As self-inflicted injuries increase so does the need to prepare for encountering someone who has attempted suicide. As a first-aid provider, you have a vital role in addressing immediate medical needs. You can also provide clarity and support to the victim and other people at the scene.
In 2017, guns were the most common method of death by suicide, accounting for a little more than half of all suicide deaths. The next most common methods were suffocation at 27.72 percent, and poisoning at 13.89 percent.
The following first-aid recommendations are for each of the most common methods of attempted suicide. Each case is unique, and it is essential to tailor your care and support to that person’s needs.
Above all ensure the safety of everyone present and address any serious medical needs first.
A self-inflicted gunshot wound (SIGW)—or any gunshot wound—to the head is correlated with severe disability and a high mortality rate. There is a greater chance of death caused by SIGWs compared to victims injured by gunshot wounds that are delivered in an assault or by accident.
Head trauma from a gunshot wound is fatal in about 90 percent of cases, with many victims dying prior to arriving at the hospital.
About 50 percent of the victims that survive the initial trauma die in the emergency department.
Head trauma from a gunshot wound is the cause of approximately 35 percent of deaths attributed to traumatic brain injury.
Although the head is the most commonly injured body region during a suicide attempt, the following is a general guideline for how to approach a gunshot wound on any area of the body.
Ensure your safety. Ensure the scene is safe and immediately call or have someone else call 9-1-1 or emergency medical services.
Locate the source of the bleeding. Attempt to open or remove the clothing over the wound so you can see it—this will allow you to see injuries that may have been covered or hidden.
Stop the bleeding. Pressure to stop the bleeding is the most critical intervention. If the victim has blood that is coming out of a hole, put steady pressure on it with both hands by pushing down as hard as you can.
Use a dressing (towels, shirts, gauze, etc.). Dressings will help seal the wound and aid in clotting.
Elevate the extremity. If the gunshot wound is above the waist do not elevate the legs to treat for shock (unless the injury is in the arm). Gunshot wounds to the chest and abdomen will bleed more rapidly if the legs are elevated, thus making it more difficult for the individual to breathe.
If you can, use a tourniquet.Tourniquets will only work on arm and leg injuries. Using them correctly takes practice, and they should only be used if the bleeding cannot be stopped when direct pressure and elevation are applied immediately and simultaneously or if there is a reason why direct pressure cannot be maintained.
Gunshot wounds to the chest may be sealed with a type of plastic to keep air from being sucked into the wound—this can help prevent a collapsed lung. Remove the seal if shortness of breath worsens after sealing the wound.
Chest compressions in a cardiac arrest caused by hemorrhagic shock from severe blood loss may worsen the situation.
First Aid for Hanging or Suffocation
Self-administered and assisted suicides by asphyxiation—the process of being deprived of oxygen resulting in unconsciousness or death—can be done by several methods. The use of a plastic bag, or suicide bag, is often in conjunction with a flow of an inert gas like nitrogen or helium.
Suicides using a plastic bag with helium were first recorded in the 90s. Since the 2000s, guides on how to use this method have spread on the internet, in print, and on video; and the frequency of suicides by this technique has increased.
Asphyxiation is also present in hanging and strangling. Both hanging and strangling can obstruct blood flow to and from the brain as well as block air flow to and from the lungs.
How to Recognize Suffocation
A constricting article is around the neck
Marks around the victim’s neck where a constriction was removed
Impaired consciousness or unconscious
Grey-blue skin (cyanosis)
Prominent veins and congestion of the face
Petechiae – tiny red spots on the face or the whites of the eyes
What to Do in the Case of Suffocation
Make sure the scene is safe, and immediately remove any constriction from around the victim’s neck; support the body if it is still hanging.
Call or have someone else call 9-1-1 or emergency services.
Lay the victim on the floor. In the case of spinal injury, don’t move the victim unnecessarily.
Check for breathing and pulse; If not breathing begin CPR.
If breathing, place in the recovery position and monitor until emergency responders arrive.
Don’t interfere with or destroy any material, such as a knotted rope, that police may need as evidence.
First Aid for Overdose or Poisoning
Poisoning is due to swallowing, inhaling, touching, or injecting various chemicals, drugs, gases, or venoms. Both suicide and unintentional drug overdoses kill adults at twice the rate today as they did two decades ago, and opioids are a key contributor to this rise. The following focuses on the use of drugs as a means of attempting suicide.
When a drug overdose is suspected, you may not know what drug the person was taking. Often, an overdose victim will either be unconscious or not fully conscious of their surroundings. Because of this, it is imperative to recognize the general signs of a drug overdose and what to do for first aid in the majority of situations.
