‘We’re the First Port of Call’ – Perspectives of Ambulance Staff on Responding to Deaths by Suicide: A Qualitative Study

Nelson, Pauline; Cordingley, Lis; Kapur, Navneet; Chew‐Graham, Carolyn; Shaw, Jenny; Smith, Shirley; McGale, Barry; Mcdonnell, Sharon

doi:10.3389/fpsyg.2020.00722

Cited by 24 publications

(51 citation statements)

References 29 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These feelings and doubts regarding the care of survivors are in line with the outcomes of Nilsson et al (2017) that studied the experiences of facing the family of a deceased by suicide in the prehospital emergency context. These findings are also in accordance with Nelson et al’s (2020) study, which concluded that having to deal with the intense emotional reactions of bereaved individuals is a difficulty for the paramedics. The loss of a patient by suicide and the coping processes of the prehospital emergency professionals of this study varied from professionals whose exposure to suicide did not appear to affect them (although it may be a process of denial as a defense mechanism) to professionals whose narratives included normal grief reactions, even though they did not last long.…”

Section: Discussionsupporting

confidence: 91%

“…Indeed, different predictors of stress and traumatic impact defined in literature were described by those participants who had stress reactions in the aftermath of the death by suicide of an emergency patient, namely, a shocking death scenario ( Gutin et al, 2011 ), the lack of training and support ( Castelli Dransart et al, 2017 ), and a closeness with the patient ( Cerel et al, 2014 , 2017 ), even if it is a subjective closeness, through identification or countertransference mechanisms (e.g., “ It was a person of my age ”). Nelson et al (2020) also found this mechanism of identification as a potential risk factor for a greater distress. In agreement with findings of the influence of both the emotional closeness and the exposure to a higher number of suicides as potential factors that increase negative consequences ( Van Orden et al, 2010 ; Cerel et al, 2017 ), in this study the rescue to relapses seems to have had a greater disturbing effect.…”

Section: Discussionmentioning

confidence: 85%

“…The emerged categories show similar impact characteristics to those found in previous studies with other professional groups (e.g., Rothes et al, 2013a , b ; Castelli Dransart et al, 2014 ), as well as highlight some specificities of the emergency context, which may increase emotional impact and traumatic reactions. The present study adds data to the few previous studies, which approached the experience of suicide cases in prehospital emergency context ( Gaffney et al, 2009 ; Nilsson et al, 2017 ; Vedana et al, 2017 ; Nelson et al, 2020 ).…”

Section: Discussionmentioning

confidence: 87%

“…The impact of a patient suicide has been studied in different groups of health and mental health professionals, including psychiatrists (e.g., Chemtob et al, 1988a ; Courtenay and Stephens, 2001 ; Henry et al, 2004 ; Ruskin et al, 2004 ; Rothes et al, 2013b ; Castelli Dransart et al, 2014 ), psychologists (e.g., Gorkin, 1985 ; Chemtob et al, 1988b ; Kleespies et al, 1993 ), physicians (e.g., Halligan and Corcoran, 2001 ; Kendall and Wiles, 2010 ; Rothes et al, 2013a ), nurses (e.g., Akeshi et al, 2003 ; Takahashi et al, 2011 ; Castelli Dransart et al, 2014 ), and social workers (e.g., Jacobson et al, 2004 ; Castelli Dransart et al, 2014 ). However, to the best of the authors’ knowledge, only four studies ( Gaffney et al, 2009 ; Nilsson et al, 2017 ; Vedana et al, 2017 ; Nelson et al, 2020 ) approached the theme of suicide impact in prehospital emergency context. These studies revealed important data, but the subject remains understudied.…”

