Hangings attended by emergency medical services: a scoping review

Abstract

<sec id="s1"> Background: In the United Kingdom (UK) there were 6507 deaths by suicide in 2018, with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted. Trauma audits conducted by North East Ambulance Service NHS Foundation Trust have identified an increased trend in hanging cases, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice. </sec> <sec id="s2"> Methods: A five-stage scoping review method was used. Relevant studies were identified by searching MEDLINE, CINAHL, EMBASE and EMCARE with the help of the Library and Knowledge Service for NHS Ambulance Services in England. Grey literature and reference lists were also searched. Studies were included based on relevance to hangings attended by EMS. Data were tabulated and narratively synthesised. </sec> <sec id="s3"> Results: Sixteen papers were included in the review. Australia was the most frequent source of studies (n = 5, 31%). Most studies (n = 11, 69%) were published in the past 10 years. The median sample size was 53 (IQR 41‐988, range 10‐3981). All papers included varying levels of patient characteristics, EMS input and patient outcomes. </sec> <sec id="s4"> Conclusion: Hanging is a highly lethal method of suicide that is increasingly used in the UK. This scoping review found that there is scarce literature focused on hangings attended by EMS. Treatment of the hanging patient in cardiac arrest is described in many of the papers included. Hanging patients may benefit from the presence of specialist resources who can deliver interventions such as sedation and advanced airway management. The psychological impact of attending, or witnessing, hanging patients is an area that needs further consideration. Further research is needed to describe and improve EMS treatment of hangings. </sec>

Hangings attended by ambulance clinicians in the North East of England

“…The population described was largely young males, which reflects national trends ( ONS, 2020 ) and data from a neighbouring ambulance service ( Hayden et al, 2021 ). Paediatric hangings were thankfully rare and reflected previously reported patterns ( Shaw et al, 2021 ).…”

“…The following data, including 58 individual fields, were selected by the authors as being relevant to hangings based on a previous scoping review ( Shaw et al, 2021 ). Data were manually extracted from the ePCRs by the authors and sorted into the following domains:…”

“…Hanging is a highly lethal method of suicide, and hanging, strangulation and suffocation has been the most common method of suicide used by males and females in the UK since 2013 ( ONS, 2020 ). A recent scoping review highlighted the limited literature on hangings attended by emergency medical services (EMS) and identified areas for further study, including the changing frequency, the demographics of the patient population and the impact of these cases on clinicians and bystanders ( Shaw et al, 2021 ).…”

Emergency First Responders’ Misconceptions about Suicide: A Descriptive Study

“…A suicide attempt is an emergency, and as such requires immediate decisions to be taken to safeguard the threatened life. In addition, actions need to be taken to reduce the risks to the safety of the victim and the professionals involved [ 21 ]. Emergency professionals are used to assisting patients who are struggling to live, and this issue breaks the mental model of the responders and can have a profound impact on them if the suicide is completed and, above all, witnessed [ 22 ].The role of these professionals becomes crucial in treatment as well as prevention to provide a good quality of care from the first second of attendance [ 23 ].…”

Three leading suicide methods in the United States, 2017–2019: Associations with decedents' demographic and clinical characteristics

“…Studies have shown that compared to the Northeastern region, firearm suicides are more common in states in the Western, Midwestern, and Southern regions where firearm ownership rates are higher ( 9 , 11 ). While research on hanging/suffocation in other counties has been extensive ( 12 , 13 ), there is a paucity of research on hanging/suffocation in the U.S. Thus, we did not posit any hypothesis regarding its clinical correlates; however, based on the increasing use of hanging/suffocation among younger age groups, we hypothesized that those age under 45 would be more likely to have used this method.…”