How to Recognize an Overdose
Unusual sleepiness or unresponsiveness
Confusion, disorientation, or hallucination
Slow, shallow, irregular, or absent breathing
Bradycardia (slow heartbeat) or hypotension (low blood pressure)
Cold and clammy skin
Constricted pupils (small or pinpoint pupils)
Cyanotic (nails and lips are blue)
Mood changes, including aggression, agitation, anxiety, or depression
Abdominal pain or vomiting
Loss of coordination or motor control
Do’s for Drug Overdoses
Make sure the scene is safe, and check alertness. Comfort them if they are awake. If they are unconscious, turn them on their side to prevent aspiration (choking on their vomit).
Call 9-1-1 or emergency medical services. Call, or have someone else call, even if the person seems not to be experiencing overdose symptoms; never wait to see if the overdose will wear off. Some effects of an overdose don’t present themselves right away.
Check for breathing and pulse; If not breathing begin CPR.
Remove unnecessary clothing if the situation allows. Some drugs cause the patient to quickly overheat.
Find details to aid with treatment. Knowing what drug was taken, how much, when, and by what method is important. If the victim is not awake, look for containers, needles, syringes, and other items.
Don’ts for Drug Overdoses
Don’t put the person in the shower. Even if the victim seems okay, a large temperature change could put them in shock.
Don’t let the person sleep. Someone who overdosed may pass out, and you will not be able to stop them; however, trying to keep them awake makes it easier to monitor their condition.
Don’t attempt to make them throw up if they took the drugs orally. This can increase the chance of aspiration.
Don’t wait for the drug to wear off. Call for emergency medical services immediately.
Don’t try to feed the victim. Some foods can have adverse effects.
Don’t leave the victim alone. Stay with them, monitor their condition, and provide help as needed.
Don’t try to reason with or restrain a violent person or put yourself in an unsafe position.
First Aid for Known Opioid Overdose
Examples of opioids include morphine, codeine, oxycodone, oxycodone with acetaminophen, and hydrocodone with acetaminophen. Because opioids affect the part of the brain that controls breathing, too high of opioid levels in the blood can slow breathing down to dangerous levels, which could cause death.
For victims with a suspected or known opioid overdose who have a definite pulse but no normal breathing or only gasping (respiratory arrest) in addition to providing standard care, it is reasonable for trained rescuers—this includes first aid providers, non-healthcare providers, or BLS providers—to administer Narcan® (naloxone) intramuscularly or intranasally to victims with an opioid-associated respiratory emergency.
Victims with no definite pulse may be in cardiac arrest or they may have an undetected slow or weak pulse. These cases should be managed as a cardiac arrest victim.
Standard resuscitation should take priority over the administration of naloxone, with a focus on high-quality CPR. It may be reasonable to administer naloxone—especially when an opioid overdose is suspected—based on the possibility that the victim is in respiratory arrest, not cardiac.
Assess and activate. Check for unresponsiveness and call for nearby help. Send someone to call 9-1-1 and get AED and naloxone. Observe for breathing versus no breathing or only gasping.
Begin CPR. If the victim is unresponsive with no breathing or only gasping, begin CPR (CPR technique based on the rescuer’s level of training). If alone, perform CPR for about 2 minutes before leaving to phone 9-1-1 and get naloxone and an AED.
Administer naloxone. Give naloxone as soon as it is available. 2 mg intranasal or 0.4 mg intramuscular. May repeat after 4 minutes.
Does the person respond? If yes, stimulate and reassess. Continue to check responsiveness and breathing until advanced help arrives. If the person stops responding, begin CPR and repeat naloxone. If no response, continue CPR and use an AED as soon as it is available. Continue until the person responds or until advanced help arrives.
First Aid for Self-Harm or Self-Cutting
Because self-harm, also known as self-injury or self-cutting, involves physical injury, it can seem like self-harm and suicide are directly related. For example, it is common to think that cutting one’s wrist may be a suicidal gesture indicating that the person wishes to slit their wrists to die.
Self-injury can indicate a number of different things. Many people who practice self-injury may not intend to kill themselves and may even see self-harm as a way of avoiding suicide. It is crucial to note that with the pattern of self-injury occurring over weeks, months, or years, the person may be at risk for suicide.
Here’s what you should do if you a self-harm situation presents to you:
Make sure the scene is safe, and assess and activate. Assess the victim’s responsiveness. Call or have someone else call 9-1-1 or emergency services.
Locate and control the bleed. Arterial blood is bright red and spurts or sprays from the wound. If the blood is darker in color and easier to control, it means that the veins have been cut, and the artery was missed.
