August 2019; Volume 8, Issue 8
Pedi Points - Tia Dickson, RN, BSN, Primary Children's Hospital
Primary Children's Hospital has a 3-pronged strategy for tackling this issue.
- Raise Awareness
- Improve Provider Capacity (training for mental health care)
- Improve Access to Treatment
EMTs can further this work in their own communities. Develop awareness campaigns and involve local media. Participate in QPR training or a free CALM course. Get involved in state suicide prevention coalitions. Primary Children's is using the Craft Screening Tool to assign risk to our behavioral health patients -see below.
You are probably aware there is also an increased risk for suicide in the EMS profession. The critical stress we experience on the job can take it's toll. Assessment and prevention are essential. You may not know that your ability to intervene and treat patients with suicidal attempts or ideation is directly related to your attitude toward suicide. In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes toward suicide prevention, skills for coping with stress, and continuous training in suicide intervention (2).
1.Youth Suicide Prevention Primary Children's Hospital, Jessica Strong
Expert Input - Jessica Strong, MPH, Community Health Manager, Primary Children’s Hospital
The teenage years are a time of tremendous possibility, but may also be a period of stress and worry. There's pressure to fit in socially, to perform academically, and to act responsibly. Adolescence is also a time of greater independence that often conflicts with the rules and expectations set by others.
The reasons behind a youth's dying by suicide or attempting suicide can be complex. Although suicide is relatively rare among youth, the rate of suicides and suicide attempts have increased in recent years. Suicide has become the leading cause of death for young people in Utah ages 10 to 17. Suicide rates differ between boys and girls. Girls attempt suicide about twice as often as boys. Yet, boys die by suicide about four times as often as girls.
While youth suicide gets a lot of media attention, it’s important to know that suicide is an issue across all age groups. People younger than age 18 only make up 6% of all suicide deaths in Utah. The clear majority of suicide deaths are adults. The information provided below applies across the age span.
People with mental health problems — such as anxiety, depression, bipolar disorder, or insomnia — are at higher risk for suicidal thoughts. Youth going through major life changes (parents' divorce, moving, a parent leaving home due to military service or parental separation, financial changes, etc.) and those who are victims of bullying are at greater risk of suicidal thoughts.
The risk of suicide increases dramatically when people in crisis have access to firearms, and more than half of all suicides in Utah are completed with a gun. Because Utah is high gun ownership state, it is even more important that guns be kept unloaded, locked up, and stored, along with ammunition, out of the reach of anyone in crisis.
Suicide attempts can happen after a stressful life event, such as problems at school, a breakup with a boyfriend or girlfriend, the death of a loved one, a divorce, or a major family conflict.
People who are thinking about suicide might:
Talk about suicide or death in general
Give hints they might not be around anymore
Talk about feeling hopeless or feeling guilty
Pull away from friends or family
Write songs, poems, or letters about death, separation, and loss
Start giving away treasured possessions to family and/or friends
Lose the desire to take part in favorite things or activities
Have trouble concentrating or thinking clearly
Experience changes in eating or sleeping habits
Engage in risk-taking behaviors
Lose interest in school or sports
Many youth who attempt or die by suicide have given some type of warning to loved ones ahead of time. It's important to see warning signs as serious, not as "attention-seeking" to be ignored.
Watch, Listen, and Ask
Keep a close eye on a youth who appears depressed and withdrawn. Monitoring social media accounts is essential. Know what your youth is doing online and with whom they are communicating. It’s not snooping, it’s parenting. Keep the lines of communication open and express your concern, support, and love. If a youth confides in you, show you take those concerns seriously. A fight with a friend might not seem like a big deal to you, but for a youth it can feel immense and consuming. Don’t minimize or discount what they're going through, as this can increase a sense of hopelessness. If you notice warning signs, directly ask if they are thinking of killing themselves.
If you learn that the youth is thinking about suicide, get help immediately. Their doctor can refer a mental health provider, or health insurance can provide a list of providers in the area. In an emergency, you can call (800) 273-TALK (8255).
