If crime scene is public space, then cleanup is firefighters’ job

Published: April 28, 2013 3:00 a.m. Archie Ingersoll | The Journal Gazette FORT WAYNE – The image was as vivid as it was heartbreaking. Firefighters late at night hosing down an alley where a man had just been shot and killed. Lit by the headlights of a fire truck, a spray of mist hung and glowed in the dark as they washed away his blood. This decontamination of a public space, freighted with the heaviness of a violent crime, is an obscure part of a firefighter’s job, a service to the city that’s seldom noted. It’s a reminder that firefighters are often called to crime scenes, not only to deal with biohazards but also to care for victims before they are rushed to the hospital. The somber cleanup in the alley, seared across this reporter’s memory, took place in the spring of 2011 near Scott Avenue and Broadway. It was one of a handful of times the fire department is asked each year to wash away grisly stains left out in the open, Fort Wayne fire officials said. Every fire truck is stocked with a small biohazard cleanup kit. Before driving away, they make sure the space – the alley, sidewalk, bus stop, street or wherever the crime happened – is safe. “We’ll mediate the situation and get it back to a respectable condition,” Fire Chief Amy Biggs said. Firefighters won’t touch a crime scene until police have finished their investigation. And before the cleansing process begins, firefighters work with city officials to ensure that anything hazardous does not drain into waterways or otherwise create a health risk, the chief said. Last month, after a fatal drive-by shooting at Indiana Avenue and Rudisill Boulevard, firefighters could be seen scrubbing and hosing the sidewalk clean before police took down the crime scene tape that cordoned off the corner. That same shooting was a clear example of firefighters using their medical training to tend to a victim of violence. First at the scene of that shooting were police. Next came firefighters who cared for the critically wounded victim until paramedics arrived and took him to a hospital, where he died. With fire stations at central locations around the city, it’s typical for firefighters to be first at the scenes of violence. In those cases, fire crews are often told to hang back until police show up and say it’s safe for them to approach. But that does not always happen. “A lot of times, we don’t know that we’re going to an incident that’s violent in nature,” Chief Biggs said. For instance, firefighters will sometimes respond to a report of someone having trouble breathing, and they arrive to find overturned furniture and a person with bruises from a domestic dispute. One way firefighters can protect themselves at times like these is by simply wearing their gear, Biggs said. “You put on that gear to separate you from law enforcement,” she said. “For the most part, that segregates us as the good guys.” The firefighters at Station 12 on South Anthony Boulevard, near East Tillman Road, have handled their share of calls to crime scenes. The station covers the area south of McKinnie Avenue and east of Calhoun Street, which includes neighborhoods where gun violence is common. “This past summer, we had a lot of shootings,” Capt. Wyman Ashford said. “It just gets tiring. It just gets old to see death all the time.” Beyond the emotional toll, Ashford said, shooting scenes are riddled with uncertainty for first responders. “It’s always helter-skelter when we first get there,” he said. “It’s a violent scene. People are mad. They’re upset.” Large crowds often gather at these scenes, leaving first responders outnumbered in a sometimes unstable setting. Knowing this puts some of the station’s crew on edge. “I’m not reluctant at all,” firefighter Bryan Bechtold said, “but believe me when I say I was extremely concerned going to a lot of the shootings just because of the massive amount of people that show up.” In January, Station 12 firefighters were sent to a double shooting at an apartment complex on Serenity Drive. Firefighter Rebekah Freds treated one of the victims, and afterward her bloodstained gear was a reflection of the man’s severe wounds. “I had blood from my waist down. I mean, there was no way to avoid it,” she said. As a remedy, Freds took off her soiled gear, put it in a biohazard bag and donned new equipment. She did not have to clean up any blood left at that scene because she was not treating the man in a public space but rather an apartment building. Authorities are not responsible for cleaning bloody scenes in homes or businesses, fire officials said. For firefighters, exposure to bodily fluids is just a risk that comes with the job, Freds said. To mitigate that risk when caring for patients, firefighters practice “body substance isolation,” which means making sure there’s a layer of protection between them and bodily fluids, she said. Firefighters are trained always to wear gloves during medical calls, and they can take more precautions, like a mask or gown, if needed, Deputy Chief Mark Nelson said. The point, obviously, is to protect their well-being. But as Station 12 crew member David Park said, there are times when his concerns for his safety are secondary. “Our health is the last thing we’re thinking about when we’re trying to help somebody,” he said.

