Prehospital Management of Suicide Attempts and Predictive Factors of Mortality Identified During Medical Dispatching

Prehospital management of suicide attempts (SA) is increasing worldwide and in Tunisia. This study aimed to describe the management of SA in the prehospital setting, and to analyze factors predicting mortality during medical dispatching.

We conducted a retrospective descriptive and analytical study including all SA-related calls managed by the Prehospital Emergency Medical Services (PEMS) between January 2023 and December 2024. We described patients' socio-demographic and clinical characteristics, medical dispatch decisions, prehospital management, and analyzed factors associated with prehospital mortality.

The sex ratio was 0.68, and the mean age was 29.6 years. Voluntary intoxication was the most common method (88.8%), followed by hanging (9.6%). A Mobile Intensive Care Unit (MICU) was deployed in 78.4% of cases. In univariate analysis, rural origin (p=0.012), calls made by medical personnel (p<0.001), and medical management initiated prior to MICU arrival (p=0.04) were significantly associated with reduced mortality. In contrast, hanging (p<0.001), calls received within the first hour following the SA (p=0.014), and calls made by Civil Protection Services (CPS) personnel (p=0.023) were associated with increased mortality. In multivariate analysis, hanging(p=0.04 ;OR=2.12 ;IC=[1.28-16.1]) and early received calls (p=0.01 ;OR=8.33 ;IC=[1.76-91.4]) remained independent predictors of mortality, whereas rural origin (p=0.03 ;OR=0.16 ;IC[0.015-0.67])and prior medical management(p=0.03 ;OR=0.33 ;IC=[0.03-0.73]) were protective.

Early identification of mortality-related factors in SA may strengthen medical dispatch decision-making. Strengthening the role of PEMS in early management could further improve patient outcomes.