Survival After Ditching in Motorized Aircraft, 1989-2022.

INTRODUCTION: Although an unintended aircraft landing on water (referred to as ditching) is a rare event, the potential for occupant injury/fatality increases immediately following the event due to adverse conditions. However, to date, few studies have addressed the subject. Herein, ditching events and post-ditching survival were investigated.METHODS: Ditchings (1982-2022) in the United States were identified from the National Transportation Safety Board database. Occupant injury severity, aircraft type, pilot experience, flight conditions, and number of occupants were extracted. Poisson distribution, the Chi-squared test (2-tailed), Mann-Whitney U test, and Kruskal-Wallis one-way analysis of variance were employed.RESULTS: A total of 96 ditchings were identified. A systematic survey was hampered by the lack of a standardized reporting matrix in the reports. In total, 77 reports were included in the analysis. Across all ditchings, 128 of 169 (76%) occupants survived ditching and were rescued. Importantly, the initial ditching event was survived by 95% of all occupants. However, 32 (19%) occupants died post-ditching by drowning (21/32 cases) or for undetermined reasons. Considering probability per ditching event, in 26 (34%) of all ditchings, one or more occupants was/were fatally injured.DISCUSSION: Initial survival of the emergency ditching is high. Drowning was the leading cause of death after ditching and reduced the overall survival to 76%. Further investigation is needed to identify risk factors for fatal outcomes and/or improve probability of survival after ditching.Schick VC, Boyd DD, Hippler C, Hinkelbein J. Survival after ditching in motorized aircraft, 1989-2022. Aerosp Med Hum Perform. 2024; 95(5):254-258.

Demographic analysis of the suicide method by gender and age of the deceased between 2001 and 2010. / Analiza demograficzna metody samobójstwa z uwzglednieniem plci oraz wieku zmarlych w latach 2001-2010.

Aim: AAnalysis of the choice of suicide method by gender and age of the deceased. Material and methods: The study presented here was based on a retrospective analysis of autopsy reports from the years 2001-2010 in the Department of Forensic Medicine of the Jagiellonian University Collegium Medicum in Kraków. The basis of the research work conducted was the collection and extensive analysis of cases of suicide deaths. Subsequently, a preference analysis of the choice of suicide method was conducted, taking into account the age and gender of the deceased. The statistical analysis performed used logistic regression in Excel's XLSTAT as an analysis tool. Results: A total of 2,073 suicide cases were collected from the time frame under discussion. The predominant method of suicide was hanging (1524 cases, 1329 men and 195 women), the second most common method was jumping from the roof or window of a high floor of a building (jumping from heights; 171 cases, 100 men, 71 women). A statistically significant correlation of suicide method with gender was found for: hanging [odds ratio (OR) male (M) vs. female (F) = 3. 4; confidence interval (CI) = 2.7-4.3; p0.001]; drowning [OR: M/F =4.1; CI = 2.6-6.4; p0.001]; jumping from heights [OR: M/F=4.1; CI=2.9-5.7; p0.001] and poisoning [OR: M/F=3.2; CI = 2.1-4.9]. Suicide with the use of firearms occurred exclusively in the case of men (40 cases). The age of the victims correlated with the method of committing suicide by jumping from heights [0R=0.98; CI=0.97-0.99; p0.001] and rail suicide [OR=0.98; CI=0.96-0.99; p0.001]. Conclusions: The study revealed that both age and gender have a significant impact on the choice of suicide method. According to available epidemiological data and the authors' predictions, a predominance of male over female sex was observed in the case of hanging, while jumping from heights was relatively more often chosen by women. The elderly were less likely to choose jumping from heights and rail suicide.

[Epidemic characteristics and trend analysis of major injuries deaths among children and adolescents in Jiangsu Province from 2012 to 2021].

