Clinical Practice Guidelines:

Behavioural disturbances/The suicidal patient

Version October 2015
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The suicidal patient

October, 2015

In Australia there were 2,535 deaths from suicide in 2012,

resulting in it ranking as the 14th leading cause of all deaths.
Three quarters (75%) of suicide were male, making suicide the
10th leading cause of death for males. Deaths due to suicide
occurred at a rate of 11 per 100,000 population in 2012.[1]

Clinical features

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The most frequent method of suicide was hanging, strangulation
and suffocation. These methods are used in more than half (54.4%)
of all suicide deaths. Poisoning by drugs is used in 14.5% of
suicide deaths, followed by poisoning by other methods including
by alcohol and motor vehicle exhaust (8.5%). Methods using
firearms accounted for 6.8% of suicide deaths. The remaining
suicide deaths included deaths from drowning and jumping from
a high place, as well as other methods.

Warning signs of suicidal intent may include:[2]

change in personality, behaviours,
sleep patterns and/or eating habits
loss of interest
worries and fears

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drug or alcohol abuse

subtle or obvious suicidal statements

and plans
finalising affairs.

Verbal clues may exist to which the paramedic

should be attentive:

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Tomorrow, there wont be a tomorrow

Sometimes I think Id be better off dead

I talked to my family last night so everything

is taken care of

On recognising warning signs and verbal

clues the paramedic should definitively
determine suicidal intent by directly asking:

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Do you want to kill yourself?

Figure 2.2

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Risk assessment
Males account for over 75% of all suicides, with
younger age groups of both sexes comprising a
much higher proportion of total deaths than
compared with older age groups.[1]

Questions for assessing suicide risk in a patient

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Other factors that influence suicide risk are:

Means

Is the method available?

Method

Is there detailed knowledge of the

method and how lethal is it?

Plans

Has a time, date and place been

established, or a plan rehearsed?

- psychiatric disorders[3]
- employment status
- occupation[4]

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- past suicide attempt

Intent

Is there intent to carry through

the plan and actually die?

Thoughts

Anxious turmoil, worthless,

hopeless, perturbation.

Supports

Are there friends, family, a case

worker or a social network available?

- stressful life events

- drug and alcohol abuse

- access to lethal means
- recent marital separation divorce

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- social isolation

IMPORTANT: No risk assessment can absolutely

exclude potential of a suicide attempt. Always be
cautious with decision-making when caring for
potentially suicidal patients.

History

Have there been previous attempts,

associated illnesses, or a family
history?

Impulsivity

Is there a history of impulsive

behaviours?

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Alcohol

Is the patient affected by drugs

or alcohol?

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Emergency Examination Order [5]

This is an involuntary assessment order
that enables QAS to transport a patient
to an appropriate facility for further mental
health assessment.

CPG: Paramedic Safety

CPG: Standard Cares

Is it safe to proceed?

Request urgent
QPS assistance

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This may be used to transport patients
against their will if there is significant
risk of harm to self or others.
For this order to be valid, the date
and time must be completed.

One officer should liaise

with the patient
Employ an empathetic,
non judgemental attitude

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Communication with the receiving facility
is important, as patients under an EEO
may receive a higher triage category or be
moved to a secure part of the department.

Does the patient have

any injury or require
clinical management?

Manage as per:

Relevant CPGs

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N

Mental state assessment

Consider:
Completion of an EEO

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Transport to hospital
(with appropriate mental
health resources)

Note: Officers are only to perform

procedures for which they have
received specific training and
authorisation by the QAS.

Pre-notify as appropriate
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