What to do in the case of Self-harm Emergency

Although most self-harm is done without the intention of suicide, self-harm is risky and always can escalate to life-or-death situations. When unsure what to do, ALWAYS call 112 or 119 (Indonesian emergency hotlines) and explain the situation. For specific situations, consult the list below:

If the person’s self-harm wounds won’t stop bleeding. 

1. Apply pressure on the wound using a cloth or tissue. Don’t remove the cloth even if blood seeps through, instead add more cloth/tissue.  If the bleeding is on an arm/leg, lift the arm/leg higher than the chest. If the bleeding does not stop in 10 minutes, get them immediate medical attention by contacting the Emergency Medical Helpline or going to the nearest healthcare facility (point a).
2. If the wound is on the chest or abdomen, it's crucial to get them immediate medical attention from either of the aforementioned sources .
3. If blood “spurts” out of a wound, get them immediate medical attention.
   
   • Call 112 or 119 for an ambulance or take them straight to the emergency department of a hospital. Unfortunately, ambulance services in Indonesia are costly and the time it takes for them to arrive can take a while —  so the best way to get someone immediate medical attention is to transport them to a hospital as soon as possible.
   • If the wound stops bleeding, clean the wound under running water and soap. Rinse the soap from the wound as much as possible. While water and soap are generally preferable, you may also use an antiseptic such as Betadine or hydrogen peroxide if available. Cover wounds with a protective bandage such as a band-aid or gauze.

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If the person is unconscious.

If they are not breathing, call 112 or 119 for an ambulance and do Cardiopulmonary Resuscitation (CPR). If getting an ambulance is not possible, bring them to the emergency department (with the assistance of someone else nearby who can drive) whilst doing CPR en route. Take note of any drugs found near them so you can inform the hospital of the suspected poisoning or overdose. If you're unsure of the exact drug(s), bring the packaging or any labels with you.

If they are breathing:

1. Look for signs of general overdose:
   
   • If drugs or medicine are found near them, overdose is likely. Check below for the specific overdose symptoms of common drugs/medicine:
     
     • Pale, bluish skin or red flushed skin
     • Abnormal (slow or fast) breathing
     • Hot or cold skin temperature
     • Loss of coordination, confused/unsteady movements, or exhibiting irrational behavior(s)
2. Symptoms of paracetamol overdose:
   
   • Yellowing of the skin and the whites of the eyes (jaundice)
   • Loss of coordination 
   • Low blood sugar (hypoglycaemia), which can cause symptoms including sweating, trembling and irritability
3. Symptoms of aspirin overdose:
   
   • Sweating 
   • Rapid breathing 
   • Ringing in the ears (tinnitus)
   • Temporary hearing loss
4. Symptoms of benzodiazepine overdose:
   Benzodiazepine is a depressant prescribed for anxiety, and often circulates as illegal drugs. It is likely that a person has been prescribed this if they have been diagnosed with anxiety.
   
   • Coordination and speech difficulties 
   • Uncontrolled movement of the eyes (nystagmus) 
   • Shallow breathing
   • Drowsiness
5. Symptoms of opioid overdose:
   Opioids are painkillers that are often prescribed for extremely painful conditions. They are highly addictive.
   
   • Small pupils 
     
   • Shallow breathing
     
   • Drowsiness
6. Symptoms of stimulant drug (cocaine, amphetamine, crack or ecstasy) overdose:
   
   • Anxiety and paranoia
   • Restlessness or agitation 
   • Hallucinations
   • High temperature 
   • Chest pain 
   • Rapid breathing 
   • Irregular or fast heartbeat 
7. Symptoms of tricyclic antidepressant overdose:
   Tricyclic antidepressants (eg. amitriptyline (Tryptizol), clomipramine (Anafranil), imipramine (Tofranil), lofepramine (Gamanil) and nortriptyline (Allegron) are not conventionally used usually only prescribed to individuals with depression that is highly resistant to SSRIs. Individuals diagnosed with depression might have them.
   
   • Excitability
   • Dry mouth
   • Large pupils
   • Irregular or rapid heartbeat
   • Low blood pressure, which can cause symptoms including lightheadedness and fainting
8. Symptoms of selective serotonin reuptake inhibitor (SSRI) overdose: SSRIs are commonly prescribed antidepressants that can be prescribed for both depression and anxiety. A commonly prescribed SSRI is Fluoxetine (Prozac). Other SSRIs include citalopram (Cipramil), paroxetine (Seroxat) and sertraline (Lustral). Poisoning by Serotonin-Norepinephrine Reuptake Inhibitor (SNRIs) and other antidepressants such as duloxetine (Cymbalta/Yentreve), venlafaxine (Effexor) or mirtazapine (Zispin) may also exhibit the same symptoms.
   
   • Feeling agitated
   • Tremor (shaking)
   • Uncontrolled movement of the eyes (nystagmus)
   • Severe muscle tension
9. Symptoms of beta-blocker overdose: Beta-blockers (propranolol, bisoprolol, atenolol, metoprolol) are medicines primarily used to lower blood pressure. However, they also relieve physical symptoms of anxiety so they are often prescribed to individuals diagnosed with anxiety.
   
   • Low blood pressure, which can cause symptoms such as lightheadedness and fainting
   • A slow heartbeat (below 60 beats per minute)

If any of these symptoms are present, call 112 or 119 for an ambulance and do CPR. If getting an ambulance is not possible, bring them to the emergency department, whilst doing CPR on the way. As previously mentioned, take note of any drugs found near them so you can inform the hospital of the suspected poisoning or overdose. If you're unsure of the exact drug(s), bring the packaging or any labels with you.

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If the person is threatening to harm themselves or conveys that they feel the urge to harm themselves.

1. Invite them to talk to you, and if they want to talk, hear them out.
2. If they don’t want to talk about it, follow their safety plan.
3. If they don’t want to talk to you and they don’t have a safety plan, do something distracting with them, such as playing a game, watching a show, or taking a walk.
4. If distraction doesn’t work, you can suggest they flick a rubber band on their skin or rub ice on their skin — which gives pain without any dangerous side effects.

For more guidance on alternatives to self-harm and supporting someone who self-harms, you can access Seribu Tujuan’s Find Help resources here: https://www.seributujuan.id/findhelp

If they don’t want to do any of these, you can suggest they call 119, then press 8 for a phone counselling service. They can also contact one of the hospitals below, as they provide phone counselling:

1. RSJ Amino Gondohutomo Semarang: (024) 6722565
2. RSJ Marzoeki Mahdi Bogor: (0251) 8324024, 8324025, 8320467
3. RSJ Soeharto Heerdjan Jakarta: (021) 5682841
4. RSJ Prof Dr Soerojo Magelang: (0293) 363601
5. RSJ Radjiman Wediodiningrat Malang: (0341) 423444

Don’t leave them alone until they feel better, unless they specifically asked to be alone. If you absolutely must leave, please try and check on them every few hours from the phone. The next time you see them, ask if they are alright and if they still need help. However, avoid asking if they have harmed themselves, as this is invasive and might make them feel uncomfortable - they would tell you if they want you to know. 

If a person is threatening to harm you or if you don’t feel safe around them.

If you don’t feel confident in your ability to de-escalate the situation, remove yourself from the premises as soon as possible. You can do this by leaving the property or locking yourself in a room. If they follow you outside or try to force their way into your locked room, call the police (110) and find a safe place to hide until the police arrive. Only try to reason with them if you are 100% confident you can — any less, you should give them space to cool down. 

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