Monday, January 3, 2011
Too Close to Home
Part
1: Suicide at Station 13
JEMS article reprinted
Wayne Zygowicz | | Thursday,
December 27, 2007
Littleton's Station 13,
geographically separated from the rest of the city's fire stations by the
windingPlatteRiver, is located in a quiet, affluent neighborhood. Throughout
the department, Station 13 is known for low-call volume, compared to the other
seven stations. However, it's also infamous for the high-profile calls,
including the 1999ColumbineHigh School shooting, that have taken place in its
response area.
On Oct. 29, death came knocking on
Station 13's front door, but luckily none of the crew was there to answer. An
elderly male parked his car on the lawn -- right in front of the station's sign
just feet away from the day room windows and front service door. He got out,
removed a large hand gun from the vehicle and shot himself in the chest with
the high-caliber weapon. He apparently survived the first wound to his chest
and then shot himself in the head. The second shot left him unconscious and
barely breathing in a large pool of blood on the sidewalk. Station 13's crew
was out of the firehouse at the time of the shooting. A series of station tones
rang out in their vehicles, and a familiar voice aired an ALS response,
"Engine 13 and Medic 13 respond on a possible suicide in front of your
station, standby for law enforcement."
ThecountySheriff quickly arrived and
secured the scene and weapon as Station 13's crew emergently returned back to
their firehouse. The crew found the 70 year-old man, unconscious with agonol
respirations at 5/min and a faint pulse around 68/min, with a gun shot wound to
the chest and a massive head wound with an entrance and exit. He had already
had lost a substantial amount of blood by the time the crew arrived. They
quickly established an airway with an endotracheal tube, packaged the patient
on a backboard with a collar and loaded him into Medic 13 for an emergent ride
to the Level One trauma center just eight miles away. The on scene time was a
short four minutes. During transport they removed his clothing and performed a
detailed assessment, established an IV with EZ-IO and applied the cardiac
monitor. He still had a good pulse ox reading of 90 percent with assisted
ventilations but had lost his pulse. CPR was started immediately. The crew knew
the chances of his survival were slim with brain matter protruding from the
exit wound. Shortly after arriving at the hospital, the man went into cardiac
arrest and was declared dead. His life was over. But he had changed the lives
of his rescuers, adding another small mark on their souls and lasting memories
of that day.
This patient was no stranger to the
members ofLittleton's Station 13. Just five months earlier, he had attempted
suicide using carbon monoxide at his home. Station 13's crew found him in his
garage with the car running. He was semi-unconscious, barely breathing and
saying he wanted to kill himself. He had written a note, collected his personal
papers and provided his insurance papers for whoever would find him. The crew
transported him to a local hospital, where he spent time in intensive care and
received mental health counseling for his depression. He was released, only to
complete his suicide wishes months later on the sidewalk ofLittleton's Fire
Station 13.
What was his motivation to commit
this act in front of a public building, where so many school children have come
for station tours? Of all places, why here? Did he come to the firehouse
looking for the crews who had defeated his earlier suicide attempt? Was this a
planned homicide-suicide quickly modified when he discovered Station 13's crew
missing? No one will ever know his motivation even though a suicide note was
found in his car. He did not mention why he chose Station 13 for his final
moments, only who he was and who should be called after his planned death.
"The reality of this suicide
death on our property didn't set in for me or my crew until long after the
call," Station 13 Capt. Tim Woodward said. "It wasn't until my family
came to visit me later that night that I realized that this tragic event could
have happened when they were in the firehouse or when school children were
seeing the firehouse. In retrospect, we all feel very lucky we were not in the
station when he did this."
The suicide is not the first of its
kind. Earlier this year, a person committed suicide in the parking lot of
another fire department in southDenver while on their cell phone with the
dispatch center. In another incident, a 36-year-old female patient with a
history of suicide attempts leaped out the back doors of a moving private
ambulance driving on aDenver expressway and jumped to her death. She had
removed her cot straps while distracting the attending EMT. Her family is now
suing the company for damages.
Two Suicides in One Day
I remember another day this year
when I was taking my normal route home, one I had traveled many times over my
career as the EMS chief atLittleton (Colo.) Fire Rescue. The communications
specialist's calm voice crackled over my radio as she dispatched an ALS
response, "Engine11 and Medic 11 respond on a possible suicide, standby
for law enforcement."
