Hyoid fracture: consensual sex-play or non-consensual nonfatal strangulation: a case report.

Hyoid fractures are uncommon, but when they occur they are commonly the result of strangulation or hanging. Although there is a lack of available quantitative data, there is increasing evidence to suggest that strangulation is a relatively common feature of consensual sex play. This creates difficulty in clinical forensic medicine given the "rough sex" defence has previously been used successfully in cases of fatal intimate partner strangulation. We present a case where consensual and non-consensual strangulation has occurred in a woman who presents with a hyoid fracture. While manual strangulation was thought to be a more likely mechanism than consensual wearing of a sex-collar; ultimately the similar timeframes of the collar-wearing and the non-consensual manual strangulation meant that the accused was not convicted of this particular strangulation offense. This case highlights the importance of further research into consensual strangulation and the incidence of resultant injuries. It also demonstrates the importance of collecting a detailed forensic history and adequately documenting injuries in a contemporaneous matter.

Transforming researchers into writers through a series of semi-structured writing retreats: a mixed methods study.

AIM: To evaluate the experience and effectiveness of six semi-structured writing retreats on research publication quantity and quality for nursing and midwifery academics and research students. BACKGROUND: Research publications are necessary to develop a track record to gain competitive funding and for promotion. Publications also improve the standing of universities because their performance is measured in-part by research outputs. However, there are challenges to writing for publication, especially for new nursing and midwifery academics and research students. Therefore, four of the authors initiated semi-structured writing retreats to support nursing and midwifery academics and research students to overcome these challenges. METHODS: A mixed methods exploratory sequential design consisting of two distinct phases and data collection methods. In phase one, an online evaluation was administered to collect participant experiences which were then analysed using content analysis. In phase two, data about the quantity and quality of publications arising from each retreat was collected, and descriptive statistics performed. RESULTS: A total of 70 participants responded to the online evaluation. Qualitative analysis of their responses demonstrated that the writing retreats were highly valued as they offered a collaborative environment with dedicated time to focus on writing for publication. Quantitative analysis identified 81 publications were planned over the six writing retreats. Of these, 60 have been published, 5 are under review, 5 have not yet been submitted, and 11 were abandoned. CONCLUSIONS: Findings demonstrated that our six semi-structured writing retreats enabled and developed nursing and midwifery academics and research students writing for publication. Semi-structured writing retreats are a research investment that enabled preparation of high-quality publications by offering protected time to write, expert peer review and collaboration and networking opportunities.

Impacts on paediatricians testifying in cases of child maltreatment: protocol for a systematic review.

INTRODUCTION: Paediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in court about child protection and criminal justice matters. To the authors' knowledge, there has been no previous systematic review of the literature synthesising the evidence on the impacts on paediatricians testifying in cases of child maltreatment. METHODS AND ANALYSIS: A search strategy comprising indexed and key terms will be applied to six electronic reference databases from inception to May 2023: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts and Cochrane Library. Two reviewers will independently screen titles and abstracts and full-text articles against predefined eligibility criteria to identify studies of interest. Conflicts will be independently adjudicated by a third reviewer. ETHICS AND DISSEMINATION: Since the systematic review methodology aims at synthesising information from available publications, this study does not require ethical approval. An article reporting the results of the systematic review will be submitted for publication in a scientific journal, presented at relevant conferences and used in subsequent stakeholder consultations.

Effectiveness of low dose computed tomography to detect fractures in paediatric suspected physical abuse: a systematic review.

PURPOSE: The skeletal survey X-ray series is the current 'gold standard' when investigating suspected physical abuse (SPA) of children, in addition to a non-contrast computed tomography (CT) brain scan. This systematic literature review synthesised findings of published research to determine if low dose computed tomography (LDCT) could detect subtle fractures and therefore replace the skeletal survey X-ray series in the investigation of SPA in children aged under 3 years. METHODS: Five electronic databases and grey literature were systematically searched from their inception to 28 April 2022. Primary studies were included where the population comprised paediatric patients up to 16 years and LDCT was used to detect fractures associated with SPA. Studies involving imaging investigations of the head, standard dose CT examinations or accidental trauma were excluded. RESULTS: Three studies met the inclusion criteria, all of which were case series. These studies did not report many of the criteria required to compare the accuracy of LDCT to X-ray, i.e. they did not meet the criteria for a diagnostic accuracy test. Therefore, it is difficult to conclude from the case series if LDCT is accurate enough to replace X-rays. CONCLUSION: Due to the gap in current literature, a phantom study and subsequent post-mortem CT study are recommended as the primary investigative methods to assess the ability of low-dose CT to identify the subtle fractures associated with SPA and to calculate how low the achievable CT dose can be.