Objective: To understand the situation and epidemic characteristics of injury deaths among children aged 5 to 24 years in Jiangsu Province from 2012 to 2021 and the trend of annual changes. Methods: The main injury mortality data of children and adolescents was collected, and the crude and standardized mortality rates of road traffic accidents, drowning, suicide, and accidental falls among children and adolescents over a decade and the annual average percentage of change (AAPC) were calculated. The main injury mortality characteristics and trends of children and adolescents of different age groups and genders were analyzed. Results: The total number of injury deaths among 5 to 24 adolescents in Jiangsu Province was 16 052, with a standardized mortality rate of 9.58/100 000. There was no significant trend in the overall standardized mortality rate of injuries (AAPC=-3.450%, P=0.055). The standardized mortality rate of road traffic injuries among children and adolescents showed a decreasing trend over the past decade, with statistical significance (AAPC=-9.406%, P<0.001). The standardized suicide mortality rate showed an upward trend over the past decade, with statistical significance (AAPC=9.000%, P=0.001). The overall injury mortality rate showed an upward trend with age. Suicide rates in males and females were on the rise and both have statistical significance (AAPC=9.420% and AAPC=9.607%, both P<0.05). The standardized mortality rates of female traffic accidents, drowning, and male traffic accidents showed a decreasing trend and were statistically significant (AAPC for female traffic accidents=-7.364%, AAPC for female drowning=-5.352%, and AAPC for male traffic accidents=-10.242%, all P<0.05). The standardized mortality rate of urban and rural traffic accidents showed a decreasing trend and was statistically significant(AAPC=-7.899% and AAPC=-9.421%, both P<0.001). The standardized suicide mortality rate showed an upward trend and statistical significance (AAPC=11.009% and AAPC=7.528%, both P<0.05). Conclusions: The overall injury situation of children and adolescents in Jiangsu Province improved in the past decade from 2012 to 2021, but the suicide mortality rate was on the rise. It is necessary to focus on the mental health issues of this age group and to strengthen the prevention and control of suicide among children and adolescents, in Jiangsu.

Rate of Aquatic and Maritime Drowning Deaths After US-Mexico Border Wall Height Increase.

This study assesses migratory drowning deaths along the southwest border of the US before and after the increase in border wall height.

Prevención del ahogamiento desde la educación para la salud escolar. Evaluación del proyecto piloto SOS 112 / Drowning prevention through school health education. Evaluation of the SOS 112 pilot project

FUNDAMENTOS: El ahogamiento representa una de las principales causas de mortalidad infantil. Los incidentes acuáticos sonprevenibles y deben ser abordados desde la educación para la salud. El objetivo de este estudio fue evaluar un programa educativoen alumnado de ocho años basado en una canción con contenido para la prevención del ahogamiento. MÉTODOS: Se realizó un estudio piloto de viabilidad que incluyó a cuarenta y seis niños/as escolarizados en un centro público deSantiago de Compostela (A Coruña, España), siendo desarrollado en tres fases. En el primer paso, un grupo de expertos y músicoscrearon el contenido educativo y la canción. En segundo lugar, se elaboró la herramienta de evaluación y, finalmente, se implementóel programa basado en el reconocimiento de las banderas, en cómo ayudar en un ahogamiento, en las actitudes seguras para elbaño y en información sobre el teléfono de emergencias 112. El porcentaje de respuestas correctas antes y después de la intervencióneducativa se compararon utilizando la prueba de McNemar. RESULTADOS: Aproximadamente la mitad de los niños/as desconocía el significado de las banderas. Después de la audición dela canción, todos los escolares identificaron el significado de la bandera roja y más del 90% reconoció la bandera verde y amarilla(p<0,001). Antes de la intervención, los niños identificaron correctamente, en promedio, el 75,3% de los pictogramas de actitudesacuáticas seguras. Esta percepción de actitudes seguras aumentó significativamente postintervención (p<0,001), reconociendo el86,4% de las conductas correctas. La puntuación general de seguridad del agua también mejoró significativamente después de laintervención un 22,7% (p<0,001). CONCLUSIONES: La canción educativa es un medio para favorecer el aprendizaje de las señales y conceptos sobre la prevencióndel ahogamiento infantil.(AU)

