First Responders

Asking About Suicide Is Vital for First Responders and the Public They Serve

Suicide risk identification is a first step in suicide prevention, and it’s a critical skill for first responders.

  • Police officers, firefighters, emergency medical technicians (EMTs), and paramedics often work on the front lines of suicide prevention. They are called into situations in which a person may be suicidal — even if not reported as such — and they serve as a resource for people who are experiencing serious emotional, mental health, and substance use issues. Properly identifying a person’s risk for suicide helps first responders determine next steps and save lives.
  • Statistics show first responders may be at a heightened risk for suicide themselves, because they work in high-stress jobs with repeated exposure to traumatic events. That’s why the ability to recognize suicide risk is so vital within their own departments or units.

More police officers die by suicide than by gunfire and traffic crashes combined, according to data collected by The Badge of Life, a Connecticut-based suicide prevention organization for police officers in the U.S. and Canada.

A fire department is three times more likely in any given year to lose a firefighter to suicide than to a death in the line of duty, the National Fallen Firefighters Foundation reports. A national Florida State University study of more than 1,000 firefighters found that nearly 50% had suicidal thoughts at some point during their career, and about 16% reported one or more suicide attempts.

A survey of EMTs and paramedics in the U.S. found that 37% had contemplated suicide and 6.6% had attempted it. A survey of Canadian paramedics found that about 28% had contemplated suicide and 60% knew of a paramedic who had.

The Columbia Protocol Is Helping First Responders Save Lives and Target Resources

Suicide is preventable, and asking the right questions to identify who is at risk is a critical first step to stopping it. Whether used within first responders’ departments or in their service to the public, the Columbia Protocol — also known as the Columbia-Suicide Severity Rating Scale (C-SSRS) — is the ideal risk detection tool because it’s:

  • Simple. Ask all the questions in a few moments or minutes — with no mental health training required to ask them. First responders can ask the questions of a colleague they are concerned about or someone they interact with on one of their service calls, typically using the two- to six-question screener.
  • Efficient. Use of the protocol redirects resources to where they’re needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help — and it makes it easier to correctly determine the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.
  • Effective. Real-world experience and data show that the protocol has helped prevent suicide.
  • Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol to identify suicide risk, making it the most evidence-based tool of its kind.
  • Universal. The Columbia Protocol is suitable for all ages and special populations in different settings and is available in more than 140 country-specific languages.
  • Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research.

Using the Columbia Protocol to develop and standardize threat assessment and response protocols

  • Provides a common language for understanding the level of risk.
  • Helps first responders and others in communities determine next steps and save lives.
  • Helps share information to coordinate prevention and crisis response efforts.
  • Increases preparedness.
  • Protects against liability because negligence is in NOT asking; asking while trying to save lives is proof of responsibility.
  • Reduces anxiety in first responders.

The C-SSRS in Action

The contributions that law enforcement officers, first responders and public safety personnel make to our communities are critical to saving lives. These public servants often encounter issues of suicide with individuals of all ages, and we have heard time and again that they do not want to hospitalize a person unnecessarily. In fact, attempting to hospitalize someone when they do not need it can often lead to that person rejecting future treatment.

One example of the impact of the Columbia Protocol is the statewide adoption of the C-SSRS as the Tennessee Crisis Assessment Tool. Adopting the C-SSRS across the state has, according to Melissa Sparks, Director of Crisis Services and Suicide Prevention at the Tennessee Department of Mental Health, created a “system-wide transformation”. Having a common language enables the linking of systems which facilitates care delivery. In Tennessee, first responders and crisis lines use the same tool as law enforcement, hospitals, primary care, the justice system, and schools. (The statewide adoption of the C-SSRS as the Crisis Assessment Tool) “has catapulted a transformation of practices in TN by ensuring professionals and family members who come in contact with an individual who may have thoughts of taking their own life receive the help they need before it is too late”.

CT Alliance to Benefit Law Enforcement worked with mobile crisis providers to develop C-SSRS tear off sheets, improving communication with hospitals where, upon arrival, they share the C-SSRS findings. A CT school counselor used the C-SSRS to identify a 4th grader who was suicidal. He was sent to mobile crisis services who confirmed his C-SSRS results. He was then brought to the hospital who provided counseling and safety planning. This timely intervention and continuity of care was all facilitated by each touch point using the common language of the C-SSRS.

We had the opportunity to bring together two metro police departments, EMTs, dispatch personnel, mobile crisis units, regional human service organizations, and a local suicide hotline in Fargo, North Dakota who are all now implementing the Columbia Protocol. They identify Fargo as a model community. One collaborator reached out to tell us, “It brought the right people together…Help us to continue to move in that direction.”

In Kissimmee, Florida, the Florida Association of Hostage Negotiators was trained in use of the Columbia Protocol. As a result, we have heard testimony such as the following statement from a Lieutenant and Crisis Negotiations Commander, The Columbia Protocol enables us “to keep more personnel out on the street instead of in the mental health facility … we can reduce law enforcement officer suicide rates with this tool as well.”

Many other emergency services organizations throughout the United States have implemented the Columbia Protocol as a tool for everyday use. Utah’s largest fire agency — the Unified Fire Authority — has employed the tool for its firefighters, paramedics, and EMTs.

The Columbia Protocol is helping first responders to save lives and redirect scarce resources, reducing unnecessary interventions and keeping officers on the street where they can do their jobs.

Police officer administers the Columbia Protocol

This demonstration shows how police officers can use Columbia Protocol questions on a call to help determine the level of assistance a person needs.

“First responders are in a unique position to determine the course and outcome of suicidal crises.”

World Health Organization’s Department of Mental Health and Substance Abuse in its report, “Preventing Suicide: A Resource for Police, Firefighters and Other First Line Responders”