A population-based cross-sectional study examining homicides among community-dwelling older adults in Victoria, Australia: A study protocol.

BACKGROUND: There is a need for both descriptive and analytical evidence on the factors associated with older adult homicide. The current landscape is insufficient because most published research is confined to the United States, and contains insufficient data about the homicide context. This study protocol describes the proposed method for examining the characteristics and factors associated with older adult homicide in the Australian state of Victoria, using data generated for the criminal and coronial investigation into these deaths stored in the Victorian Homicide Register (VHR). Outcomes will support practitioners, policy makers and other key stakeholders to strengthen prevention strategies to reduce the risk of future homicides among older Victorians. METHODS: This study will comprise a single-jurisdiction population-based cross-sectional design to analyse consecutive cases of homicide among community-dwelling older adults in Victoria, Australia for the period 2001 to 2015. All homicides of adults aged 18 years and older, and where the Coroner's investigation is completed at data extraction will be included. Variables will be selected in accordance with elements of the social-ecological model (i.e., individual, interpersonal, incident, and community). This will include: socio-demographic characteristics; presence of mental or physical illness; deceased-offender relationship; nature of any abuse between the deceased and offender; incident location and weapon used; the presence of alcohol or drugs; and criminal justice outcomes. Homicide rates per 100,000 population will be calculated for older adults (aged 65 years and older) and younger adults (aged 18-64 years), and compared as rate ratios using Poisson regression. Descriptive statistics and cross-tabulation will be generated for factors associated with homicide for older compared to younger adults. Homicide typologies based on deceased-offender relationship and motive will be explored within group and family homicides will be compared between older and younger adults.

Availability and quality of data related to cultural and linguistic diversity in the Victorian Suicide Register: A pilot study.

OBJECTIVE: While people from culturally and linguistically diverse (CALD) backgrounds have been identified as a priority for suicide prevention in Australia, little is known about suicide in CALD communities. We aim to describe the availability and quality of CALD data in the Victorian Suicide Register (VSR). METHODS: A retrospective consecutive case series review of suicides reported to the Coroners Court of Victoria during 2016 was conducted. Using the VSR, we identify suicides showing evidence of CALD identity and relevant variables were extracted and coded according to an adapted Australian Institute of Health and Welfare framework. RESULTS: During 2016, 126 of 652 suicides (19.3%, 95% confidence intervals 16.4-22.6) were flagged as showing evidence of CALD. The two most frequent CALD indicators for which information was recorded were country of birth and year of arrival. There was less information pertaining to citizenship, residency/visa status, preferred language, English language proficiency and religious affiliation. CONCLUSIONS: This study demonstrates that the VSR, like other databases, has substantial gaps in availability and quality of CALD data. IMPLICATIONS: A framework to capture richer data on cultural, religious and linguistic diversity when coding suicides is needed to inform policy on suicide prevention initiatives designed for CALD communities.

Suspension-associated dislocation of the jaw in hanging.

Hanging is a common type of death, and the role of the medical investigation of such deaths by a forensic pathologist not only requires the determination of the cause of death but providing information to assist in the determination of the manner of death. The forensic pathologist should be well versed in the spectrum of injuries known to be associated with neck compression, to document injuries known to be associated with hanging, but also to identify those that are inconsistent with self-inflicted hanging or that may suggest the involvement of a third party in the death. Comprehensive identification and correct interpretation of external and internal injury are crucial for the appropriate degree of police and coroner/medical examiner investigation. We present two cases of deaths believed to be caused by self-inflicted hanging that were observed to have unexpected unilateral dislocation of the temporomandibular joint identified on routine post-mortem computed tomography, without any evidence of involvement of a third party. This injury was unexplained and had not been previously observed at our Forensic Institute nor was it identified after a review of the published biomedical research literature. Issues regarding the cause of this abnormality, possible mechanisms, and the medicolegal significance of this finding will be discussed.

Quality Management in forensic science: A closer inspection.