There's Been A Disturbing Increase In Middle-Aged Suicides Since 2000

Robert Ferris | May 2, 2013, 5:17 PM | 2,070 | 17 inShare1 Email More depression Youtube/netsavy006 Just one death by suicide to one-far-too-many, but the increasing rate at which Americans are killing themselves is deeply disturbing. Suicide now accounts for more deaths in the U.S. than car crashes, according to a new report by the Center for Disease Control. The study was published Thursday, May 2, in the CDC journal Morbidity and Mortality Weekly Report. For reasons still unclear, the biggest increases by age group occurred among middle-aged Americans, with dramatic increases of about 50% among those between the ages of 50 and 60. "Suicide is a tragedy that is far too common," CDC Director Tom Frieden said in a press release. "The stories we hear of those who are impacted by suicide are very difficult. This report highlights the need to expand our knowledge of risk factors so we can build on prevention programs that prevent suicide." Native Americans saw a shocking 65% increase in suicides, and non-Hispanic whites followed with a 40% increase. Hanging and suffocation cases increased by just over 80%. Along with firearms, those remain a preferred method among men, while women use guns and poisoning to kill themselves. The economic downturn may have something to do with the increase in the suicide rate, the report says. Suicide rates tend to rise and fall along with economic cycles. It may also have something to do with the historically high rates of suicide among the baby boomer generation — who are now in their 50s and 60s — as well as the increased availability of prescription drugs commonly used in suicide. While successful suicide prevention efforts have focused on young people and the elderly, middle-aged Americans are often overlooked and may be especially vulnerable in a turbulent economy. The CDC report suggests numerous strategies, including providing family support, increased access to mental health treatment, and eliminating the stigma associated with seeking help. Read more: http://www.businessinsider.com/suicide-rat-increasing-since-2000-2013-5#ixzz2SFio4aOv

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Health Care Reform: The Opportunity for Suicide Prevention

By Michael Hogan, Ph.D., Independent Advisor and Consultant at Hogan Health Solutions LLC, Action Alliance Executive Committee member, and co-lead of the Clinical Care and Intervention Task Force When the Action Alliance selected the integration of suicide prevention into health care reform as one of its four national priorities stemming from the National Strategy for Suicide Prevention, it was still unclear as to what the Supreme Court’s response would be to legal challenges involving the Affordable Care Act. Either way, the Action Alliance felt that major changes to the health care system were going to occur. Should we not strive to use the momentum of reform to better focus health care on people at risk for suicide? Most mental health professionals and advocates agree that the health and behavioral health care system in the US does not currently meet the needs of patients struggling with suicidal behavior – in sum, “suicide care” is inadequate. Health care reform presents the most significant opportunity in a generation to make the health care system more responsive to individuals who are at risk for suicide or who are engaging in suicidal behavior. It’s an opportunity to save lives, contributing to the realization of the Action Alliance’s goal of saving 20,000 lives in five years. The US Centers for Medicare and Medicaid Services (CMS) has the lead responsibility of interpreting and implementing the Affordable Care Act of 2010, and the Substance Abuse and Mental Health Services Administration (SAMHSA) has the lead on behavioral health issues. For this reason, the Action Alliance has been working with SAMHSA Administrator Pam Hyde to engage senior CMS leadership in a conversation about the integration of suicide prevention into health care reform over the last year and a half. Health care reform aims to deliver what former CMS Administrator Don Berwick called the Triple Aim: better health for populations, better care for individuals, and reduced costs to society. Transforming health systems to prevent suicide and improve suicide care addresses all of these goals. By identifying patients at risk for suicide early, risks can be reduced and effective treatment can be delivered. By providing early and effective treatment in a behavioral health setting or in a collaborative care setting where primary care and behavioral health care are integrated, we can save lives and prevent some suicide attempts that result in costly emergency medical expenses. We know that people admitted to hospital or emergency department care with suicidal behavior remain at high risk when they leave. And we know that if we ensure a patient receives continuity of care through the discharge and out-patient care engagement process, we can reduce expensive re-hospitalizations and suicides. We have also learned that when health systems focus on safety and suicide care, the results are far better than those achieved through piecemeal approaches. One of the keys must be leadership among health plans and systems. They can encourage better screening for depression and suicidality, delivery of effective, evidence-based treatment and continuous care to patients who are at risk. Health plans and payers must transition from paying for the quantity of episodic services to paying for better integrated care that will change the health outcomes of populations. I have been privileged to meet with the Action Alliance Co-Chairs, SAMHSA Administrator Hyde, CMS Administrators (Acting Administrator Don Berwick in 2011, and current Acting Administrator Marilyn Tavenner in 2012), my fellow Action Alliance Executive Committee member Paul Schyve, and the Action Alliance Secretariat on several occasions to discuss areas of health care reform implementation that are relevant and critical to suicide prevention. The Action Alliance has also submitted public comments in response to CMS’s efforts to implement electronic health record technology. In all of our interactions, we have focused on three domains: promoting early identification of those at risk for suicide, the delivery of effective treatment for suicidal behavior, and the provision of the follow-up care for those at risk as they transition from one setting of care to another. Later this year, the Suicide Prevention Resource Center will partner with The National Council for Community Behavioral Healthcare to “go live” with a website providing tools for providers to take these steps. These improvements within an evolving health system are the key targets for getting us to that goal of saving 20,000 lives in five years. What do you think? How would you like to see suicide prevention integrated into health care reform? Please comment and share your ideas below.

