Paramedics describe nightmares, flashbacks from suicide callouts

Attending suicide callouts is taking a toll on the mental health of paramedics, causing nightmares and flashbacks and harming their personal relationships, a study by the University of Otago, Wellington - Ōtākou Whakaihu Waka, Pōneke, has found.

Psychologist Dr Renan Lopes de Lyra interviewed nine paramedics in New Zealand as part of his PhD research in the University's Department of Psychological Medicine. His findings are published in the international journal Paramedicine.

Two of the nine paramedics he interviewed had been diagnosed with post-traumatic stress disorder (PTSD) and anxiety disorders, while others described symptoms consistent with PTSD and anxiety, such as flashbacks and nightmares and said they avoided places where suicide deaths had occurred.

Dr Renan Lopes de Lyra

The paramedics talked in detail about the trauma of attending suicide callouts and the impact it was having on their mental health and relationships, Dr Lyra says.

"For some participants, their mental distress arose from a single traumatic encounter they could recall in detail, while for others the emotional toll came from the cumulative effect of numerous traumatic encounters with suicide.

"Several described the tension they experienced between having a public front as a health professional skilled in an emergency response and the private reality of being a vulnerable human like anyone else. One of the paramedics commented, 'If you're a human being and you've got feelings, how can you not be traumatised?'"

The cumulative emotional distress could lead to feelings of isolation, and emotional disconnection from family and friends, with some paramedics withdrawing from social interactions in order to avoid 'spreading trauma'.

"The participants in the study would have liked more training in dealing with mental health crises and felt unprepared to deal with suicide callouts," Dr Lyra says.

Most developed the skills they needed through 'trial and error' experience while on duty. Some were concerned that taking the wrong approach to discussing the subject of suicide could aggravate the crisis, a common misconception.

"Paramedics found they needed different skill sets for mental health callouts than those they had learned in their emergency health training. In critical situations, the focus of paramedics is generally to stabilise vital signs and keep the patient alive using protocol-based approaches, whereas mental health situations require intuitive skills on how best to approach and de-escalate the situation."

The absence of suicide-related protocols for managing patients meant paramedics had to deal with situations based on their own experience and knowledge, increasing their anxiety levels.

Those interviewed felt they were being required to 'fill in the gaps' for a health system that was failing to adequately support those experiencing mental health crises, Dr Lyra says.

"They were often surprised to find the people they transported to hospital were discharged without any apparent treatment plan in place. This left them feeling frustrated and helpless, particularly when they were called out to attend the same patient in subsequent shifts.

"Paramedics felt they had become de facto support people to frequent callers - something they had not thought of as being part of their role."

The study highlights the risks that on-the-job exposure to suicide can pose to people's mental health, he says.

"Organisations that employ first responders really do need to be thinking about the impact of suicide callouts on their staff."

The research paper, 'How can you not be traumatised: Experience of paramedics occupationally exposed to suicide' is published in the journal, Paramedicine.

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