An international survey was conducted on the benefits and limitations of accreditation to ISO17025 in forensic science, and how quality management could be improved to reflect the complexities of the end-to-end process. The survey was in response to growing concern within the forensic science community that the standard ISO17025 (and ISO17020), which is the backbone of forensic science accreditation, does not have sufficient depth and reach to properly address the quality of both the inputs (crime scene traces) and outputs (e.g., opinions in a report) of forensic science. The survey was developed around three themes: (1) fitness for purpose, (2) competences and (3) education & training. It targeted directors and senior managers, including quality managers, of forensic science laboratories/facilities. The survey was developed by the research team and disseminated with the cooperation of the International Forensic Strategic Alliance (IFSA) and six regional Networks: the American Society of Crime Laboratory Directors (ASCLD), the European Network of Forensic Science institutes (ENFSI), the Australian and New Zealand Forensic Executive Committee (ANZFEC) (formerly SMANZFL), Acadamia Iberoamericana de Criminalistica Estudios Forenses (AICEF), Asian Forensic Sciences Network (AFSN) and Southern Africa Regional Forensic Science Network (SARFS). What emerged for each of the three themes of the survey are areas of concern where the forensic science community should reconsider its approach to quality management if it is to have continuing value and relevance into the future. The results are evaluated and discussed. Briefly, the results include evidence of a lack of fitness for purpose of ISO17025 as a standard for the forensic science continuum, a lack of agreement on what forensic science is and poor levels of recognition of crime scene investigation, many competences, particularly cognitive competences, are not identified, monitored or assessed and the incentive to gain accreditation and maintain continuous improvement is intrinsic rather than customer driven.

The epidemiology of homicide among older adults: retrospective analysis using data from the Victorian Homicide Register.

Older adult homicide is unique and under-researched, requiring immediate attention due to the rapidly ageing population. The current study aims to contribute to the description of homicide at the individual, interpersonal, incident and community levels. This research comprised a whole of state jurisdiction population-based retrospective analysis of homicide deaths of older adults aged 65 years and older reported to the Coroner between 2001 and 2015. Descriptive statistical analyses were conducted to compare older adult homicides by sex and the deceased-offender relationship. There were 59 homicide incidents involving 23 female and 36 male deceased (median age=72 years) and 16 female and 41 male offenders (median age=41 years). Individual factors included the following: Deceased frequently had a recorded physical illness (66%), and over one-third were born overseas (37%) or had recent contact with general practitioners and human services (36%). Offenders frequently had a history of illicit drug or alcohol use (63%), diagnosed mental illness (63%) and historical exposure to violence (61%). Interpersonal factors included the following: The deceased-offender relationship tended to be intimate or familial (63%). Incidents factors included the following: incident predominantly occurred in the victim's home (73%), involving the use of a sharp object (36%), bodily force (31%) or blunt force (20%). The older adult homicide is characterised by poor health in the victim, mental illness, substance abuse or a history of conflict in the either the victim or the offender, familial deceased-offender relationship and the home as the incident location. The results identify future prevention opportunities in clinical and human services settings.

Epidemiology of Homicide in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Empirical research investigating older adult homicide is sparse and rarely accumulated for greater insights. This systematic review and meta-analysis quantifies the prevalence and characteristics of homicide victimization among older adults (65 years and older) compared with younger adults (18-64 years). METHOD: We searched Cumulative Index to Nursing and Allied Health Literature, Cochrane, Criminal Justice Abstracts, EMBASE, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science for studies published before December 31, 2018 (International Prospective Register of Systematic Reviews registration: CRD42017054536). Included were English-language, original, peer-reviewed studies describing the homicide of older adults. Excluded were studies not meeting age criteria, residence as an institution, or with insufficient outcome variables. The review included 39 studies; 17 were included in the meta-analysis. Data were extracted via open access or from study authors. Heterogeneity was assessed through study-level random effects estimates. RESULTS: Pooled homicide rates per 100,000 population were 2.02 (95% CI [1.23, 3.33]) for older adults (n = 35,325) and 3.98 (95% CI [2.42, 6.53]) for younger adults (n = 607,224; rate ratio = .51, 95% CI [0.37, 0.70], p < .001). Proportion estimates for older adults: victim female 46.3%, location home 71.4%, offender familiar 25.2%, compared to stranger, 24.2%, motive argument 36.1%, compared to felony 30.8%, and weapon firearm 24.5%. Older adults were significantly different to younger adult victims (p = <.001) for female (OR = 2.5, 95% CI [2.02, 3.10]), home (3.87, 95% CI [3.45, 4.35]), stranger (1.81, 95% CI [1.66, 1.98]), argument (0.33, 95% CI [0.28, 0.39]), felony (2.78, 95% CI [2.58, 2.99]), and firearm (0.38, 95% CI [0.36, 0.40]). CONCLUSIONS: Homicide against older adults differs from younger adults and warrants specific research and tailored prevention strategies.

