Being aware of ligatures

People who use mental health services are most likely to commit suicide by hanging. Three quarters of people who kill themselves on psychiatric wards commit suicide or strangulate themselves, according to the Care Quality Commission (CQC). High ligature points can result in fractures of the upper spinal column. Being aware of ligatures is what i will be discussing in this passage. Strangling a victim without suspending their body is also possible with a ligature point at or below head height.

It is very important to train people about ligatures in order to save lives. Healthcare professionals who support people who may attempt suicide or self-harm with ligatures should attend this training. The term ligature refers to anything that can be used to make loops or nooses for the purpose of self-harm through hanging or asphyxiation.

 Make a ligature around your neck, suspend it or leave it undisturbed. Materials commonly used as ligatures include rope, bedding, light cords, clothing, shoelaces, phone chargers, plastic bags, and plastic aprons, among others.

To strangle or hang an individual, ligatures use ropes, cords, or other materials attached to the ligature points. A ligature point can consist of a railing, a pipe or radiator, a window frame, a door frame, a ceiling fitting, a handle, or a coat hook.

A ligature audit is a good way to become aware of ligature points in your setting, so that you can work on reducing the risk of these in your setting. Many inpatient psychiatric centers perform ligature audits, so that they are aware of any such points within their facility, and can take steps to reduce the risk of these occurring. Assessors trained in ligature risk assessment should conduct the assessment.

According to the CQC:

A service is unlikely to be able to eliminate every potential ligature point in all wards. The use of fixed ligatures should be avoided whenever possible or replaced with those that have ‘anti-ligature’ fittings that allow ligatures to collapse or fall off when a certain amount of weight is applied.

It is your responsibility to inform the nurse in charge if anything appears to be a possible ligature point or hazard. When it is safe to remove the point, the nurse will do so. To report the risk in a formal manner, you should seek the advice of a senior manager.

Patients at risk of suicide should have a bedroom without ligature points in order to reduce the risk of suicide. It would be wise to ask them to turn in any potentially dangerous ligatures they may have.

It is extremely vital that you have ligature risk management policies within your trust that outline your obligations as a health professional, as well as the rights of patients. Generally, these policies should pertain to the removal of possessions that might pose a threat. If you are in a new trust, you should try to review these carefully before you start your work.

Rescue from the Ligature

A ligature can strangle someone, break their neck, and compress blood vessels that travel to the brain. Ligatures are dangerous because they can break someone’s neck, restrict their airway, and rupture their blood vessels. The use of ligatures can be fatal in just a few minutes, so acting quickly can save lives when someone has attempted to harm themselves using one. Finding out that someone has ligatured themselves requires knowing what steps you should take.

The doctor in the video below demonstrates a ligature rescue in real-time. Several people may find this clip triggering due to footage showing a life-size mannequin hanging from a neck ligature.

Watch the video and consider the actions taken by the healthcare worker who found the mannequin suspended by a ligature. To what extent does he assist?

Thanks to Norvic Training UK for making this video.

As you watch the video, you’ll notice that the actions move rather quickly. You may need to watch the video again and think about the actions taken by the two staff members.

You should take the following steps if you discover someone who has used a ligature to suspend themselves:

• Take a moment to assess the situation in front of you – is it safe to proceed? If you feel unsafe entering a situation, you should refrain from doing so.

• You can call for help by shouting, pulling an emergency buzzer, dialing the local crash team code, and telling them your medical emergency and exact location, or dialing 999.

• CRASH trolley and ligature cutters are available upon request

• In the event that someone is suspended by a ligature, lift them upward by holding onto their thighs, as long as it is safe to do so. Be sure to follow the principles of safe manual handling here. By taking these precautions, you can ensure that you have a secure handgrip, lift with your knees rather than your back, and use a stable base of support.

• Halfway along the ligature, cut both the knot and the ligature point. By doing so, the person will no longer be attached to a ligature point or suspended from it. The person should be placed on their back after being carefully lowered to the floor.

• Use a ligature cutter to carefully cut the ligature around the neck of the person

• Use the AVPU score to assess the casualty’s alertness, responsiveness to voice, pain sensitivity, and unconsciousness.

• When necessary, perform resuscitation on a patient, beginning with an assessment and management of their airway, followed by breathing, and circulation. Practicing life support skills at your basic or intermediate level will help you here.

• Manipulating a person’s spinal cord. In order to stabilize the spinal cord of the patient (which can break a person’s neck) while hanging. One member of staff (trained in life support) should hold their neck still until a medically trained practitioner can assess whether they are at risk of spinal cord fractures.

• As long as medical help is not available, continue resuscitation

To get more information on life support. Make a review of this BASIC LIFE SUPPORT TRAINING MANUAL

A ligature rescue should be reported to the appropriate people after it is completed. In most clinical settings, ligature incidents require formal reporting. As soon as you become aware of a ligature incident, seek guidance from your senior supervisors or local policymakers regarding appropriate reporting action.

The debriefing

The consequences of a ligature can be devastating, and you may experience strong emotional reactions as a result. Immediately following an incident involving a ligature, your team will likely debrief. Support should be available to you personally – speak with your colleagues and seniors, or determine the local policy regarding emotional and well-being support available in your workplace.