I was just blocks away and had a
truck full of ALS equipment. I pulled into the modest subdivision and waited
for law enforcement to stabilize the scene. Within minutes a safety message
radioed to all incoming fire units that it was safe to enter. I parked across
the street as children gathered to see what all the commotion was about. I
could hear the sirens from the approaching fire department apparatus still
blocks away as I was motioned toward the garage by a police supervisor. A
female police officer was leading a distraught wife away from the home and
toward a waiting police car. I remember thinking to myself, "this doesn't
look good."
The scene was disturbing as I stared
from the garage door. A male in his late 40s or early 50s, a father and a
husband, had hung himself from the rafters of the detached garage. His wife
found him after she returned home from work. He had successfully taken his own
life and was now cold and mottled. His fists, still clinched tightly, showed obvious
signs of rigor. There was no hope of resuscitation. The death scene was very
silent, and the sounds of his wife crying faintly in the police car could be
heard in the background. Crew members fromLittleton's Engine 11 and Medic 11
joined me. We stood quietly, police and firefighters, not saying a word and
just looking at one another. We had all seen that "look" on each
other's faces before. Toys and small bicycles were in the yard, and I wondered
who would pick the kids up from daycare today. What would they tell the
children happened to their dad, and how would they cope with this tragedy of
immeasurable proportions? It was a sad scene not uncommon to public safety
officers and first responders. As I went "in service" and drove from
the scene, I waived to the children who had gathered near the fire truck. I
slowly exited the neighborhood and wondered just how many of these sad suicide
stories I had witnessed over the 25 years of my public service career.
Later that same day, on the opposite
side of the fire district, another middle-aged man hung himself in his garage.
He too was a father and a husband. He too was found by his wife in the garage
at the end of her work day. Two middle-aged men -- both family men with so much
to live for -- died that day, leaving families in turmoil and first responders
with questions. Was this an eerie coincidence or a sign of the much bigger
problem facing the affluent communities in the southDenver area?
A Larger Problem
Suicide deaths and attempted
suicides are a major health problem inColorado -- affecting people of all age
groups. In 1998,Colorado's suicide rate was the 12 highest in the nation, and
suicide was the ninth-leading cause of death in the state. Today,Colorado has
the sixth-highest suicide rate in theU.S., and suicide is now the
second-leading cause of death among people ages 10 to 34. It's estimated that
9,600 Coloradans seriously contemplate suicide each year, with the largest
number of suicide deaths occurring among men between the ages of 35 and 44. The
risk of suicide increases as men grow older and is particularly high among men
75 years and older.
The government recently released
figures showing the suicide rate among middle-aged Americans has reached its
highest point in the last 25 years. The U.S. Centers for Disease Control (CDC)
estimates the suicide rate for people between the ages of 45 and 54 rose by
about 20 percent between 1999 and 2004. The CDC figures show that there were
16.6 completed suicides per 100,000 people in that age group, the highest
suicide rate recorded by the CDC since 1980. Experts believe suicide is an
unrecognized tragedy many communities across the country face. Studies suggest
middle-aged men are the least likely to have sought counseling prior to their
untimely deaths.
Death and Cake
Paramedic Capt. Monte Fleming is a
seasoned veteran of the fire service and dedicated family man. When his
daughter graduated sixth grade, he was on duty and attended the ceremony with
his crew. The school was in his first in district, and it was the perfect
opportunity to make a public appearance with the fire truck. The ceremony was
short and well attended by 25 other families of sixth-grade graduates.
Following the ceremony was a party with cake, ice cream and fire-truck tours.
As the crew members chatted with parents and enjoyed the refreshments, a series
of alert tones rang out on their portable radios and a familiar voice aired an
ALS response, "Truck 12 and Medic 15 respond on a possible suicide and
standby for law enforcement."
Crew members climbed onto their
truck and headed toward the call. The scene was charged with profound emotion.
Police officers were consoling a distraught wife and her children. The family
had come home to find that the father and husband had shot himself in their basement.
On assessment, the crew found a man
in his late 40s cold with rigor. He had sustained a self-inflected gun shot
wound to the head from a small caliber handgun that now lay between his legs.
Fleming's crew quickly realized there would be no resuscitation or happy ending
to this situation. The crew stood silently with the "look" on their
faces. The firemen carefully left the man's body undisturbed, mindful of the
potential crime scene. After emotionally supporting the surviving family, the
crew returned to the graduation party and tried to pick up where they had left
off. Things had changed for one family in a matter of minutes, and the
uncertain future for this family was on the minds of the rescue crew. The raw
reality of their jobs inEMS was apparent to each crew member. In the few short
minutes, their joyful celebration turned to sadness, and the graduation cake
just didn't taste quite the same. "Each one of these suicides leaves a
small mark on your soul," Fleming said. "You just can't help [but] feel
sorry for each of these families, and the reality they face."