Domestic/Family Homicide: A Systematic Review of Empirical Evidence.

BACKGROUND: Domestic/family homicide (D/FH) is a global social, economic and public health problem. To date, the research studies into risk factors associated with D/FH has largely focused on intimate partner homicide (IPH). A more contemporary approach recognizes that D/FH extends beyond the intimate partner relationship. This systematic review sought to identify and quantify the individual, relationship, community and societal factors in the empirical evidence literature on D/FH. METHODS: Eight electronic databases were searched from January 1999 to December 2020. Published journal articles on studies of D/FH were included if the study included victims and/or perpetrator of D/FH, reported risk and/or protective factors associated with D/FH, reported primary data and was published in English. Factors were descriptively synthesized by the categories of the social ecological model and D/FH sub-type. RESULTS: Three hundred and forty published articles met the inclusion criteria. From 1999 to 2020 the number of articles on D/FH increased globally from 10 to 40 respectively, declining to 23 in 2020. Almost half of the articles examined populations located in the Americas (160, 47.1%), predominately the United States and the majority of articles used quantitative designs (277, 81.5%). The forms of homicide more commonly studied were intimate partner (171, 50.3%), and filicide (98, 28.8%). Approximately 90% of articles reported individual victim and perpetrator factors, 64.7% examined relationship factors, 17.9% examined community factors and 15.6% examined societal factors. CONCLUSION: To inform universal and targeted D/FH elimination and prevention strategies, more research across different regions and a greater emphasis on community and societal-level factors is needed.

Gambling-related suicide in Victoria, Australia: a population-based cross-sectional study.

Background: Gambling is associated with serious harms to health, including suicide. Yet public health systems for recording the role of gambling in suicide deaths are relatively underdeveloped. This study contributes to the understanding of this relationship. Methods: A population-based cross-sectional study of suicides reported to the Coroners Court of Victoria between 2009 and 2016 was performed to identify the incidence and characteristics of gambling-related suicides (GRS). Findings: From 2009 to 2016 there were 4788 suicide deaths in Victoria. Of these, 184 were identified as direct GRS and a further 17 were GRS by 'affected others'. Together, these GRS comprise 4.2% of all suicides in Victoria over this eight-year period. Direct GRS account for an annual average rate of 5.13 GRS per million Victorian adults. GRS were significantly more likely to be male (n = 153, 83%), than the Victorian population of total suicide deaths and significantly more likely to occur among those most disadvantaged. Family members and friends were more likely than clinicians to know about the deceased gambling. Interpretation: Given that gambling is not routinely investigated by coroners and may be hidden from family, friends, and health professionals, this is an underestimate of the true scale of the GRS in Victoria. A range of measures should be introduced to prevent, screen, support, and treat gambling harm. Family members and friends should also be provided with help services. Preventing gambling-related harm through public health measures could significantly reduce suicidality and suicide, both in Australia and globally. Funding: Federation University Australia, Coroners Court of Victoria, Suicide Prevention Australia.

Search and rescue incidents among persons 65 years and older in the USA: Examination of factors associated with death.

OBJECTIVES: Older people are vulnerable to becoming lost from home, especially if alone and in unfamiliar environments. Incidents of older persons becoming lost are frequently reported and often requiring a search and rescue (SAR) response. Becoming lost is distressing to the person concerned, their carer, and family and may result in physical injury and/or death. This study examined what factors are associated with death among older persons reported lost from home. METHODS/DESIGN: A retrospective cross-sectional study. Data were obtained from the International Search and Rescue Incident Database from 1985 to 2013. Participants comprised persons aged 65 years and older living in the United States. Individual, SAR incident, and environmental factors were analysed. The primary outcome of this study was lost person found alive or found dead on arrival. Relationships between categorical variables and outcome were summarised with contingency tables, chi-squared test p-values (or Fisher's-exact-test), and odds ratios (OR) with 95% confidence intervals (CI). Association between continuous variables and outcome were examined using multiple logistic regression. p-value of <0.05 was considered significant. RESULTS: Among the 5242 SAR incidents, 1703 met the inclusion criteria, of which 87.8% (n = 1495) were found alive and 12.2% (n = 208) were found dead. Factors associated with death included: male gender (OR 1.46; CI 1.01-2.13; p = 0.048), cognitively intact (OR 0.32; CI 0.22-0.47; p < 0.001), prolonged SAR duration (OR: 1.028; CI: 1.021-1.035; p < 0.001), found in water/wetlands (OR 7.40; CI 3.37-16.24; p < 0.001), and extreme weather (OR: 2.06; 95% CI: 1.10-3.86; p = 0.024). CONCLUSIONS: Older people have a fundamental human right to protection from preventable deaths. Findings indicate these rights are not being protected with deaths occurring frequently among older people who have become lost from home. To minimise fatalities, knowledge of factors associated with death could inform the development suitable assessment and intervention strategies for SAR teams and caregivers.

Non-fatal strangulation and COVID-19 common symptoms and signs: considerations for medical and forensic assessment.

Emerging evidence suggests that an onset or escalation of interpersonal violence has been occurring during the COVID-19 pandemic, particularly among persons in intimate or familial relationships. Strangulation (or neck compression) is a common form of interpersonal violence and can result in serious adverse health outcomes, including death. The identification and attribution of injuries from non-fatal strangulation are complex, as there may be an absence of external signs of injury and their appearance may be delayed by many days. There is a heavy reliance on clinician identification of 'red flag' symptoms and signs, the presence of which necessitates urgent further assessment. Additional challenges arise when acute non-fatal strangulation symptoms and signs are shared with other clinical conditions. In such cases, differentiating between the conditions based on the symptoms and signs alone is problematic. We present the diagnostic challenges faced when conducting forensic assessments of COVID-19-positive and suspected COVID-19 (S/COVID) patients following allegations of non-fatal strangulation in the setting of physical and sexual assaults. The implications of shared symptoms and signs, for forensic clinicians, primary healthcare, and emergency practitioners, as well as other frontline service providers, are discussed.

Injury-Related Emergency Department Presentations Among Residential Aged Care Residents in Victoria, Australia.

OBJECTIVE: This study aimed to quantify and describe the characteristics of emergency department (ED) injury presentations and subsequent hospital admissions among residents of residential aged-care facilities (RACFs) in Victoria, Australia between 2008 and 2018. METHODS: This study comprised a single jurisdiction population-based study of consecutive injury-related ED presentations of RACFs residents using the Victorian Emergency Minimum Dataset (VEMD). RESULTS: The rate of ED injury presentations per 100,000 population decreased by .8% per year over 10 years (P = .03); however, the rate per 100,000 RACF bed days increased by .6% per year (P = .05). The proportion of presentations subsequently admitted to hospital increased 4.0% per year (P<.0001). The majority of presentations were due to falls (82.5%), with fracture(s) being the most common injury type (34.0%). DISCUSSION: The increased rate of ED visits and hospital admissions in RACFs residents highlights the need to design specialized emergency care services and/or provide better direct access to hospital care for this vulnerable population.

Killing of Elderly Patients by Health Care Professionals: Insights From Coroners' Inquests and Inquiries in Three Cases.

As the world's population ages, a question of who can be trusted to look after the increasing elderly population arises. Health care professionals are commonly considered one of the group of people we entrust with our health care and maintenance of a good quality of life. Unfortunately, some abuse this trust. Harold Shipman, Elizabeth Wettlaufer and Roger Dean are three examples of health care professionals held responsible for multiple homicides of patients aged 65 years and older in their care. Harold Shipman, a United Kingdom doctor, is suspected of killing potentially 400 patients over 27 years. However, the true number may never be known. Elizabeth Wettlaufer, a Canadian nurse, admitted to killing eight patients over seven years and Roger Dean, an Australian nurse, killed 11 patients in one night by deliberately lighting a fire in a health care facility. The subsequent inquiry reports into their actions resulted in multiple recommendations which aimed to prevent similar occurrences and to protect the lives of this vulnerable cohort of people. These recommendations included restrictions on the hiring process of health care professionals and increasing the accountability of access to Schedule Eight drugs by doctors and registered nurses. The governments responsible for responding to the inquiry reports have done so in various ways, although not all recommendations have been implemented and some may not be practical with current residential care infrastructure provisions and requirements. More work is required to determine the types of countermeasures that could be implemented to protect the elderly from maverick health care professionals.

