Tag Archives: Hanging

Suicidal Ideation 3/3

“Medic-40 copy code three.” The dispatcher’s abrupt call snaps me out of my otherwise boring day surfing the web on my iPad. It’s been quiet today – not too many calls have been getting sent out. Crews across the county have been sitting idle for the last few hours. Scottie is off today so I got assigned one of the float EMTs – we call that “mystery meat.” This is the first time I’ve worked with him and I got tired of listening to his diatribe six hours ago – so I’m happy to have a call.

“Medic-40 go.”

“Medic-40, code three for you. 1055 Vincent St. for the 22 year old male with a noose around his neck. You’ll need to stage for this please. PD is en route.”

“Medic-40, ten-eight” (we’re en route). Plugging the address into my iPad I see that we’re only ten blocks away from the call. We’ll be there in just a minute.

Almost immediately the radio crackles again. “Medic-22, we’d like to jump that call for 40.” Finally something interesting to relieve the boredom of the day and everyone else wants a piece of it. I’m not sure where 22 is but we’re close enough to make it in stellar time and I really want something to break the monotony of the day. Not today guys.

“Medic-40, we’re pretty much on top of it, we’ll take the call. Thanks Medic-22.”

As we pull out of the parking lot where we have been sitting for the last few hours a fire engine screams past us headed towards the call – we pull in behind them with our lights and siren singing a duet. I like going to calls with the fire engine clearing traffic for us. People tend to clear out of the way a lot faster for the BRT than they do for a little ambulance. It’s like having a big brother who’s a linebacker clearing the hallway between classes in high school – we just follow along in the wake.

Two police cars pass us as we turn into the residential neighborhood and the BRT follows them straight to the house. So much for staging and waiting for police to secure the scene. I’m usually happy to stage and wait for police to call us into the scene – it’s safer. But in this case there are only a few possible outcomes; the person is dead and has been for a while, he just hung himself and cutting him down now could save his life, or it’s complete BS.

As we get out of the rig the firefighters are headed into the house with their bags. We decide to just walk up and see what’s going on before pulling the gurney and equipment out. Walking to the front door a woman exits the house with her hands covering her face, crying. I step through the front door and into the living room to an officer coming down the stairs with a young man in handcuffs.

The officer comes over to us. “He wasn’t hanging; just lying on the bed with a noose around his neck. He said he wanted to hang himself but couldn’t find anything to tie the other end of the rope to. We’ll have a green sheet for you in a few.”

According to the American Foundation for Suicide Prevention:

  • Over 34,000 people in the United States die by suicide every year.
  • In 2007 (latest available data), there were 34,598 reported suicide deaths.
  • Suicide is the fourth leading cause of death for adults between the ages of 18 and 65 years in the United States (28,628 suicides).
  • Currently, suicide is the 11th leading cause of death in the United States.
  • A person dies by suicide about every 15 minutes in the United States.
  • Every day, approximately 90 Americans take their own life.
  • Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death.
  • There are four male suicides for every female suicide, but three times as many females as males attempt suicide.
  • There are an estimated 8-25 attempted suicides for every suicide death.

Suicidal Ideation 2/3

An officer meets us as we walk up to the apartment building. “She’s in that apartment. Watch your step as you go in, there’s blood all over the place. Looks like she bit her tongue. We’ll have a green sheet for you in a few.”

We were called here for a 5150 but it’s looking like there’s more going on than someone who voiced suicidal thoughts. Once an officer hears a person say they want to kill themself, they have to write up a Form 5150 – it’s on green paper so we just call it a green sheet. Basically the 5150 is a tool used by law enforcement to hold an unstable person for 72 hours during which time they are psychologically evaluated. More often than not they are not “suicidal” – they just said the wrong thing at the wrong time or PD has nothing else to hold them on so they get the person off the street using the 5150 because it’s less paperwork for them.

Walking into the apartment I see two more officers standing in front of a slim woman in her forties. She’s sitting on a chair in front of a closet with blood dripping down her chin –  enough to saturate her shirt. She has ligature marks around her neck which are consistent with the belt that is sitting next to her. Looking in the closet I see the closet rod is broken in the middle.

The officer lets me take it in before he gives me the update. “Hey guys, this is Sandy. She’s been going through some pretty rough times and she tried to kill herself today. She drank a bottle of wine and put a belt around her neck and tied it to the closet rod. She hung there for maybe ten seconds before the rod broke. When she hit the ground she bit her tongue pretty bad. The blood freaked her out so she called 911.”

As I kneel down to examine Sandy I see the bottle of wine on the side table – it’s a Mondavi Pino Noir; not the usual crappy two-buck-chuck that they sell in the local liquor stores. Sitting next to the bottle is a Riedel Vinum wine glass. Riedel is known for being shaped so that the wine lands on your palate just so, and you pay for the privilege – a single glass can cost $25 or more. Well, she gets points for taste even if she can’t calculate load bearing stability very well.

“Hi Sandy, I’m going to be taking you to the hospital to get you checked out. Can you open your mouth so I can see what’s going on?” Sandy nods her head and opens her mouth. Pulling out my flashlight I see that she’s nearly severed the end of her tongue – it’s being held on by less than a half inch, yet the bleeding has slowed to a small trickle. I pull out a sterile piece of gauze and tell Sandy to pinch her tongue with her fingers as we walk out to the ambulance.

Once in the rig I can assess Sandy a little better. She checks out fine aside from the tongue and a minor abrasion to the chin. My only real concern is if the attempted hanging caused any damage to the throat that could cause airway obstruction issues or if her tongue were to swell to the point that it blocked her airway. Admittedly these are big concerns, yet I don’t find anything that would make me light up the rig and drive fast.

Sandy’s not much for conversation – partially because she’s holding her tongue (literally) and the reality that if not for the closet rod breaking she would be dead right now. We start driving towards the trauma center – I don’t plan to trauma activate her but I want her in the trauma center where they are prepared – in case the swelling causes any issues over the next hour or so.

I dim the lights in the back and tap away on my laptop as we take a quiet drive to the ED. I’ve watched partners in the past who will talk to people on a 5150 to try and figure out where they went wrong and offer advice. I have mixed feelings about that as it’s not necessarily our function in the medical community. Although I’ve probably taken more psych classes than my peers I feel it’s my job to treat the physical condition and understand the mechanism that led to the injury – so as to give as much information to the nurses and doctors that will continue to care for the patient. I feel it’s inappropriate to play Paramedic Psychoanalyst.

I’ve transported more people on 5150s for voicing suicidal ideation than I can even count – one man was even placed on a hold for texting it. But this is a different presentation. Sandy wanted to end her life so desperately that she put together a plan and acted on it. The carpenter that installed the closet will never know that had he put a third closet rod support in the middle, as he should have, a woman would be dead right now.