Apply direct, firm pressure. Apply a towel or dressing directly to the wound.
Elevate. Position the wounded limb in a position where it’s above the victim’s heart.
Occlude or pinch an artery above the injury. If possible apply pressure to an artery to halt the blood supply to that limb. If the bleeding does not stop after direct pressure, a tourniquet may be needed.
Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1–800–273–TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential.
Washington State Crime Victim Service Center Hotline: 888.288.9221
Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.
Learn more on the NSPL’s website. The Crisis Text Line is another resource available 24 hours a day, 7 days a week. Text “HOME” to 741741.
We’ve put together a list of helpful national and local Portland, OR and Seattle, WA resources for mental health and suicide prevention, updated for COVID-19. Please let us know if any of these links are broken, or if you have new ones to suggest. Thank you, and be well.
https://suicidepreventionlifeline.org The National Suicide Prevention Lifeline at 1-800-273-8255 provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. Telephone and online chat available.
https://www.nami.orgNAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. Oregon NAMI Chapter:https://namior.org/
http://gettrainedtohelp.com – Suicide First Aid. Free trainings in suicide prevention for the general public, youth workers, and more. Includes the ASIST curriculum. Trainings temporarily suspended.
https://www.detoxrehabs.net/ – This site helps you find centers in your home state or out of state. We also provide information for different community needs, such as help for our veterans, LGBTQ+ friendly programs, free or Medicaid accepting treatment, and pet-friendly facilities.
www.AlcoholRehabGuide.org – This guide doesn’t promote any specific clinic or service, but it does provide valuable information to help people understand the effects of alcoholism and the variety of ways to find help.
Me, standing under the bridge in my neighborhood in Portland, Oregon. The bridge is the site of weddings, festivals, film shoots, and deaths.
How to Save a Million Lives
It starts with being visible.
November 2, 2019
In anyone’s memory, certain dates stand out forever.
I remember standing in my aunt and uncle’s sunny family room in San Mateo, California on April 18, 2018. That was when the customer service rep on the phone told me I did not qualify for life insurance. This was a problem. In fact, it was a huge problem. It meant I would not be able to obtain what is called “Key Man” Insurance, which shields professional investors in case of the accidental or untimely death of the CEO or other essential team members. Key Man Insurance is a must for any startup seeking serious investor funding (seed round or VC). Unknowingly, I had raised funds from friends and family for a venture that could not succeed with me at the helm.
I checked it out. I got a second quote. It didn’t matter that I was healthy and had managed the condition successfully for 19 years.
This wasn’t a case of bias, or stigma. It was a numbers game. The diagnosis is bipolar disorder. The reason I couldn’t get life insurance was that my diagnosis carries a 15 – 20% lifetime fatality rate. That means that as many as one in five people with bipolar disorder may die by suicide. (National Institute of Mental Health, as cited by DBSA.)
If present trends continue, over 855,000 of the 5.7 million individuals living today with bipolar disorder in the U.S will die by suicide. That’s almost a million people.
We are living in the middle of an epidemic. And one ever seems to notice.
Our company’s investor woes seemed pretty trivial in comparison.
Which brings me to the other date. Just over a year ago.
October 17, 2018
On that single day, in my home city of Portland, Oregon, we lost three people to suicide. One of the deaths happened a few hundred feet from my apartment, when a woman jumped off the St. John’s Bridge. I found out when I heard the sirens and saw the flashing red lights. I took some roses out of a vase, went outside, walked down the hill, and put the roses by the police line.
For me, that death brought home the reality of the suicide epidemic in America. I don’t know whether any of the three people who died had a diagnosis, but given the high risk factor and the fact that 1 in 23 Americans are bipolar, it is likely. Suicide fatality rates are actually higher for people with bipolar disorder than for those with unipolar depression(NCBI). Because suicide is a social epidemic, the death of one individual can result in the deaths of other individuals, who may not even share the same diagnosis. There a lot of reasons why this post has been hard for me to write. One of them is that this year, in the time since I started writing this blog post, about three weeks ago, I learned of two other likely suicides in my home communities: one here in Oregon and one in Massachusetts. The taboo around speaking about suicide is strong, just like the taboo against discussing bipolar disorder. I went to a walk this month by the American Society for Suicide Prevention. It’s a worthy event, and it does a lot of good for survivors. But nowhere — nowhere — was bipolar disorder mentioned as a cause or a killer. Talking about America’s suicide epidemic without talking about bipolar is like trying to talk about heart disease and never mentioning high blood pressure.
Last fall it felt like the bodies were literally dropping from overhead. Those deaths, in particular the one so close to home, jolted me out of complacency. I kept thinking to myself, “If fifteen percent of bipolar people are dying by suicide, why don’t we hear about it? Why aren’t we doing more to stop it?”