If the youth is in crisis, seek immediate help or go to the nearest emergency room to get a comprehensive psychiatric evaluation and referrals to appropriate resources. If you're unsure about whether you should bring your child to the emergency room, contact their doctor or call (800) 273-TALK (8255) for help. In some areas of Utah, you can ask 9-1-1 to send an MCOT (Mobile Crisis Outreach Team) for help.
Suicide is preventable with attention, support, and resources for youth in need. If you see a child who is struggling, ask for help.
Suicide Prevention Lifeline
Suicidepreventionlifeline.org; 1-800-270-TALK (8255)
App for confidential, anonymous texting with a crisis worker
NAMI Utah – National Alliance on Mental Illness
News from National
Protocols in Practice - Death Determination and Termination of Resuscitation
Ask Our Doc
Happenings - Melanie Martin, Trauma Program Manager & Lynsey Cooper, EMS Liaison, Primary Children's Hospital
Primary Children’s has a problem. Will you help us fix it?
Please contact us at least 15 minutes out from arriving at Primary Children.
Primary Children's Hospital (PCH) has started tracking prearrival reports and the reporting of ETAs. We have found that, especially on patients that are less urgent or transfers, there are times when ETAs are not called in at all, or are called just prior to arrival. This communication gap has been found in both air and ground transports, for trauma and medical patients.
Many of our pediatric specialists responding to trauma patients come from outside of Primary's ER and our providers are held to tight response times. Your reported ETA is VERY important in helping us be prepared for the arrival of these children. When the ED is running at full capacity, your accurate ETA is essential in decreasing your wait time while we arrange room assignment and staffing.
In our tracking, gaps may stem from the belief that your dispatch is providing the ETA to the ER. Others situations occurred where the patient arrived as “here now” with no prearrival report given. And often we are getting ETAs when teams are only a few minutes out. Ideally it would be great to have at least a 15 minute heads up. This may be more of a challenge in a patient coming urgently from the scene, but with transfers (which makes up about 70% of Primary's patients), it would hopefully be easier.
Feedback from our transferring facilities has been that they usually do not call PCH after they have given their EMTALA report which occurs sometimes hours before the patient arrives at PCH. These transfer facilities don't know your transport times and assume you are reporting them.
FYI, it takes approximately 30 minutes for a fixed wing transport (one that reports their ETA as they leave the airport) to arrive at the PCH doors. Coming off I-15 on Foothill can be greatly influenced by traffic but usually takes 16 minutes.
Our hope is that with better communication between our teams that we can be better prepared to receive these children and improve their outcomes by having a more organized and expedited response when they arrive. Please consider this when transporting patients to our facility.
You are a critical member of our team and we truly appreciate the excellent care you provide the children of Utah!
Thank you for your time.
EMS Awards honored our EMSC Coordinators of the year and many of our other fantastic team members - CONGRATS!
Pediatric Education and Trauma Outreach Series (Petos)
Monday, Aug. 12th, 2-4pm
475 300 East
Salt Lake City, UT
Pediatric lectures for EMS. Face time with PCH attending physicians. These lectures occur monthly on the 2nd Monday from 2-3 p.m. You may attend in person or watch the webinar. It will qualify for pediatric CME from the Utah Bureau of EMS and Preparedness. Access at https://intermountainhealthcare.org/locations/primary-childrens-hospital/classes-events/petos/
Looking for a PEPP Class?
EMSC Pediatric Education for Prehospital Providers
Register online at peppsite.org. Look up classes in Utah and find the one that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($18.95). Return to peppsite.org to register for the class and follow the prompts.
If you have any questions, please email Erik Andersen at firstname.lastname@example.org or text/call 435-597-7098. Continue to watch the website for additional classes.
Emergency Medical Services for Children, Utah Bureau of EMS and Preparedness
The Emergency Medical Services for Children (EMSC) Program aims to ensure that emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure that the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, no matter where they live, attend school, or travel.