BACKGROUND: Drowning represents one of the main causes of child mortality. Water-related incidents are preventable and shouldbe addressed through health education. The aim of this study was to evaluate an educational program for eight-year-old studentsbased on a song with content on drowning prevention. METHODS: A feasibility pilot study was conducted, including forty-six children enrolled in a public school in Santiago de Compostela(A Coruña, Spain). The study was developed in three phases. In the first step, a group of experts and musicians created the educationalcontent and the song. Secondly, the evaluation tool was developed, and finally, the program was implemented based on flag recognition,how to help in a drowning situation, safe swimming attitudes, and information about the emergency phone number 112. The percentageof correct responses by children before and after the educational intervention were compared using the McNemar test. RESULTS: Approximately half of the children were unaware of the meaning of the flags. After listening to the song, all studentsidentified the meaning of the red flag, and over 90% recognized the green and yellow flags (p<0.001). Before the intervention, childrencorrectly identified, on average, 75.3% of the safe water attitude pictograms. This perception of safe attitudes significantly increasedpost-intervention (p<0.001), with recognition of 86.4% of the correct behaviours. The overall water safety score also significantlyimproved by 22.7% after the intervention (p<0.001). CONCLUSIONS: The educational song is a resource to promote the learning of signals and concepts related to child drowningprevention.(AU)

Potential of photoautotrophic microbial organisms in deciphering forensic issues.

In forensic pathology, solving the crime mystery of death due to drowning still remains a challenging issue. The amalgamation of autopsy findings and comparative study of diatoms recovered from the victim's body organs and suspected drowning site help to decipher the cause of death due to drowning or post-mortem immersion. Since the correct interpretation of the cause of death is an important criterion to provide justice to the victim, therefore, the main objective of our study is to throw light on the application of photoautotrophic micro-algal organisms, known as Diatoms, in solving seven cases of victims whose bodies were recovered from various water bodies of Himachal Pradesh, India. The diatom test was conducted by using reverse aqua regia solution (15 ml HNO3: 5 ml HCl) on the bone marrow extracted from the organs and water samples respectively. The informative outcomes of the experimental analysis demonstrated that the diatom test acts as a beneficial adjunct to solve drowning-related crimes where the exact cause of death remains hidden even after performing an autopsy of the victims. The protocol followed by the authors can be used conveniently to recover diatoms from bone marrow as well as from water samples. Our results showed that the maximum cases were of death due to accidental drowning but for one case of suicidal drowning in extremely cold water.

Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study.

BACKGROUND: Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients' prognosis remains poorly explored in Intensive Care Units (ICUs) patients. METHODS: We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. RESULTS: Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03-3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51-52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03-1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11-1.3], p < 0.0001). CONCLUSIONS: In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis.

Drowning prevention: turning the tide on a leading killer.

Drowning is a leading killer, particularly of children and young adults, yet has been greatly neglected. Despite accounting for a higher number of deaths than many other substantial public health issues, drowning has not benefitted from the targeted attention it requires, which is particularly tragic because low cost and effective drowning prevention interventions exist. Therefore, the recent UN General Assembly's adoption of a resolution on global drowning prevention is a historic first, and offers an exciting opportunity by providing a comprehensive framework and a practical roadmap that a range of actors and sectors, including governments, can follow to address the challenge of drowning prevention.

Land-traffic crash leading to passenger vehicle submersion, drowning and other fatal injuries: A 44-year study based on records from the Finnish Crash Data Institute.

BACKGROUND: Land motor traffic crash (LMTC) -related drownings are an overlooked and preventable cause of injury death. The aim of this study was to analyze the profile of water-related LMTCs involving passenger cars and leading to drowning and fatal injuries in Finland, 1972 through 2015. MATERIALS AND METHODS: The database of the Finnish Crash Data Institute (FCDI) that gathers detailed information on fatal traffic accidents provided records on all LMTCs leading to drowning during the study period and, from 2002 to 2015, on all water-related LMTCs, regardless of the cause of death. For each crash, we considered variables on circumstances, vehicle, and fatality profiles. RESULTS: During the study period, the FCDI investigated 225 water-related LMTCs resulting in 285 fatalities. The majority of crashes involved passenger cars (124), and the cause of death was mostly drowning (167). Only 61 (36.5%) fatalities suffered some-generally mild-injuries. The crashes frequently occurred during fall or summer (63.7%), in a river or ditch (60.5%), and resulted in complete vehicle's submersion (53.7 %). Half of the crashes occurred in adverse weather conditions and in over 40% of the cases, the driver had exceeded the speed limit. Among drivers, 77 (68.8%) tested positive for alcohol (mean BAC 1.8%). CONCLUSION: Multidisciplinary investigations of LMTCs have a much higher potential than do exclusive police and medico-legal investigations. The risk factors of water-related LMTCs are similar to those of other traffic crashes. However, generally the fatal event in water-related LMTC is not the crash itself, but drowning. The paucity of severe physical injuries suggests that victims' functional capacity is usually preserved during vehicle submersion. Practical Applications: In water-related LMTCs, expansion of safety measures is warranted from general traffic-injury prevention to prevention of drowning, including development of safety features for submerged vehicles and simple self-rescue protocols to escape from a sinking vehicle.

