An underappreciated cause of ocean-related fatalities: A systematic review on the epidemiology, risk factors, and treatment of snorkelling-related drowning.

AIM: Snorkelling is a popular aquatic activity which may result in fatal and non-fatal drowning. However, little is known about the scale of injury, factors impacting risk and strategies for prevention. This review assesses the current literature on snorkelling-related drowning with the aim of assessing available data, improving safety recommendations and reducing the global mortality burden. METHODS: A systematic review of peer-reviewed literature in English, Spanish and Portuguese language published between 1 January 1980 and 31 October 2020 was conducted using the PRISMA guidelines. CINAHL Complete, Embase, Medline (Ovid), PubMed, SafetyLit, SportDiscus and grey literature were searched to identify studies reporting the incidence of fatal and non-fatal snorkelling-related drowning, or associated risk factors, prevention strategies, treatments or casualty characteristics. Quality was assessed using the NIH Quality Assessment Tool. RESULTS: Forty-three studies were included (26 reporting population data, 17 case series), of which 27 (62.8%) studies reported data from Australia. Incidence was reported as about 8% of total ocean-related drownings. Case series documented 144 fatalities over 17 years. Frequent casualty characteristics include male (82.6%), pre-existing heart disease (59.4%), tourists (73%) who were inexperienced (71.0%), and lack of a buddy system (89.6%). Two at-risk profiles identified were older adult tourists with pre-existing medical conditions and local, experienced spearfishers. Twenty-two expert recommendations were developed to improve the safety of snorkellers related to individuals, tourism companies, government agencies and diving organisations. CONCLUSION: Snorkelling-related drownings are not infrequent, and there are many opportunities to improve the safety of this activity based on available data.

Development of a novel 3D-printed multifunctional thorax model simulator for the simulation-based training of tube thoracostomy.

Tube thoracostomy is a high-acuity, low-occurrence (HALO) procedure with significant morbidity when performed incorrectly; this is amendable through simulation. Commercially available trainers exist but often have limited realism or exorbitant cost. Three-dimensional (3D) printing produces realistic and cost-effective models suitable for simulation, but no simulator has been developed for tube thoracostomy. The aim of this paper is to describe the initial development of a multifunctional 3D-printed thorax trainer for the instruction of tube thoracostomy. The thorax model was developed in conjunction with a multi-disciplinary team using 3D-printing capable software. An existing ribcage model was modified and printed in separate elements, including bony portions (ribcage, sternum and clavicles), flexible joints, skin, heart and lungs and then assembled. The total printing cost was $180 CAD. Future research will focus on incorporating the model's ability to simulate other HALO procedures and evaluating it as a training adjunct.

RéSUMé: La thoracostomie par tube est une procédure de haute acuité et de faible occurrence (HALO) avec une morbidité significative lorsqu'elle est mal exécutée; ceci est modifiable par simulation. Il existe des formateurs disponibles dans le commerce, mais ils sont souvent d'un réalisme limité ou d'un coût exorbitant. L'impression tridimensionnelle (3D) produit des modèles réalistes et rentables adaptés à la simulation, mais aucun simulateur n'a été développé pour la thoracostomie tubulaire. L'objectif de ce document est de décrire le développement initial d'un simulateur de thorax multifonctionnel imprimé en 3D pour l'enseignement de la thoracostomie tubulaire. Le modèle du thorax a été développé en collaboration avec une équipe pluridisciplinaire utilisant un logiciel capable d'imprimer en 3D. Un modèle de cage thoracique existant a été modifié et imprimé en éléments séparés, comprenant des parties osseuses (cage thoracique, sternum et clavicules), des articulations souples, la peau, le cœur et les poumons, puis assemblé. Le coût total d'impression était de 180 $ CAN. Les recherches futures se concentreront sur l'incorporation de la capacité du modèle à simuler d'autres procédures HALO et à l'évaluer en tant que complément de formation.

A systematic review on the effectiveness of anti-choking suction devices and identification of research gaps.

AIM: Despite an obstructed airway (choking) being a relatively preventable injury, it has a considerable mortality burden globally, with increasing incidence. Given new technologies in choking management, this systematic review aimed to assess current literature on the effectiveness of anti-choking suction devices at relieving obstructions. METHODS: Ovid MEDLINE, Embase, PubMed, The Cochrane Library, SCOPUS, Web of Science, CINAHL Plus and the English websites of the devices were searched on September 23, 2019. Studies were included if they reported the anti-choking devices' dislodgment success rate (primary outcome) or associated adverse events (secondary outcome). Articles, conference abstracts or technical reports were included if peer reviewed. Certainty of evidence was assessed in accordance with GRADE. RESULTS: Five studies satisfied the inclusion criteria for this review. Two studies (40%) reported findings of a single centre mannequin trial, one (20%) of a single centre cadaveric trial, and two (40%) were case series. Cohen's Kappa for the first and second round of screening was 0.904 and 0.674 respectively. Although several devices have been manufactured worldwide, the LifeVac© has been most extensively studied, with a combined dislodgement success rate of 94.3% on first attempt. However, certainty of evidence for the primary outcome was evaluated as very low. CONCLUSIONS: There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations.