Article Text

Download PDFPDF
Comparison of deliberate self-harm incidents attended by Helicopter Emergency Medical Services before and during the first wave of COVID-19 in the East of England
  1. Joanna Stevens1,2,
  2. James Price1,2,3,
  3. Antonia Hazlerigg2,3,
  4. Sarah McLachlan4,5,
  5. Ed Benjamin Graham Barnard1,2,6
  1. 1 Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich, UK
  2. 2 Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3 Magpas Air Ambulance, Huntingdon, UK
  4. 4 Research Department, Essex and Herts Air Ambulance, Earls Colne, Colchester, UK
  5. 5 Department of Allied Health and Medicine, Anglia Ruskin University, Chelmsford, UK
  6. 6 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr Joanna Stevens, Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich NR6 6ER, UK; joanna.stevens{at}


Introduction There is significant interest in the mental health impact of the COVID-19 pandemic. Helicopter Emergency Medical Services (HEMS) attend the most seriously unwell and injured patients in the community; their data therefore present an early opportunity to examine self-harm trends. The primary aim was to compare the incidence of deliberate self-harm incident (DSH-I) encounters by HEMS before and during the first wave of COVID-19.

Methods Data were obtained from all three East of England HEMS: total number of activations and stand-downs, number of DSH-I activations and stand-downs, self-harm mechanism and number of ‘severe’ DSH-I patient encounters, in two 61-day periods: 1 March to 30 April in 2019 (control) and 2020 (COVID-19). Severe DSH-I was defined as cardiac arrest and/or died prehospital. Proportions were compared with a Fisher’s exact test.

Results There were a total of 1725 HEMS activations: n=981 (control) and n=744 (COVID-19), a decrease of 24.2% during COVID-19. DSH-I patient encounters increased by 65.4%: n=26 (control) and n=43 (COVID-19). The proportion of encounters that were DSH-I and severe DSH-I both significantly increased during COVID-19: p=0.002 and p=0.001, respectively. The absolute number of hangings and falls from height both approximately tripled during COVID-19, whereas the number of other mechanisms remained almost constant.

Conclusion Despite a reduction in overall HEMS patient encounters, there were significant increases in both the proportion of DSH-Is and their severity attended by HEMS during the first wave of the COVID-19 pandemic in the East of England.

  • self harm
  • suicide
  • prehospital care
  • mental health

Data availability statement

Data are available on reasonable request.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request.

View Full Text


  • Handling editor Jo Daniels

  • Twitter @josumpter, @edbarn

  • Contributors This study was conceived by JS with input from JP and EB. Data acquisition was undertaken by JS, JP, AH and SM. The manuscript was drafted by JS, JP and EB with critical revisions by AH and SM. All authors and organisations have agreed the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Press release Yes.