Each suicide is unique -- from the
senior citizen who duct taped a bag over his head to the middle-aged man who
put rocks in his pockets and cut a hole in the ice he was standing on at a local
reservoir, or the war veteran who dressed in his old military uniform and shot
himself in the chest. "Each one leaves a lasting memory," said
Fleming.
What have we learned from fatal
events and near misses, and how can we protect our first responders from also
becoming causalities of individuals bent on self destruction? What role does
EMS have in suicide prevention, and what programs are established to reduce
these increasing suicide rates inColorado? Read more about the lesson learned
from the suicide at Station 13, as well as other information on suicide and
suicide prevention, in Part 2 of "Too Close to Home: Suicide at Station 13
Too Close to Home
JEMS article reprinted
Wayne Zygowicz | | Friday, January
11, 2008
Suicide rates in "Colorful
Colorado" and across the nation continue to climb. Nationally, suicide
claims more than 31,000 lives every year -- or one person every 17 minutes. In
any given year inColorado as many as 720 people will die from suicide and
hospitals will admit 2,600 for attempts.
The actual numbers of annual suicide
deaths may be understated, since some suicides are classified as accidents and
may go unreported. These intentional acts, designed to take one_s own life, are
costly to society, devastating to the surviving families and difficult for
emergency responders to understand. Public safety personnel are at personal
risk when they interface with suicidal individuals before, during or after
their act of self destruction. Responders jeopardize their own safety trying to
rescue people who feel they have nothing left to live for. Even national park
rangers, from the Golden Gate National Recreation area inSan Francisco to
theColoradoNational Monument inGrand Junction,Colo., have seen a sharp increase
in suicides amid the natural beauty of our parks system. First responders often
perform demanding and dangerous search-and-rescue operations in difficult
terrain during bad weather to access horrific scenes in attempt to provide
life-saving care to suicidal people.
People who complete their suicide on
the first attempt have often given no indication of their intent to die. Their
means often involve highly lethal methods, such as firearms or hangings. The
suicide of a 70-year-old man by two self-inflected gunshot wounds on the
sidewalk ofLittleton (Colo.) Fire Rescue_s Station 13 on Oct. 29, 2007 brought
a strong dose of reality to first responders working that day. The incident
left them wondering about their own personal safety and security while at work
-- in their second home, the fire station.
This incident has served as a
wake-up call to many first responders. What were the intentions of this man
whoLittleton crews had successfully rescued from a previous carbon monoxide
suicide attempt earlier in the year? Was this a planned public suicide or a
more complex homicide-suicide averted when the man found the crew members
missing from the station? No one will ever know his real intentions but some
somber lessons can be learned from this "near miss." Below are some
safety tips to ponder from the suicide at Station 13.
Pre-incident Planning
- Develop Standard Operating Procedures (SOP) that
address station security. Develop a department-wide plan that outlines
measures to improve personnel safety at the station and also raises
awareness among department members.
- Develop "situational awareness." Responders
should always remain vigilant and have an awareness of who is in and
around stations, ambulance bases or on department property. Individuals
who are unfamiliar to the crew should be questioned as to who they are and
why they are there.
- Any time, day or night, when a crew member is on
station grounds (cutting grass, shoveling snow, relaxing in a lawn chair)
they should have a department radio available to immediately call for
assistance if necessary. New radios have emergency alert buttons that
quickly signal the dispatch center of the emergency without having to say
a word on the radio.
- Restrict open bay doors at all times, especially at
night. It_s common in most fire stations or ambulance bases to leave the
bay doors open while the crew works out, eats dinner or watches a movie in
the day room. Bay doors are often left open for hours, allowing anyone
easy access to enter the building while the crew is distracted by doing
other things.
- Service doors should remain locked at all times.
Install a key-card access system to prevent easy access for intruders,
including employees who have been terminated. If an employee is
terminated, their access card should be immediately shut off -- ending
their ability to enter all stations. Changing locks on service doors can
be time-consuming and expensive. Key-card access systems can save money
while adding a high level of security and accountability.
- Crew members should have a warning signal (a word,
phrase or gesture) that will alert other members that something isn't
right and to be alert and assume a defensive posture or "code
red."
- Develop an SOP that addresses what to do if a civilian
is injured or killed on department property.
- Develop an SOP on how to clean up large pools of blood
safely and effectively.
During an Incident on Department Property
- Notify the communication center of the situation.
Communication specialists will immediately notify law enforcement and the
administrative staff.
