Evidence
Alert

Ambulance staff who respond to suicides need more support

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. 

What’s new?

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.

What’s next?

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.

Commentaries

Study author

These are mind-blowing findings. It’s important to say it was a small study, but the data was rich and revealed the complex challenges that are faced by ambulance staff. They feel ignored and under-valued, and were ready and open to speak and be heard.

I was surprised that every single person in this sample had been bereaved by suicide, either friends, family or very often colleagues. I found that quite shocking. Staff who are dealing with suicides, and working with colleagues who are thinking about suicide, must have a raised risk of mental health conditions.

Pauline Nelson, Applied Health Researcher, University of Manchester

Paramedic

Although the sample size is small and focused within one ambulance trust, the participant responses resonate with the larger community.

There is constant pressure on ambulance services throughout the country. Although the pandemic has increased demand, ‘normal’ demand is already at a state of emergency – it has been like this for so long that it has become the new ‘norm’ in ambulance services. Staff turnover is immense, and most ambulance staff are barely able to cope with rising community demand. Ambulance staff perform well under pressure, but only over short periods. The response to the pandemic by ambulance staff has been phenomenal, but prolonged periods of unrelenting strain may have severe consequences for their mental health, potentially leading to their own suicide.

Suicides among emergency service staff have increased over the last year. This message needs to reach the most senior managers. Staff wellbeing must be a priority.

Enrico Dippenaar, Paramedic and Senior Lecturer in Emergency Medicine, Anglia Ruskin University

Conflicts of interest

None declared.