Violent Death among First Responders: Using North Carolina Violent Death Reporting System Data to Inform Prevention

Transcription

1 Violent Death among First Responders: Using North Carolina Violent Death Reporting System Data to Inform Prevention Safe States Annual Meeting 2015 April 30 th, 2015

2 Source: 1 Parsons, J. Occupational Health and Safety Issues of Police Officers in Canada, the United States and Europe: A Review Essay Retrieved from 2 Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in Emergency Medical Services: A hidden crisis Annals of Emergency Medicine;40: ; 3 Fisher P, Etches B. Comprehensive Approach to Workplace Stress and Trauma in Firefighting Retrieved from Background First responders play a critical role in ensuring the safety and wellbeing of others First responders are often cited as being at increased risk for violent death including homicide and suicide 1-3 Range of occupational stressors Acute/critical incident: exposure to traumatic events Chronic: overtime, shift-work, excessive workload Inherent dangers associated with the occupation Exposure to violent events and behaviors

3 Background Law Enforcement Officers High rates of suicide compared to other occupations and the general population 1 Variations by force type and location 2 High-risk occupation for homicide 3 Firefighters Little is known about suicide rates and risk for homicide High rates of depression, PTSD, substance abuse 4,5 Emergency Medical Services Personnel Little is known about suicide rates and risk for homicide Risk for PTSD symptomology 6 Exposed to violence during pre-hospital care 7 Source: 1 Chopko BA, Palmieri PA, Facemire VC. Prevalence and predictors of suicidal ideation among U.S. law enforcement officers. Journal of Police and Criminal Psychology. 2014;29: Loo R. A meta-analysis of police suicide rates: Findings and issues. Suicide and Life-Threatening Behavior. 2011;33(3): Parsons, J. Occupational Health and Safety Issues of Police Officers in Canada, the United States and Europe: A Review Essay Retrieved from 4 Murphy SA, Bond GE, Beaton RD, Murphy J, Johnson C. Lifestyle practices and occupational stressors as predictors of health outcomes in urban firefighters. International Journal of Stress Management. 2002;9(4): ; 5 Corneil W, Beaton R, Murphy S, Johnson C, Pike K. Exposure to traumatic incidents and prevalence of posttraumatic stress symptomology in urban firefighters in two countries. Journal of Occupational Health Psychology. 1999;4(2): ; 6 Donnelly E. Work-related stress and posttraumatic stress in Emergency Medical Services. Pre-hospital Emergency Care. 2012;16:76-85; 7 Grange JT, Corbett SW. Violence against emergency medical services personnel. Pre-hospital Emergency Care. 2002;6(2):

4 Data Source North Carolina Violent Death Reporting System (NC-VDRS) Collect timely, detailed data on deaths due to violence Suicide Homicide Unintentional firearm Undetermined intent Legal intervention Includes data from multiple sources Death certificate Medical Examiner reports Local Law Enforcement reports N.C. State Bureau of Investigations

5 NC-VDRS data, Methods Included cases: any mention of decedent as current or former law enforcement officer, firefighter, or Emergency Medical Services personnel on the death certificate, medical examiner report, or police report and a North Carolina resident Identified cases using key search terms of occupation variables Police Officer, Law Enforcement, Sheriff, State Trooper, etc. Firefighter, Fireman, etc. EMS, EMT, Paramedic, etc. Comparison group: all other violent deaths among North Carolina residents

6 Violent Death among First Responders in North Carolina: NC-VDRS Number of Deaths

7 Violent Death among First Responders in North Carolina: NC-VDRS Number of Deaths Law Enforcement Officers Firefighters EMS Personnel

8 Violent Death among First Responders in North Carolina: NC-VDRS % male Number of Violent Deaths > % white 7.7% black 2.6% American Indian 99.2% non-hispanic 65.8% some college 29.9% high school graduate or GED Age (years) 59.8% married 21.4% divorced 38.5% military veterans

9 Violent Death among First Responders in North Carolina: NC-VDRS Percent of Violent Deaths 100% 80% 60% 40% 20% 0% 22.2% homicide Manner of Violent Death First Responders 32.8% homicide 74.4% suicide 62.0% suicide Manner of Violent Death All Other N.C. Residents Suicide Homicide Undetermined Intent Legal Intervention Unintentional Firearm

10 Violent Death among Law Enforcement Officers in North Carolina: NC-VDRS % 2.7% Percent of all Violent Deaths 80.0% 60.0% 40.0% 20.0% 32.0% 65.3% Undetermined Intent Homicide Suicide 0.0% Manner of Violent Death

11 Violent Death among Firefighters in North Carolina: NC-VDRS % Percent of all Violent Deaths 80.0% 60.0% 40.0% 20.0% 8.7% 82.6% Legal Intervention Undetermined Intent Homicide Suicide 0.0% Manner of Violent Death

12 Violent Death among Emergency Medical Services Personnel in North Carolina: NC-VDRS % Percent of all Violent Deaths 80.0% 60.0% 40.0% 20.0% 100% Suicide 0.0% Manner of Violent Death

13 Violent Death among First Responders in North Carolina: NC-VDRS Method of Suicide First Responders Method of Suicide All Other N.C. Residents Firearm 70.1% Firearm 59.0% Poisoning 17.2% Poisoning 18.6% Hanging, strangulation, suffocation 12.6% Hanging, strangulation, suffocation 18.1% Sharp Instrument 1.4% Other 2.9%

14 Violent Death among First Responders in North Carolina: NC-VDRS Method of Homicide First Responders Method of Homicide All Other N.C. Residents Firearm 83.3% Firearm 68.0% Sharp Instrument 4.2% Sharp Instrument 13.7% Blunt Instrument 4.2% Blunt Instrument 5.7% Unarmed Assault 4.2% Unarmed Assault 5.4% Fire or Burns 4.2% Hanging, strangulation, suffocation 3.5% Other 3.7%

15 Violent Death among First Responders in North Carolina: NC-VDRS Suicide Circumstances: Mental Health Current Depressed Mood 41.3% 49.4% Current Mental Health Problem 32.2% 41.6% Current Treatment for Mental Health Problem 38.0% 31.0% 0% 20% 40% 60% All Other N.C. Residents First Responders

16 Violent Death among First Responders in North Carolina: NC-VDRS Suicide Circumstances: Life Stressor, Interpersonal, and Substance Abuse Crisis in past 2 weeks Intimate Partner Problem Job Problem 7.7% 17.2% 25.0% 31.9% 36.8% 41.4% Physical Health Problem Alcohol Problem 18.6% 20.7% 13.0% 13.8% 0% 10% 20% 30% 40% 50% All Other N.C. Residents First Responders

17 Violent Death among First Responders in North Carolina: NC-VDRS Suicide Circumstances: Suicide Events Left a Suicide Note 26.8% 37.9% Disclosed Intent to Commit Suicide 23.6% 24.1% History of Suicide Attempts 2.3% 15.3% 0% 10% 20% 30% 40% All Other N.C. Residents First Responders

18 Violent Death among First Responders in North Carolina: NC-VDRS Homicide Circumstances Victim was a police officer on duty 50.0% Precipitated by another serious crime 27.8% 30.8% Other argument, abuse, conflict Intimate Parnter-Violence related Victim used a weapon 7.9% 26.9% 17.3% 23.1% 15.4% 41.9% 0% 20% 40% 60% All Other N.C. Residents First Responders

19 Violent Death among First Responders in North Carolina: NC VDRS Narratives Law Enforcement Officer (occupation from death certificate, medical examiner report, or police report) A 46 year old male with intentional, self-inflicted asphyxiation due to hanging. V was found in his garage at home by a friend. V had been medically retired from work due to depression and had been receiving treatment. V had been depressed due to a coworker being killed four years ago. No information was given regarding any prior attempts or threats. There was no mention of V leaving a note.

20 Violent Death among First Responders in North Carolina: NC VDRS Narratives Law Enforcement Officer (occupation from death certificate, medical examiner report, or police report) The V was a 25 year old male who was shot in the line of duty. V was a deputy sheriff and his partner was responding to a 911 hang up call. S's wife placed the call due to domestic violence. When they arrived at the residence the V and his partner were shot by the suspect. The V's partner lived due to having a bullet proof vest on. EMS arrived and the V was transported to the hospital ER where he was pronounced approximately two hours later.

21 Violent Death among First Responders in North Carolina: NC-VDRS Narratives Firefighter (occupation from death certificate, medical examiner report, or police report) V was a 50 year old male who was found dead in his home from a self inflicted gunshot wound to the head. According to his wife, V had slept on the couch that night. When she came downstairs to check on him she found him with a gunshot wound and his finger still on the trigger of the handgun. V was reported to have been depressed due to a hip injury which required a hip replacement. V was forced to retire from his job as a fireman due to his disability. There was no indication that V had been diagnosed with depression. V had never attempted suicide or threatened. V left an extensive suicide note asking for forgiveness. The note also explained the house was in foreclosure. The handgun along with a spent casing was recovered.

22 Violent Death among First Responders in North Carolina: NC VDRS Narratives Emergency Medical Services Personnel (occupation from death certificate, medical examiner report, or police report) A 35 year old male that hung himself from a bridge. EMS pronounced V at the scene. Toxicology was positive for alcohol (BAC 79 mg/dl.) V had a history of alcoholism. It was stated that V had recently broken-up with his girlfriend and he had texted her stating that it would be too late when you find me (timeframe not given.) There was no mention of a mental health diagnosis or of V being in a depressed mood. No information was given regarding any prior attempts or threats. There was no mention of V leaving a note.

23 Trauma exposure intervention 1 Psychological debriefings Conclusions Establish and institutionalize effective early warning and intervention protocols to identify and treat those at risk 2 Awareness campaigns Gatekeeper training and peer support services Access to confidential mental health and mentoring programs 2 Education on self-care, stress-management, and effective coping 2 Establish post-vention policies and protocols 2 Continually enhance training programs based on current knowledge to help first responders stay safe during violent or dangerous situations 3 Source: 1 Violanti JM. Predictors of police suicide ideation. Suicide and Life-Threatening Behavior. 2004;34(3); 2 International Association of Chiefs of Police IACP National Symposium on Law Enforcement Officer Suicide and Mental Health: Breaking the Silence on Law Enforcement Suicides. Washington, DC: Office of Community Oriented Policing Services.; 3 The Federal Bureau of Investigation. The Risks to the Thin Blue Line Retrieved from

24 Prevention in North Carolina Data to inform action 2014 Emergency Medicine Today Conference Buncombe County Peer Response Network International Critical Incident Stress Foundation Suicide Prevention Training in March 2015 North Carolina Suicide Prevention Summit 2015: Together We Can Prevent Suicide Resources, connections, tools Dissemination of 2015 North Carolina Suicide Prevention Plan

25 Acknowledgements Scott Proescholdbell, MPH Head Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, North Carolina Division of Public Health Tammy Norwood, BS Program Manager, North Carolina Violent Death Reporting System, Injury and Violence Prevention Branch, North Carolina Division of Public Health This study was supported in part by an appointment to the Applied Epidemiology Fellowship Program by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U38OT

26 Questions? Anna Austin, MPH Injury and Violence Prevention Branch N.C. Division of Public Health