|
According to the Surgeon General’s National
Strategy for Suicide Prevention (2001), a gatekeeper is someone in a position
to recognize a crisis and the warning signs that someone may be contemplating
suicide. Gatekeepers include parents, friends, neighbors, teachers, ministers,
doctors, nurses, office supervisors, squad leaders, foremen, police officers,
advisors, caseworkers, firefighters, and many others who are strategically
positioned to recognize and refer someone at risk of suicide.
As a QPR-trained Gatekeeper you will learn
to:
- recognize the warning signs of suicide
- know how to offer hope
- know how to get help and save a life
|
HOW IS QPR LIKE CPR?
CPR stands for cardio pulmonary resuscitation, an emergency medical intervention
created by Peter Safar and first described in his 1957 book the ABC of
resuscitation (A for airway, B for Breathing, C for Circulation).
QPR stands for Question, Persuade and Refer, an emergency mental health
intervention for suicidal persons created by Paul Quinnett, and first
described in 1995 in a number of presentations and publications by the
QPR Institute.
CPR is part of what is called the "Chain of Survival," a term
first coined in 1987 by Mary Newman, a founding member of the Citizen
CPR Foundation. According to the Chain of Survival model of emergency
cardiac care, the likelihood that a victim will survive a cardiac arrest
increases when each of the following four links is connected:
- Early Recognition and Early access.
The sooner 9-1-1 or your local emergency number is called the sooner
early advanced life support arrives.
- Early CPR. Application of
early CPR helps circulate blood that contains oxygen to the vital organs.
- External Defibrillator (AED)
is ready for use or advanced medical personnel arrive.
- Early Advanced Life Support.
This is given by trained medical personnel who provide further care
and transport to hospital facilities.
With QPR, the following Chain of Survival elements must also be in place:
- Early
recognition of suicide warning signs. The sooner warning signs
are detected and help sought, the better the outcome of a suicide crisis
will be.
- Early QPR. Asking someone about
the presence of suicidal thoughts and feelings opens up a conversation
that may lead to a referral for help.
- Early intervention and referral.
Referral to local resources or calling 1-800-Suicide for evaluation
and possible referral is critical, as most people thinking about suicide
are suffering from an undiagnosed and/or untreated mental illness or
substance abuse disorder for which excellent treatments exist. Also,
the offering of hope and social and spiritual support can often avert
a suicide attempt
- Early professional assessment and treatment.
As with any illness, early detection and treatment results in better
outcomes and fewer lives lost to suicide.
| We
cannot overemphasize the need for early recognition of suicide warning
signs. In a cardiac crisis, the difference between recognizing and
acting where there is chest discomfort before it becomes crushing
chest pain can mean the between life and death.
|
| In a suicide crisis, the difference between
recognizing and acting where there are vague ideas of suicide before
these lead to a self-inflicted injury, can mean the difference between
life and death. |
Please note: a well-executed, strong and positive
response to the early warning signs of a pending suicide event may render
subsequent links in the Chain of Survival unnecessary. Just as the prompt
recognition of the scream of a smoke detector can eliminate the need to
suppress a raging fire, so can the early recognition of suicide warning
signs, confirming their presence, and opening a supporting dialogue with
a suicidal person - while securing a consultation from 1-800-SUICIDE and/or
or a professional - may prevent the need for an emergency room visit or
inpatient psychiatric hospitalization.
WARNING SIGNS OF PENDING A CRISIS…
HOW ARE THEY DIFFERENT?
In CPR the general public is educated about the classic signs of a heart
attack: pressure, fullness, squeezing and pain in the center of the chest,
sweating, and other symptoms, and how to respond.
In QPR the general public is educated about the known warning signs of
a suicide crisis (AAS, 2003): expressions of hopelessness, depression,
giving away prized possessions, talking of suicide, securing lethal means
and how to respond.
WHO NEEDS TRAINING?
In 2002 the American Heart Association estimated that over the past 35
years some 250 thousand CPR instructors have trained several millions
of US citizens in CPR. As a result, lives are saved that might otherwise
have been lost.
As many people know the city of Seattle, Washington and surrounding King
County has trained more citizens in CPR per capita than any other region
in the country. As result, CPR-trained citizens are more likely to respond
to perceived medical emergencies in Seattle than in any other city in
the United States, which leads to more favorable survival rates.
According to Sanddal and his colleagues (Sanddal, 2003), “In the
Seattle cardiac care system it is estimated that one in four persons has
been exposed to CPR training. One can conjecture that the recognition
of, and survival from, an acute suicide event would be more likely if
one in four persons were trained as a suicide lay gatekeeper.”
At the end of 2003, an estimated 250,000 American citizens have been trained
in QPR by Certified QPR Instructors. Because of the nature of suicidal
warning signs, and who is most likely to recognize and respond to them,
we at the QPR Institute strongly concur with the goal of one in four persons
trained a basic gatekeeper role for suicide prevention in the United States
and in other countries. Because suicides happen in families – where
emergency interventions are more likely to take place - we believe that
AT LEAST ONE PERSON PER FAMILY UNIT should be trained in QPR.
BUT WHAT ABOUT MY LIABILITY?
If you become trained in QPR you should have no liability for attempting
to intervene in a suicide crisis. In fact, many professionals already
have a duty to respond, and may not know how. As regards intervening in
medical emergencies, and according to the Good Samaritan Act of 1985,
a layperson or professional who does not have a legal duty to respond
to a stranger’s emergency, and who is acting in “good faith”
and is not being compensated, and who is not guilty of Gross Negligence
(deliberately careless conduct), is immune from liability. There are no
recorded cases against a Good Samaritan since 1985 (ProCPR, 2003).
SUMMARY
QPR is a simple educational program that teaches ordinary citizens how
to recognize a mental health emergency and how to get a person at risk
the help they need. It is also an action plan that can result in lives
saved. Our research and evaluations to date have shown positive results,
some of which are available on this web site.
WHAT YOU CAN DO…
- Become a Certified QPR Gatekeeper Instructor
click here. We offer this training on site
and through a self-study program.
- To locate a Certified QPR Gatekeeper Instructor
in your area contact us and
ask if one is available.
- Learn QPR through online QPR
Online Gatekeeper Training.
- For institutional subscriptions click
here.
Sources and References
American Association of Suicidology (2003) @ www.suicidology.org.
Goldstein, A.S. (1998), EMS and the law. Prentice-Hall Inc.
Lundberg, G. (ed), Kerber, R. (chairman) (1992): Guidelines for CPR and
ECC: recommendations of the 1992 national conference. JAMA, 268:2172-2183.
Newman, M. (1990). The chain of survival: converting a nation." Currents
in Emergency Cardiac Care, 1,1:3
ProCPR.org CPR Philosophy of Rescue @ www.procpr.org
Safar P. & Bircher, N. (1998) Cardiopulmonary
Cerebral Resuscitation. W.B. Saunders Company, Ltd., third edition.
Sanddal, N.D., Sanddal, T.L., Berman, A., & Silverman, M.M. (2003).
A General Systems Approach to Suicide Prevention: Lessons from Cardiac
Prevention and Control. Suicide and Life-Threatening Behavior. 33, 4,
341-352
|
