For every suicide, there are about 25 attempts.
• In 2017 alone, there were about 1.4 million suicide attempts.
• Risk for suicide was 22 percent higher among Veterans when compared to US non-Veteran adults.
• The highest suicide rate was noted among adults between the ages of 45 and 54.

As self-inflicted injuries increase so does the need to prepare for encountering someone who has attempted suicide. As a first-aid provider, you have a vital role in addressing immediate medical needs. You can also provide clarity and support to the victim and other people at the scene.

In 2017, guns were the most common method of death by suicide, accounting for a little more than half of all suicide deaths. The next most common methods were suffocation at 27.72 percent, and poisoning at 13.89 percent.

The following first-aid recommendations are for each of the most common methods of attempted suicide. Each case is unique, and it is essential to tailor your care and support to that person’s needs.

Above all ensure the safety of everyone present and address any serious medical needs first.

© Staff Sgt. Natasha Stannard / Joint Base Langley-Eustis / CC-BY-SA-3.0

 

First Aid for Gunshot Wound

A self-inflicted gunshot wound (SIGW)—or any gunshot wound—to the head is correlated with severe disability and a high mortality rate. There is a greater chance of death caused by SIGWs compared to victims injured by gunshot wounds that are delivered in an assault or by accident.

• Head trauma from a gunshot wound is fatal in about 90 percent of cases, with many victims dying prior to arriving at the hospital.
• About 50 percent of the victims that survive the initial trauma die in the emergency department.
• Head trauma from a gunshot wound is the cause of approximately 35 percent of deaths attributed to traumatic brain injury.

Although the head is the most commonly injured body region during a suicide attempt, the following is a general guideline for how to approach a gunshot wound on any area of the body.

• Ensure your safety. Ensure the scene is safe and immediately call or have someone else call 9-1-1 or emergency medical services.
• Locate the source of the bleeding. Attempt to open or remove the clothing over the wound so you can see it—this will allow you to see injuries that may have been covered or hidden.
• Stop the bleeding. Pressure to stop the bleeding is the most critical intervention. If the victim has blood that is coming out of a hole, put steady pressure on it with both hands by pushing down as hard as you can.
• Use a dressing (towels, shirts, gauze, etc.). Dressings will help seal the wound and aid in clotting.
• Elevate the extremity. If the gunshot wound is above the waist do not elevate the legs to treat for shock (unless the injury is in the arm). Gunshot wounds to the chest and abdomen will bleed more rapidly if the legs are elevated, thus making it more difficult for the individual to breathe.
• If you can, use a tourniquet. Tourniquets will only work on arm and leg injuries. Using them correctly takes practice, and they should only be used if the bleeding cannot be stopped when direct pressure and elevation are applied immediately and simultaneously or if there is a reason why direct pressure cannot be maintained.
• Gunshot wounds to the chest may be sealed with a type of plastic to keep air from being sucked into the wound—this can help prevent a collapsed lung. Remove the seal if shortness of breath worsens after sealing the wound.
• Chest compressions in a cardiac arrest caused by hemorrhagic shock from severe blood loss may worsen the situation.

First Aid for Hanging or Suffocation

Self-administered and assisted suicides by asphyxiation—the process of being deprived of oxygen resulting in unconsciousness or death—can be done by several methods. The use of a plastic bag, or suicide bag, is often in conjunction with a flow of an inert gas like nitrogen or helium.

Suicides using a plastic bag with helium were first recorded in the 90s. Since the 2000s, guides on how to use this method have spread on the internet, in print, and on video; and the frequency of suicides by this technique has increased.

Asphyxiation is also present in hanging and strangling. Both hanging and strangling can obstruct blood flow to and from the brain as well as block air flow to and from the lungs.

How to Recognize Suffocation

• A constricting article is around the neck
• Marks around the victim’s neck where a constriction was removed
• Impaired consciousness or unconscious
• Grey-blue skin (cyanosis)
• Uneven breathing
• Prominent veins and congestion of the face
• Petechiae – tiny red spots on the face or the whites of the eyes

What to Do in the Case of Suffocation

• Make sure the scene is safe, and immediately remove any constriction from around the victim’s neck; support the body if it is still hanging.
• Call or have someone else call 9-1-1 or emergency services.
• Lay the victim on the floor. In the case of spinal injury, don’t move the victim unnecessarily.
• Check for breathing and pulse; If not breathing begin CPR.
• If breathing, place in the recovery position and monitor until emergency responders arrive.
• Don’t interfere with or destroy any material, such as a knotted rope, that police may need as evidence.

First Aid for Overdose or Poisoning

Poisoning is due to swallowing, inhaling, touching, or injecting various chemicals, drugs, gases, or venoms. Both suicide and unintentional drug overdoses kill adults at twice the rate today as they did two decades ago, and opioids are a key contributor to this rise. The following focuses on the use of drugs as a means of attempting suicide.

When a drug overdose is suspected, you may not know what drug the person was taking. Often, an overdose victim will either be unconscious or not fully conscious of their surroundings. Because of this, it is imperative to recognize the general signs of a drug overdose and what to do for first aid in the majority of situations.