Persistent Racial/Ethnic Disparities in Fatal Unintentional Drowning Rates Among Persons Aged ≤29 Years - United States, 1999-2019.

During 1999-2019, a total of 81,947 unintentional drowning deaths occurred in the United States (1). Drowning is one of the three leading causes of unintentional injury death among persons aged ≤29 years and results in more deaths among children aged 1-4 years than any other cause except birth defects (2). Drowning death rates have decreased since 1990 (declining by 57% worldwide and by 32% in the United States) (3). However, because of racial/ethnic disparities in drowning risk, rates remain high among certain racial/ethnic groups, particularly American Indian or Alaska Native (AI/AN) persons and Black or African-American (Black) persons (4). To assess whether decreasing drowning death rates have been accompanied by reductions in racial/ethnic disparities, and to further describe these disparities by age group and setting, CDC analyzed U.S. mortality data during 1999-2019. The drowning death rate among persons aged ≤29 years was 1.3 per 100,000 population. The rate per 100,000 among AI/AN persons (2.5) and Black persons (1.8) was higher than among all other racial/ethnic groups and was 2.0 and 1.5 times higher than among White persons (1.2). Racial/ethnic disparities in drowning death rates did not significantly decline for most groups, and the disparity in rates among Black persons compared with White persons increased significantly from 2005-2019. Drowning death rates are associated with persistent and concerning racial/ethnic disparities. A better understanding of the factors that contribute to drowning disparities is needed. Implementing and evaluating community-based interventions, including those promoting basic swimming and water safety skills, among disproportionately affected racial/ethnic groups could help reduce drowning disparities.

Analysis of fatal unintentional drowning in Australia 2008-2020: implications for the Australian Water Safety Strategy.

OBJECTIVE: To examine temporal trends in drowning in Australia against targets set in the Australian Water Safety Strategy (AWSS) 2008-2020 and to inform the development of the next iteration of the Strategy. METHODS: A national analysis of unintentional fatal drowning rates per 100,000 population over 16 years (2004/05-2019/20) was conducted. Baseline rates (three-year average 2004/05-2006/07) were compared to the current three-year average (2017/18-2019/20) by sex, age group, drowning location and jurisdiction. RESULTS: The overall rate of unintentional fatal drowning during the period decreased by 28%. Substantial reductions were observed in children 0-4 years (-63%) and 5-14 years (-56%). Progress has been less pronounced among people aged 75 years and over (-11%) and 15-24-year-olds (-14%). All locations and jurisdictions recorded reductions, aside from rocks (+46%). CONCLUSIONS: Although the strategy fell short of its aspirational target of a 50% reduction in drowning by the year 2020, this target was exceeded in key age groups, including children. Implications for public health: The AWSS is a powerful tool to align drowning prevention sector actions to agreed objectives. Forthcoming strategies must take into consideration demographic and social change, areas where limited progress has been made and the latest evidence to guide future priorities.

Day care as a strategy for drowning prevention in children under 6 years of age in low- and middle-income countries.