No Known Benefits Of Suicide Screening In Primary Care Settings

Banner No Known Benefits Of Suicide Screening In Primary Care Settings By News Staff | April 22nd 2013 09:08 PM | 1 comment | Print | E-mail | Track Comments News Articles More Articles Bacterial Vaginosis - More Common Than Yeast Infections And A Risk For Premature Births, STDs Water, By Jove: Shoemaker-Levy 9 Impact Still Evident Today In Jupiter's Atmosphere Phase IIb Aviator Trial Shows High Viral Response Rates In Patient Types With HCV Genotype 1 All Articles About News News From All Over The World, Right To You... View News's Profile User pic. News Staff Suicide is the 10th leading cause of death in the United States. Statistics show that 38 percent of suicidal adults and 90 percent of youths had visited their primary care physicians in the 12 months prior to committing suicide. An evidence review finds that while there are screening tools to help physicians identify adults at risk for suicide, there's no evidence that using these screening tools in primary care will actually prevent suicides. In adolescents, there are no proven primary care-relevant screening tools to identify suicide risk. The U.S. Preventive Services Task Force reviewed evidence for upcoming recommendations on suicide screening and treatment for adults and adolescents and issued a paper. Finding accurate and feasible screening tools that can be used in the primary care setting could help to identify those at increased risk for suicide so that appropriate preventive measures can be taken. In 2004, the U.S. Preventive Services Task Force (USPSTF) concluded that evidence was insufficient to recommend for or against routine screening by primary care clinicians to detect suicide risk in the general population. To update its previous recommendation, the Task Force reviewed 56 studies published between January 2002 and July 2012. Although evidence was limited, the researchers found that primary care-feasible screening tools could probably identify adults at increased risk for suicide who need treatment. However, screening tools have limited ability to detect suicide risk in adolescents. Treatment with psychotherapy reduced the risk for suicide attempts by 32 percent in high-risk adults (e.g., those with a recent suicide attempt), but did not appear to benefit adolescents. No drug treatments were proven effective at reducing suicide risk in adults or adolescents. Here is the draft recommendation statement based on this evidence review

Demographics of Homicide and Suicide Victims Reveal Differences

City Room - Blogging From the Five Boroughs New York by the Numbers April 23, 2013, 9:51 am Comment Demographics of Homicide and Suicide Victims Reveal Differences By SAM ROBERTS More people killed themselves last year in New York City than were murdered, the authorities have said, a consequence of the city’s plunging murder rate. A peek behind the numbers reveals some interesting differences. New York by the Numbers Mining public data. While men died in disproportionate numbers from both causes, the victims of homicide and suicide come from very different universes. Typically, most murder victims are young and black. Most suicides are older and non-Hispanic white. “There’s no explanations that I think are fully satisfying and explain what accounts for the contrast,” said Dr. Sandro Galea, an epidemiologist at Columbia University’s Mailman School of Public Health. “What you’re seeing is a reflection of the context in which homicides and violence are endemic,” he said. “The myth of the unexpected homicide occurring to a wealthy person in a wealthy neighborhood is vanishingly rare.” “The vast majority of suicides are known to have had some psychopathology, and although the literature is muddy, depression is more common in majority groups,” Dr. Galea continued. “The second reason may well be that there are different coping mechanisms among minorities that are more externalism than internalizing. But there’s an interesting paradox: If we know that adverse living circumstances are associated with greater risk of depression why aren’t minorities more prone to suicide?” According to preliminary figures from the Police Department, 418 murders were recorded in 2012. Among the victims, 84 percent were men, 60 percent were black, 27 percent were Hispanic, and 9 percent were non-Hispanic white. (Among the known assailants, 93 percent were men; 53 percent were black and 35 percent were Hispanic). More than two-thirds of the victims were 40 or younger. In 2011, the city’s health department recorded 509 suicides. Though the rate for 2012 is not yet available, city officials believe that, based on recent trends, suicides outnumbered murders last year. While the homicide rate has been declining, the suicide rate has remained fairly steady in the last decade. Homicide was the leading cause of death among New Yorkers 15 to 34, suicide was third among 15- to 24-year-olds and fourth among 25- to 34-year-olds. Among people under 65, suicide was the third leading cause of death among Asians, fifth among non-Hispanic whites and non-Puerto Rican Hispanic people. It was not among the top 10 causes of death among blacks. Non-Hispanic whites recorded the highest death rates from suicide, blacks the lowest. Louis B. Schlesinger, a professor of forensic psychology at John Jay College of Criminal Justice, said the shifting ratio of murders to suicides reflect two other factors: “A lot of suicides go unreported,” he said, “and because of the increased sophistication of emergency medical technology, people who 10 years ago would be dead from murder are now living.”