- Administrative staff should respond to the scene to
provide support and advice. They should assume the role of a liaison
between your department and law enforcement. A member with investigate
powers is preferable.
- Notify any schools or churches in the immediate area of
the incident. They may choose to go into "lock down" mode.
Information from the incident can be provided to parents so they and their
children can be directed away from the immediate area. Special
considerations are important when a body is in a public area or a large
amount of blood is on the ground.
- Shield the incident from the street and passing
motorists by restricting access. Use fire trucks, ambulances or tarps to
block the public_s view. Protect the public from unpleasant sights.
- Secure the building. Check the utilities (cooking on
the stove) if the crew left the building in a hurry.
- Having a second crew respond to the scene to assess the
needs of witnesses and bystanders. Witnessing a person commit suicide in a
public place can cause emotional distress and physical illness.
Post-incident
- Support the responders who were directly involved in
the incident. Any violation of their personal space by a traumatic event
can be threatening and unsettling.
- Complete an internal investigation of the incident.
Take pictures of the scene and get witness statements from the crew
members.
- Notify and brief all stakeholders of the situation. A
written and verbal report should explain the details of the event.
- Notify the rest of the members of the department.
Specific details of the incident should be disseminated to everyone from
an administrator instead of through the "rumor mill."
- The department_s safety committee should review the
incident and make recommendations to improve safety and security.
- Consider the need for critical incident stress
management (CISM) interventions.
A Vital Link in Prevention
First responders find themselves in
a complicated position when answering suicide calls. Suicidal behavior is
usually viewed as a mental health issue, and first responders have no cure for
that in their medical kit. Responders usually have had no formal education in
suicides. They also often don_t understand the individual_s behavior or what
role they play in suicide prevention. Suicide scenes are often ugly and leave
everyone involved feeling empty and frustrated. Often, suicide calls are the
worst situations public safety personnel experience in their careers.
EMSresponders are usually the first
medical professional to interact with people involved in a suicide plot.EMS has
a window into the private lives of our patients and must be able to identify
common suicide predicting factors. The providers then must provide a link to
definitive care and mental health support. Some common suicide predicting
factors are:
- Hopelessness (believed to be a primary predicting
factor of suicide);
- Isolation, living alone or loss of support;
- Work problems or unemployment;
- Marital problems;
- Stress caused from negative life events;
- Alcoholism or drug abuse;
- Major depressive illness or disorder;
- Anger, aggression or impulsivity;
- Significant physical illness;
- Family history of suicide;
- Suicide thoughts, talk or preparation;
- Prior suicide attempts, and
- Use of lethal means.
Police, fire,EMS and other first
responders who find themselves in the crossfire of individuals attempting
suicide must develop strategies to prevent or reduce these tragedies. The
future vision ofEMS and public health is injury prevention, not a continued
response to preventable deaths. Public safety personnel provide a vital link in
suicide prevention and should recognize their unique position in providing
emotional support and direction to those contemplating their own demise.
Educating those in "gatekeeper" positions to recognize individuals
exhibiting suicidal behavior is a key component in a comprehensive community
suicide prevention program. Public safety personnel must recognize the
importance of providing outreach connections to at-risk individuals while
responding effectively to those in a suicide crisis.EMS has primary access to
homes, schools, senior centers and other community-wide settings to launch
educational programs directed at suicide prevention. Below are key components
to consider in a broad-based community suicide prevention strategy:
Encourage At-Risk Individuals to
Seek Care
- Encourage public awareness of suicide.
- Develop community-based prevention programs.
- Improve primary-care providers' ability to direct,
treat and refer suicidal patients.
- Create suicide prevention in schools.
- Expand gatekeeper training.
- Provide services to people experiencing traumatic
events.
Improve Care for At-Risk Individuals
- Refine and distribute screening assessment tools.
- Expand professional training on suicide prevention.
- Improve the ability for mental health providers to
address suicide.
- Provide support for suicide survivors.
- Encourage culturally competent approaches.
Promote Policies to Help Reduce the
Risk of Suicide
- Improve financing for mental health services.
- Reduce access to firearms.
Many lessons were learned from the
suicide atLittleton's Station 13. Two strategic lessons learned from this
unfortunate incident are the importance of suicide awareness programs for first
responders and the significance of community based suicide prevention programs.
Communities must work together to prevent future tragedies by reducing these
needless deaths. For further information and educational resources on suicide
and suicide prevention check out the following references:
Suicide
Prevention Coalition of Colorado http://www.suicidepreventioncolorado.org/
Yellow
Ribbon Suicide Prevention Program http://www.yellowribbon.org/
