EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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JOURNAL WATCH: EXAMINING THE LATEST IN EMS EVIDENCE 20 FEBRUARY 2019 | EMSWORLD.com W hen providing prehospital care, we do our best to keep our patients alive and ensure their emergency doesn't lead to long-term morbidity. We don't often think about the impact our work has on us. We know from our experience and previ- ous research that EMS is an inherently dan- gerous job. Published research has also eval- uated occupational stress related to EMS, and we've been paying more attention to the risk of suicide among EMS professionals. According to the CDC, suicide is the 10th- leading cause of death in the U.S. This has led the National Institutes of Health to increase funding for suicide and suicide- prevention research by approximately $46 million from 2008 to 2016. Nevertheless, sui- cide rates have continued to rise. In 2016 the NAEMT published results from a survey indi- cating that, compared to the general public, EMS professionals had a tenfold higher rate of suicidal thoughts and attempts. While studies have investigated suicidal thoughts and attempts among EMS profes- sionals, little research has examined com- pleted suicides. University of Arizona MD candidate Neil Vigil and colleagues recently published a study that utilized data from Arizona's state electronic death registry (AZ-EDR). Their objective was to assess the proportion of deaths attributed to sui- cide among EMS professionals compared to non-EMS professionals. Data Compilation This was a retrospective case-control study. The study period was from January 1, 2009 to December 31, 2015. The AZ-EDR captures data on all deaths that occur in Arizona as well as deaths of Arizona resi- dents that occur outside the state. Data in the AZ-EDR are provided by funer- al directors, medical examiners, and medi- cal facilities. It includes demographic data (age, gender, race, and ethnicity) as well as the individual's occupation and specific cause of death. The authors categorized occupation as EMS professional or non-EMS professional. EMS professionals included those with an occupation listed as firefighter, fireman, emergency medical technician, EMT, or paramedic. The occupation question was a free- text field. If this field was left blank or if the authors were unsure (following investiga- tion) if the occupation required an EMS certification, the individual was categorized as a non-EMS professional. They categorized cause of death as suicide or all other causes. Vigil and coauthors compared demo- graphics and methods of suicide among EMS professionals and non-EMS profession- als using chi-square tests (statistical tests of proportions). They also performed logistic regression modeling to determine if the odds of suicide were different among EMS pro- fessionals and non-EMS professionals. The authors called this the mortality odds ratio. Results During the study period there were 350,998 total deaths. Of those 1,205 were categorized as EMS professionals, and 349,793 were cat- egorized as non-EMS professionals. Among EMS professionals 5.2% (63) of deaths were suicides. Among non-EMS professionals, 2.2% (7,775) of deaths were suicides. After adjusting for gender, age, race, and ethnicity, EMS professionals had increased odds of suicide compared to non-EMS pro- fessionals (mortality odds ratio 1.39; 95% confidence interval, 1.06–1.82). Further, EMS professionals were younger (EMS profes- sionals less than 55 years old, 24%; non- EMS professionals less than 55 years old, 14%) and had a higher percentage of males (94% vs. 53%, p<0.001). When evaluating race and ethnicity, the reported proportions were similar, with EMS professionals having a slightly higher proportion of white non-Hispanic (81% vs. 80%). EMS professionals also had a higher proportion of suicides in the 35–54-year-old group (16% vs. 10%, p<0.001) as well as in the 18–34-year-old group (24% vs. 16%, p-value not reported). New research fi nds we do, indeed, have a higher toll than the general public By Antonio R. Fernandez, PhD, NRP, FAHA After adjusting for gender, age, race, and ethnicity, EMS professionals had increased odds of suicide. Look for research podcasts based on the topics featured in this column at www.emsworld.com/pcrf-podcasts REVIEWED THIS MONTH Death by Suicide—The EMS Profession Compared to the General Public. Authors: Vigil NH, Grant AR, Perez O, et al. Published in: Prehosp Emerg Care, 2018 Sep; 14: 1–6. . EMS DEATHS BY SUICIDE

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