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UK ambulance staff report lasting and troubling memories of being called to suicides. But in a small qualitative study, they said there was little acknowledgment in the workplace that such events are traumatic. This is important since someone exposed to suicide is known to be themselves at greater risk of suicide. Each worker interviewed had lost a colleague to suicide at least once and often multiple times.
Ambulance crews are trained to save lives. But when called to a suicide, they find themselves – often with no advance warning - dealing with bereaved families, taking custody of a body and preserving a potential crime scene. This is a uniquely difficult and stressful situation.
The researchers call for ambulance staff to receive adequate training and support to cope with this aspect of the job.
What’s the issue?
More than 6,000 people in the UK die every year by suicide. When ambulance crews respond, they face a distressing and complex situation, which they say they are not adequately trained to handle. This raises serious concerns about the impact on their own mental health.
Studies in countries including Australia and the US show that first responders are significantly more likely to die by suicide than people in other jobs. Suicide risk is higher in men, who make up the majority of ambulance staff. Work-related stress is already blamed as a possible reason why levels of sickness absence among ambulance staff are higher than other NHS workers, and five times the national average.
Anecdotal reports have previously suggested that ambulance staff feel they are a forgotten part of the UK health system. They feel somewhat unpopular with other workers, such as those in hospital emergency departments. They deliver patients who need treatment, and believe they are seen to be generating extra work for other staff.
Little is known about how their experience with suicide could compound the already heavy strain of the job.
The study interviewed nine staff (six male, three female) who worked at a single ambulance service in England. They had between eight and 28 years’ service. The semi-structured interviews lasted from 50 to 110 minutes and were carried out by an expert in the field. The ambulance staff were encouraged to elaborate and describe their own feelings and experiences.
Questions included: “How does attending a suicide impact upon you?” and “How equipped do you feel to respond to bereaved individuals in these circumstances?”
On responding to suicide in a professional capacity, answers included:
- “I’ve done at least four in the last ten months”
- “I couldn’t sleep. I just constantly… it was like a horror movie. I just kept seeing this [person].
- “[Suicide] affects you mentally in some other way whether you think you’re over it or not.”
On workplace support, they said:
- “There’s no ‘oh are you okay?’… because we’re just stretched to the limits. There’s not enough of us.”
- “There’s nothing we’ve been given that says, if you go to this job and then come back in [you] have somebody to speak to.”
Why is this important?
The study shines a light on a hidden problem within the healthcare system and brings the concerns of ambulance crews to wider attention. This is especially important now, given the impact the COVID-19 pandemic could be having on the mental health of workers and the general population. It may include an increase in suicide risk.
Some ambulance staff reported feeling pressured to suppress their emotions, due to the lack of workplace support. They described a “macho” culture and stigma around asking for help. Others were not immediately aware of being traumatised when they were exposed to suicide. But subconscious trauma could cause delayed stress reactions and mental health problems.
The survey suggests that ambulance crews are being asked to manage and coordinate difficult and distressing situations for which they are unprepared. They arrive at a scene expecting to be able to help a patient. Instead, they can find themselves having to secure the scene for forensic analysis, and to tell family members that a loved one has died. They deal with the consequences, which may be violent, and sometimes have to negotiate with suicidal people to save their lives.
This small study demonstrates that ambulance crews feel they are not given the help they need either to deal with suicide attempts or the impact on their mental health afterwards. The ambulance service provides a support service but it is staffed by volunteers within their own ranks. Concerns about confidentiality and a lack of expertise means this service is rarely accessed.
There is increasing awareness that being exposed to suicide raises an individual’s own risk of suicide. A major report from the NHS Staff and Learners’ Mental Wellbeing Commission published last year highlighted the risks to ambulance crews. It warned of “concerning evidence that suggests some NHS professional groups are at heightened risk of death by suicide”.
The researchers want to use the study findings to raise awareness among NHS managers and policymakers of the particular pressures placed on ambulance staff.
The research is part of a broader research effort to investigate how other groups in society, including GPs and parents, encounter and respond to suicide. It informed the Emergency Services Postvention Response Training and will feed into improvements in the design of Postvention Assisting those Bereaved By Suicide (PABBS) training offered by organisations such as Suicide Bereavement UK.
You may be interested to read
The full paper: Nelson PA ,and others. ‘We’re the first port of call’ – Perspectives of Ambulance Staff on Responding to Deaths by Suicide: A Qualitative Study. Frontiers in Psychology 2020;11:722
Jones S, and others. Prevalence and correlates of psychiatric symptoms among ﬁrst responders in a Southern State. Arch. Psychiatr. Nurs. 2018;32: 828–835
Milner A, and others. Suicide among police oﬃcers, ﬁreﬁghters, EMTs, emergency and protective service workers: a retrospective mortality study in Australia, 2001 to 2012. Work 57, 281–287. 2017;57:281-287
Vigil NH, and others. Death by suicide: the EMS profession compared to the general public. Prehosp. Emerg. Care 2019; 23:340-345
Postvention Assisting those Bereaved By Suicide (PABBS) training
NHS Staff and Learners’ mental wellbeing commission report
Funding: This research was funded by the NIHR Research for Patient Benefit Programme.
Conflicts of Interest: The authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.