How to Recognize an Overdose

• Unusual sleepiness or unresponsiveness
• Confusion, disorientation, or hallucination
• Slow, shallow, irregular, or absent breathing
• Bradycardia (slow heartbeat) or hypotension (low blood pressure)
• Cold and clammy skin
• Constricted pupils (small or pinpoint pupils)
• Cyanotic (nails and lips are blue)
• Mood changes, including aggression, agitation, anxiety, or depression
• Abdominal pain or vomiting
• Loss of coordination or motor control

Do’s for Drug Overdoses

• Make sure the scene is safe, and check alertness. Comfort them if they are awake. If they are unconscious, turn them on their side to prevent aspiration (choking on their vomit).
• Call 9-1-1 or emergency medical services. Call, or have someone else call, even if the person seems not to be experiencing overdose symptoms; never wait to see if the overdose will wear off. Some effects of an overdose don’t present themselves right away.
• Check for breathing and pulse; If not breathing begin CPR.
• Remove unnecessary clothing if the situation allows. Some drugs cause the patient to quickly overheat.
• Find details to aid with treatment. Knowing what drug was taken, how much, when, and by what method is important. If the victim is not awake, look for containers, needles, syringes, and other items.

Don’ts for Drug Overdoses

• Don’t put the person in the shower. Even if the victim seems okay, a large temperature change could put them in shock.
• Don’t let the person sleep. Someone who overdosed may pass out, and you will not be able to stop them; however, trying to keep them awake makes it easier to monitor their condition.
• Don’t attempt to make them throw up if they took the drugs orally. This can increase the chance of aspiration.
• Don’t wait for the drug to wear off. Call for emergency medical services immediately.
• Don’t try to feed the victim. Some foods can have adverse effects.
• Don’t leave the victim alone. Stay with them, monitor their condition, and provide help as needed.
• Don’t try to reason with or restrain a violent person or put yourself in an unsafe position.

First Aid for Known Opioid Overdose

Examples of opioids include morphine, codeine, oxycodone, oxycodone with acetaminophen, and hydrocodone with acetaminophen. Because opioids affect the part of the brain that controls breathing, too high of opioid levels in the blood can slow breathing down to dangerous levels, which could cause death.

For victims with a suspected or known opioid overdose who have a definite pulse but no normal breathing or only gasping (respiratory arrest) in addition to providing standard care, it is reasonable for trained rescuers—this includes first aid providers, non-healthcare providers, or BLS providers—to administer Narcan® (naloxone) intramuscularly or intranasally to victims with an opioid-associated respiratory emergency.

Victims with no definite pulse may be in cardiac arrest or they may have an undetected slow or weak pulse. These cases should be managed as a cardiac arrest victim.

Standard resuscitation should take priority over the administration of naloxone, with a focus on high-quality CPR. It may be reasonable to administer naloxone—especially when an opioid overdose is suspected—based on the possibility that the victim is in respiratory arrest, not cardiac.

Opioid-Associated Life-Threatening Emergency (Adult) Algorithm

• Assess and activate. Check for unresponsiveness and call for nearby help. Send someone to call 9-1-1 and get AED and naloxone. Observe for breathing versus no breathing or only gasping.
• Begin CPR. If the victim is unresponsive with no breathing or only gasping, begin CPR (CPR technique based on the rescuer’s level of training). If alone, perform CPR for about 2 minutes before leaving to phone 9-1-1 and get naloxone and an AED.
• Administer naloxone. Give naloxone as soon as it is available. 2 mg intranasal or 0.4 mg intramuscular. May repeat after 4 minutes.
• Does the person respond? If yes, stimulate and reassess. Continue to check responsiveness and breathing until advanced help arrives. If the person stops responding, begin CPR and repeat naloxone. If no response, continue CPR and use an AED as soon as it is available. Continue until the person responds or until advanced help arrives.

First Aid for Self-Harm or Self-Cutting

Because self-harm, also known as self-injury or self-cutting, involves physical injury, it can seem like self-harm and suicide are directly related. For example, it is common to think that cutting one’s wrist may be a suicidal gesture indicating that the person wishes to slit their wrists to die.

Self-injury can indicate a number of different things. Many people who practice self-injury may not intend to kill themselves and may even see self-harm as a way of avoiding suicide. It is crucial to note that with the pattern of self-injury occurring over weeks, months, or years, the person may be at risk for suicide.

Here’s what you should do if you a self-harm situation presents to you:

• Make sure the scene is safe, and assess and activate. Assess the victim’s responsiveness. Call or have someone else call 9-1-1 or emergency services.
• Locate and control the bleed. Arterial blood is bright red and spurts or sprays from the wound. If the blood is darker in color and easier to control, it means that the veins have been cut, and the artery was missed.
• Apply direct, firm pressure. Apply a towel or dressing directly to the wound.
• Elevate. Position the wounded limb in a position where it’s above the victim’s heart.
• Occlude or pinch an artery above the injury. If possible apply pressure to an artery to halt the blood supply to that limb. If the bleeding does not stop after direct pressure, a tourniquet may be needed.
• Assuming the bleeding has stopped, continue to assess the victim—circulation, airway, and breathing. Follow the Basic Life Support (BLS) Algorithm.

If You Know Someone in Crisis:

Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1–800–273–TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential.

Washington State Crime Victim Service Center Hotline: 888.288.9221

Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

Learn more on the NSPL’s website. The Crisis Text Line is another resource available 24 hours a day, 7 days a week. Text “HOME” to 741741.