Page 111 - 2022 Ranger Medic Handbook

Assessment & Management of Suicidal Risk
Suicide
Suicide remains a serious public health problem, with more than 47,000 people taking their lives every year (CDC, 2019).
Suicide was the tenth leading cause of death for all ages in 2016 and the second leading cause of death for persons
aged 24 and younger. Among military members and veterans, suicide and other forms of suicidal self-directed violence
have steadily increased over the past decade. According to estimates from the National Veteran Suicide Prevention
Annual Report (2019), veterans account for approximately 13.5% of deaths by suicide among US adults. While even
the most accurate suicide data do not predict suicide in a given individual, thorough clinical assessment informed by
demographic and other suicide-related associations may improve risk-appropriate management. The following protocol
represents the VA/DoD Clinical Practice Guidelines for the assessment and management of suicidal risk.
Table 1: Warning Signs SECTION 3
Warning Signs: Observations that signal an increase in the probability that person intends to engage in suicidal
behavior in the immediate future (i.e. minutes and days). Warning signs present tangible evidence to the clini-
cian that a person is at heightened risk for suicide in the short term. Warning signs may be experienced in the
absence of risk factors.
Direct Warning Signs portend the highest likelihood of suicidal behaviors occurring in the near future:
Suicidal Communication: Writing or talking about suicide, wish to die, or death (threatening to hurt or kill self)
or intention to act on those ideas.
Preparations for Suicide: Evidence or expression of suicide intent, and/or taking steps towards implementation
of a plan. Makes arrangements to divest responsibility for dependent others (children, pets, elders), or making
other preparations such as updating wills, making financial arrangements for paying bills, saying goodbye to
loved ones, etc.
Seeking Access or Recent Use of Lethal Means: Owning or planning to acquire weapons, medications, toxins,
or other lethal means.
Other Indirect Warning Signs presentation(s) or behavioral expressions that may indicate increased suicide
risk and urgency in a patient at risk for suicide:
Substance abuse: Increasing or excessive substance use (alcohol, drugs, smoking)
Hopelessness: Expresses feeling that nothing can be done to improve the situation
Purposelessness: Express no sense of purpose, no reason for living, decreased self-esteem
Anger: Rage, seeking revenge
Recklessness: Engaging impulsively in risky behavior
Feeling trapped: Expressing feelings of being trapped with no way out
Social withdrawal: Withdrawing from family, friends, society
Anxiety: Agitation, irritability, angry outbursts, feeling like wants to “jump out of my skin”
Mood changes: Dramatic changes in mood, lack of interest in usual activities/friends
Sleep: Insomnia, unable to sleep or sleeping all the time
Guilt or shame: Expressing overwhelming self-blame or remorse

2022 RANGER MEDIC HANDBOOK 97