I had been marked as a plague victim and I didn’t even know it.
I found a replacement CEO for my startup. After stepping down, my plan had been to take a course or two in data science and rejoin the corporate world. Instead, I found myself on an entirely different path. I earned a certification in Life Coaching, another as a Peer Support Specialist, and completed the excellent QPR suicide prevention training which is offered for free to lay people in the Portland area. The goal: work part time coaching bipolar and entrepreneurial clients from around the world. Spend the rest of my time learning a new coding language and building something cool.
The crazy thing is, one year later it actually seems to have worked.
The people I have coached confound my expectations. They are C-level executives, computer programmers, bankers, and accountants. Leave every expectation you have surrounding bipolar people and their temperament or personality type at the door. Just know, above all, we are here. And there are a lot of us. The recovery rate for bipolar disorder is 80%. (Health Central) Mostly you can’t tell us apart from anybody else. Because when the medication works well for us, like most other Americans, we’d much rather concentrate on our lives and families and hobbies than on getting riled up with anything that resembles activism.
Coaching is intense. I have had more than one occasion where the client burst into tears during the first session. Unlike therapy, the emphasis is on achieving short term goals. Most of my service offerings are designed to last 3-6 sessions, although some clients stay on much longer. I think my favorite sessions are the outdoor fitness sessions, where we do the coaching during an hourlong walk or hike. I never agree to work with a client unless they are also seeing a licensed doctor or clinician. Confidentiality is key. In the event of a situation where someone’s safety is at risk or where someone expresses suicidal thoughts, I will of course contact emergency services, as well as other members of a client’s care team.
Whatever assorted coaching gurus may promise, my type of coaching won’t make you rich. That’s not why I do it. I just know that it’s important for bipolar people to be visible.
This is where the saving lives come in. It’s about much more than the coaching, although I believe that’s important and meaningful work. It’s about being visible, and letting people know that bipolar gets better. Coming out is risky, and it has a cost. You may not get asked on that second date. As a programmer the last thing you want is your supervisor wondering what medications you were taking when you pushed that last commit! But I’ve come to believe that the cost of silence is greater. Silence equals death. Stigma equals death.
Here’s how we can save one million lives over the next generation:
1.) Make stigma against bipolar people unacceptable. End the jokes. Stop using bipolar as shorthand for a personality disorder. Educate yourselves. This shouldn’t be my job, as the person with the disability, but I need to take responsibility first and foremost for my own actions. I am not “out” in every professional or social social situation, but I try to live my life in a way that I can communicate to others, who may be more closeted, that there is hope.
2.) Improve quality and access to mental health care. Bipolar people face special challenges. We encounter more stigma than people with depression or anxiety disorders, and if we are misdiagnosed, the consequences can be serious. But all mental health conditions deserve treatment on a par with physical health. The quality of generic medications has taken an alarming dive. I have experienced these issues myself, and heard alarming reports from others. Legal or regulatory action must be taken to ensure that vulnerable populations do not suffer.
3.) Work for a cure. Amazingly, for a disease that affects millions of Americans and people the world over, we still do not understand the causes of bipolar disorder. It receives only a fraction of the federal funding for diseases with a similar mortality rate. Meanwhile, the pharmaceutical industry shows off its latest advances: a pill with a tracking device to make sure the patient complies and takes their medication. We are solving for the wrong goal here.
You may have noticed that the beginning of this piece promised to tell you how to save one million lives. And you may have noticed that based on the figures above, we’re still 145,000 lives short. There’s a reason for that. The reason is that bipolar people, when we are well and healthy, save lives.
The reason is that bipolar people are our best and our brightest. We are leaders. We are artists. We are entrepreneurs and innovators. We are mystics. We are heroes. We feel deeply, and we act on the courage of our convictions. From Winston Churchill to Kanye West, the names of famous bipolar people read like a roll call. Bipolar people who are able to live out their lives to their fullest potential will design lifesaving vaccines, help mitigate climate change, and create songs and stories that sustain and offer hope for an imperiled planet. We give back every day. We are mothers and fathers, aunts and uncles, teachers and mentors, some of the best and most loyal friends you will ever find. We are generous. We go the extra mile. Maybe we are still trying to prove we are “good enough.” Maybe deep down we know that we different, and also blessed. There is a reason we are in this genome.
We have so much to give, and we are irreplaceable.
Due to the COVID-19 epidemic, I have scaled back my coaching practice. I have a limited number of phone and video entrepreneurial and coaching slots available. Full professional resume and credentials available on request.