Section: Introductionmentioning

confidence: 99%

“…Although Vedana et al’s (2017) study also includes the experience and impact of death by suicide, it is not always clear when it is referring to suicides or suicide attempts. A very recent study ( Nelson et al, 2020 ) highlighted that ambulance staff presented long-term and emotionally impacting memories of suicide cases and often had difficulties to deal with the persons bereaved by suicide at the emergency setting, reporting uncertainty, anxiety, and lack of training. Nelson’s study used a small sample of paramedics and technicians and was conducted in the scope of a prehospital emergency setting based on the Anglo-Saxon model, centered essentially on the activity of paramedics, “of taking the patient to the hospital” ( Dick, 2003 ; Al-Shaqsi, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals

et al. 2020

View full text Add to dashboard Cite

The suicide of a patient can be a disturbing experience for health professionals. According to literature, a patient suicide is a professional hazard in the path of prehospital emergency professionals. In the emergency context, several factors pointed out in literature as predictors of increased emotional impact and more severe traumatic reactions are present. However, the impact of patient suicide on prehospital emergency professionals is still an understudied subject. The aim of this study was to better understand the impact and emotional reactions of prehospital emergency professionals facing a patient suicide, using a qualitative approach. Semi-structured interviews were conducted with 19 prehospital professionals. Fourteen narratives about a patient suicide experience were obtained. Three main categories emerged from the process of content analyses: (1) emotional impact and related factors; (2) perceptions of impact; (3) emergency context and professional growing. Death by suicide in the prehospital emergency context had a considerable emotional impact on these professionals. Several participants described intrusive thoughts and images as a consequence of attending to the death scene. Regarding the perception of impact, there seemed to exist a variation between the levels of exposed to and affected by suicide. There are specific features of the prehospital emergency context that emerged in the narratives of participants as factors which increased the patient suicide impact, namely attending the death scene, encountering the family or other survivors, and managing the feeling of responsibility for not arriving in time of the rescue. The narratives of prehospital professionals also indicated some negative effects on their professional practice, such as doubts about their competence, training, and limits to liability. The death of a patient by suicide in the prehospital emergency context can be a difficult experience, marked with an intense emotional impact. Nevertheless, it can have some positive effects, such as professional growth and increased awareness for the phenomenon. Specific training appears to be fundamental to promote professional growth and to overcome the negative emotional impact.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals

et al. 2020

View full text Add to dashboard Cite

show abstract

Examining the psychometric properties of the expressions of moral injury scale in a sample of first responders.

Tappenden

Cole

Valentine

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

View full text Add to dashboard Cite

Objective: There is emerging evidence that first responders, like military personnel, are at risk for exposure to potentially morally injurious events. However, studies examining expressions of moral injury in first responders are nascent, in large part due to the limited number of measures validated for use in this population. To address this gap, the present study sought to investigate the psychometric properties of the Expressions of Moral Injury Scale-Military Version (EMIS-M) in a sample of first responders. Method:The psychometric properties of the EMIS-M were investigated in a sample of 228 first responders to determine reliability, convergent validity, discriminative validity, and divergent validity. In addition, confirmatory factor analysis was conducted to test the bifactor model identified in a veteran sample (Currier et al., 2018). Results: Results yielded an excellent fit for the bifactor model with correlated self-directed and other-directed subscales identified in the EMIS-M development study. In addition, the measure evidenced strong reliability, convergent validity, discriminative validity, and divergent validity. Conclusions: The findings of the present study suggest that the Expressions of Moral Injury Scale-First Responder Version is a psychometrically sound measure capable of assessing self-and other-directed expressions of moral injury in first responders. The significance of these findings to our understanding of moral injury in first responders and their implications for future research are discussed. Clinical Impact StatementThe findings of this study contribute to the limited extant research suggesting that first responders may be impacted by moral injury. Further, this study's findings suggest that the Expressions of Moral Injury Scale-First Responder Version (EMIS-FR) is a psychometrically sound tool with which clinicians, researchers, and public safety agencies can assess symptoms related to moral injury in first responders. Since the EMIS-FR does not ask respondents to indicate the specific potentially morally injurious event that they were exposed to, this measure may have optimal utility as a minimally distressing tool for public safety agencies to assess expressions of moral injury.

show abstract

Exploring the wellbeing of ambulance staff using the ‘public value’ perspective: opportunities and challenges for research

Heath

Wankhade

Murphy

2021

Public Money & Management

View full text Add to dashboard Cite

‘We’re the First Port of Call’ – Perspectives of Ambulance Staff on Responding to Deaths by Suicide: A Qualitative Study

Cited by 24 publications

References 29 publications

When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals

When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals

Examining the psychometric properties of the expressions of moral injury scale in a sample of first responders.

Exploring the wellbeing of ambulance staff using the ‘public value’ perspective: opportunities and challenges for research

Contact Info

Product

Resources

About