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Outcomes in Suicidal Bridge Jumping in the Lower Mainland-JRB

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Outcomes in Suicidal Bridge Jumping in the Lower Mainland-JRB Outcomes in suicidal bridge jumping in the Lower Mainland by DYLAN STEPHANIAN BASc, The University of British Columbia, 2014 Thesis submitted in partial fulfilment of the requirements for the degree of Master of Science in The Faculty of Graduate and Postdoctoral Studies (Experimental Medicine) The University of British ColumbiA (Vancouver) December, 2019 © Dylan Stephanian, 2019 The following individuals certify that they have read, and recommend to the faculty of Graduate and Postdoctoral Studies for acceptance, the thesis entitled: Outcomes in suicidal bridge jumping in the Lower Mainland Submitted by Dylan Stephanian in partial fulfillment of the requirements for the degree of MAster of Science in Experimental Medicine. Examining committee Dr Jeff Brubacher, Emergency Medicine Supervisor Dr Doug Brown, Emergency Medicine Supervisory Committee Member Dr Andrew MacPherson, Emergency Medicine External Examiner ii Abstract On average, one person attempts suicide by jumping from a bridge in the Lower Mainland of British ColumbiA once every 14 days, but the population that jumps and their outcomes following a suicide attempt are poorly understood. A multi-agency retrospective chart review was performed using records from the Canadian Coast Guard, Joint Rescue Coordination Center, police departments, and the British Columbia Coroner’s Service to identify incidents. A complete picture of each incident was then built by identifying corresponding BC Ambulance Service and hospital records, and linking all records for each incident. This methodology successfully identified a comprehensive list of incidents, and may be useful in future prehospital and search and rescue medicine research. Records from the ten agencies involved in these incidents were collected and linked to create a dataset describing all known jumps from a bridge >12m in height in the Lower Mainland of BC from January 1, 2006 to February 28, 2017. 1208 incidents were identified, 273 were confirmed jumps, and 197 were jumps into water. The multi-agency linkage portion of the study was highly successful; outcomes were identified for 90.6% of all incidents. The population that jumps from a bridge is similar to those who commit suicide by other means. Those jumping are mostly male (74.9%), and early to mid-life (IQR 28-48 years). Of those who jumped and hit water, 59.9% were promptly recovered, 25.4% were iii transported to hospital and 15.2% survived. Survival is dependent on bridge height, patient age, and time interval between jumping and being recovered from the water. The presence or absence of vital signs, and level of consciousness (measured on the AVPU scale) on recovery appears to prognosticate survival to hospital discharge. This may assist prehospital care providers making treatment decisions for these patients. iv Lay summary In Greater Vancouver, a person tries to kill themselves by jumping off a bridge every 14 days. Unfortunately, a large percentage of these people die and caring for these patients can be traumatic for rescuers. Prior to this work, little was known about the people who jump, the details of their rescue, and how to best care for them. This study showed that most jumpers are men between 28 and 48 years old. People are more likely to die if they jump from higher bridges, are not rescued quickly, or if they have no pulse when rescued. People who are awake at the time of rescue are likely to survive. This information will help guide treatment for first responders and paramedics caring for people who have jumped from a bridge. v Preface This thesis and all associated research is the result of the independent work of the author, Dylan Scott Stephanian. A portion of this thesis was presented as a poster at the UBC Medicine Research day. Data collection, storage, analysis, and publication is covered by University of British Columbia Clinical Research Ethics Certificate H16-02263, as well as Fraser Health Research Ethics Certificate 2018-024 vi Table of contents Abstract ...................................................................................................................... iii Lay summary ............................................................................................................... v Preface ........................................................................................................................ vi Table of contents ....................................................................................................... vii List of tables .............................................................................................................. xii List of figures ............................................................................................................ xiii Symbols and abbreviations ...................................................................................... xiv Glossary .................................................................................................................... xvi Acknowledgements .................................................................................................. xix Dedication ................................................................................................................. xx Suicide by jumping in context ...................................................................................... 1 Suicide rates ......................................................................................................................... 1 Sex trends in suicide ............................................................................................................ 2 Age trends in suicide ........................................................................................................... 3 Ethnicity and immigration in suicide ................................................................................. 4 Suicide contagion ................................................................................................................ 5 Time trends in suicide ......................................................................................................... 7 vii Psychiatric conditions in suicide ........................................................................................ 8 Suicide means ...................................................................................................................... 9 Suicide from bridges ...................................................................................................................................... 10 Objectives ................................................................................................................... 12 Primary objectives .............................................................................................................. 12 Objective 0: ..................................................................................................................................................... 12 Objective 1: ...................................................................................................................................................... 12 Objective 2: ...................................................................................................................................................... 12 Secondary objectives .......................................................................................................... 13 Objective 3: ...................................................................................................................................................... 13 Objective 4: ..................................................................................................................................................... 13 Hypothesis .................................................................................................................. 15 Settings ....................................................................................................................... 16 Bridges ................................................................................................................................ 16 Water bodies ....................................................................................................................... 19 Response in the Lower Mainland ...................................................................................... 21 OrgAnisAtionAl involvement .......................................................................................................................... 21 CommunicAtion And coordinAtion Agencies ................................................................................................ 23 Response Agencies ......................................................................................................................................... 25 Current prehospital treatment ......................................................................................... 30 CanadiAn Coast GuArd ................................................................................................................................... 30 British ColumbiA AmbulAnce Service ........................................................................................................... 35 PrehospitAl treAtment limitAtions ................................................................................................................ 38 viii Outcomes ...........................................................................................................................
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