COVID-19 as a context in suicide: early insights from Victoria, Australia.

OBJECTIVE: To examine how the coronavirus (COVID-19) pandemic and its consequences may have influenced suicide in Victoria, Australia. METHODS: A mixed methods study of consecutive Victorian suicide cases spanning 1 January 2015 to 31 January 2021. Interrupted time series analysis examined whether suicide frequency changed following the pandemic onset. Thematic analysis was undertaken of police reports in suicides linked with COVID-19 to try to understand how COVID-19 acted as a stressor. RESULTS: The frequency of Victorian suicides did not change following the onset of COVID-19. Sixty COVID-linked suicides were identified, featuring three recurring themes: COVID-19 as a disturbance in the self, in relationships with others and institutions. CONCLUSIONS: While COVID-19 has not led to an increase in Victorian suicide frequency to date, it is an important background stressor that can erode one's wellbeing, sense of agency and connectedness to others. Implications for public health: Clinical interventions that serve to reconnect people with a sense of agency and seek to re-establish contact with significant others are indicated. Clinicians should ensure they are familiar with pathways for their patients to access government social and economic supports. A better understanding of how government interventions may be lessening psychological distress is needed.

Exertional heat fatalities in Australian sport and recreation.

OBJECTIVES: To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives. DESIGN: Descriptive, population-based, retrospective cohort study. METHODS: Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased's socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations. RESULTS: Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8-77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training. CONCLUSIONS: Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15-45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.

Effective Elements for Workplace Responses to Critical Incidents and Suicide: A Rapid Review.

Despite high rates of critical incidents (CIs) in working class occupations, there is a significant gap in our understanding of responses to these events. In this study, we aimed to inform a response training module by synthesising the key elements of pre-, during- and post-incident responses to CIs and suicide in the workplace. A rapid review identified studies on responses to CIs or suicide deaths in the workplace published between January 2015 and June 2020. A systematic search of six databases (Medline, CINAHL, PsycINFO, Sociology Collection, Academic Search and Business Search Complete) and grey literature was performed. Studies were excluded if the focus was on non-colleagues. Two reviewers independently conducted record screening, a review of the full text and assessed study quality. The existing evidence was synthesised and interventions were categorised using Haddon's Matrix. Five studies were included, reporting on CIs across a range of workplace settings, including railways, factories, police and military, along with external critical response units. Overall, study quality was assessed as being poor. Most of the evidence focused on the pre-incident and post-incident stage. There is little evidence on responses to CIs in the workplace. Evidence-based education and training is necessary to establish organisational responses to assist with supporting workers exposed to workplace CIs.

Suicide along the Australian coast: Exploring the epidemiology and risk factors.

Suicide is an increasing global concern with multiple risk factors, yet location-based understanding is limited. In Australia, surf lifesavers (SLS) and lifeguards patrol the coast, performing rescues and assisting injured people, including people who suicide. This study is a descriptive epidemiological analysis of Australian coastal suicide deaths. The results will be used to inform training and support surf lifesaving personnel and suicide prevention organisations. This is a population-based cross-sectional study of suicide deaths at Australian coastal locations (between 1 January 2005 and 31 December 2019). Data were sourced from the National Coronial Information System and SLS Australia's Incident Report Database. Analyses explored decedent, incident, and risk factors by sex and method. Across the study period, there were 666 coastal suicide deaths (71.0% male, 43.4% jumping from high places [X80]). Males were more likely to suicide by other means (hanging, self-poisoning, firearm discharge; n = 145, 83.8%), compared to females who were more likely to suicide by drowning ([X71]; n = 77, 37.7%). In one third (n = 225, 38.3%) toxicology was a contributing factor. The risk of coastal suicides was 10.3 times higher during the seven-days prior to their birthday (p<0.001). Evidence of mental ill health was reported in 61.4% (n = 409) of cases and evidence of suicidal behaviour was reported for 37.4% of decedents (n = 249), more prevalent in females. SLS responded in 10.7% (n = 71) of coastal suicides (most jumps from high places; n = 36, 50.7%). Coastal suicides differ to national trends suggesting that location-based differences should be considered during development of preventative and protective measures, especially at a community level. Accessibility, availability, perceived lethality and symbolic qualities are proposed to influence suicide location decisions. These results will guide support and education strategies for surf lifesaving personnel, contributes to established, ongoing suicide surveillance efforts (including hot-spot identification) and add to the limited literature exploring place-based suicide.