Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis.

Background: The global age-standardised suicide rate is estimated at 8.9/100 000, while South Africa is at an alarming 23.5/100 000. The prehospital Emergency Medical Services (EMS) is located within this burden of health need. Emergency Care providers have a duty to assess, treat and transport healthcare consumers with suicidality, when attending to the suicide-related caseload. Aim: To appraise suicidality case frequency and suicide typology for the EMS. Objectives: To estimate the scope of the suicidality challenge faced by a jurisdictional EMS and its care providers. Methods: Using a retrospective cross-sectional design and a novel data collection instrument, a census of three years of Ambulance Incident Management Records was undertaken in a rural district of the Western Cape, South Africa. Results: Of 413,712 records, 2,976 (N) mental health-related incidents were sampled. Fourteen percent (n = 412) were assessed to have descriptors of suicidal ideation (n = 227), attempted suicide (n = 83) or death by suicide (n = 102). There were, on average, 2.8 deaths by suicide per month over the 3-year study period in the Garden Route District. Women were reported to mostly ingest poison and overdose on medication, while men used asphyxiation/hanging and were 5 times more likely to die by suicide than women. Conclusion: This study estimates the prehospital suicide and suicidality burden for the Western Cape public Emergency Medical Services, elucidating an under-researched health concern within South African prehospital care. Further study is required on the risk of emergency care provider stigmatisation towards suicide and suicidality cases, while auditing the need to assess policy, praxis, medical surveillance, EC provider clinical capacity and victim needs and experiences.