BACKGROUND: Drowning is responsible for an estimated 320,000 deaths a year, and over 90% of drowning mortality occurs in low- to middle-income countries (LMICs), with peak drowning rates among children aged 1 to 4 years. In this age group, mortality due to drowning is particularly common in rural settings and about 75% of drowning accidents happen in natural bodies of water close to the home. Providing adequate child supervision can protect children from drowning, and organized formal day care programs could offer a way to achieve this. OBJECTIVES: Primary objective • To assess the effects of day care programs for children under 6 years of age on drowning-related mortality or morbidity, or on total drowning accidents (fatal and non-fatal), in LMICs, compared to no day care programs or other drowning prevention interventions Secondary objectives • To assess the effects of day care programs in LMICs for children under 6 years of age on unsafe water exposure • To assess safety within these programs (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) • To assess the incidence of unintentional injury within these programs • To describe the cost-effectiveness of such programs, in relation to averted drowning-related mortality or morbidity SEARCH METHODS: On November 23, 2019, and for an update on August 18, 2020, we searched MEDLINE (PubMed), Embase, CENTRAL, ERIC, and CINAHL, as well as two trial registries. On December 16, 2019, and for an update on February 9, 2021, we searched 12 other resources, including websites of organizations that develop programs targeted to children. SELECTION CRITERIA: We included randomized, quasi-randomized, and non-randomized controlled studies (with explicitly listed specific study design features) that implemented formal day care programs as a single program or combined with additional out-of-day care components (such as educational activities aimed at preventing injury or drowning or early childhood development activities) for children of preschool age (below 6 years of age) in LMICs for comparison with no such programs or with other drowning prevention interventions. Studies had to report at least one outcome related to drowning or injury prevention for the children enrolled. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection and data extraction, as well as risk of bias and GRADE assessment. MAIN RESULTS: Two non-randomized observational studies, conducted in rural Bangladesh, involving a total of 252,631 participants, met the inclusion criteria for this review. One of these studies compared a formal day care program combined with parent education, playpens provided to parents, and community-based activities as additional out-of-day care components versus no such program. Overall we assessed this study to be at moderate risk of bias (moderate risk of bias due to confounding, low risk of bias for other domains). This study showed that implementation of a formal day care program combined with parent education, provision of playpens to parents, and community-based activities, in a rural area with a high drowning incidence, likely reduces the risk of death from drowning over the study period of 4 years and 8 months compared to no day care program (hazard ratio 0.18, 95% confidence interval [CI] 0.06 to 0.58; 1 study, 136,577 participants; moderate-certainty evidence). Drowning morbidity (non-fatal drowning resulting in complications), total drowning (fatal and non-fatal), unsafe water exposure, and program safety (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) were not reported, nor was the incidence of other unintentional injuries. Cost-effectiveness was reported as 812 USD (95% CI 589 to 1777) per disability-adjusted life-year averted as a consequence of drowning (moderate-certainty evidence). The second study compared day care programs with or without playpens provided to parents as an additional component versus only playpens provided to parents as an alternative drowning prevention intervention. Overall we assessed the study to be at critical risk of bias because we judged bias due to confounding to be at critical risk. As the certainty of evidence was very low, we are uncertain about the effects on drowning mortality rate of implementing a day care program compared to providing playpens (rate ratio 0.25, 95% CI 0.15 to 0.41; 1 study; 76,575 participants; very low-certainty evidence). Likewise, we are uncertain about the effects of a day care program with playpens provided as an additional component versus playpens provided alone (rate ratio 0.06, 95% CI 0.02 to 0.12; 1 study, 45,460 participants; very low-certainty evidence). The other outcomes of interest - drowning morbidity, total drowning, unsafe water exposure, program safety, incidence of other unintentional injuries, and cost-effectiveness - were not reported. AUTHORS' CONCLUSIONS: This review provides evidence suggesting that a day care program with additional out-of-day care components such as community-based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.

Epidemiology of unintentional fatal drowning among migrants in Australia.

OBJECTIVE: This study aimed to describe the epidemiology and risk factors contributing to drowning among migrants in Australia. METHODS: A total population retrospective epidemiological study of unintentional drowning deaths in Australia between 1 July 2009 and 30 June 2019 of people born outside Australia (migrants). Cases were extracted from the National Coronial Information System. Descriptive statistics, chi-square and relative risk were calculated. Crude drowning rates were based on country of birth and population in Australia. RESULTS: There were 572 migrant deaths over the study period, 28.9% of total drowning deaths, 82.9% were male. Twenty-one per cent were aged 25-34 years and 40.8% had lived in Australia for 20+ years. Migrants at highest risk of drowning were from: South Korea (2.63/100,000 95%CI: 0.85-8.25), Taiwan (2.29/100,000 95%CI: 0.27-13.44), and Nepal (2.15/100,000 95%CI: 0.23-11.55). Migrants were more likely to drown when around rocks (p<0.001) compared with Australian-born people, who most frequently drowned in rivers (p<0.001). CONCLUSIONS: Migrants are not over-represented in drowning statistics. However, unique trends were found for drowning among migrants based on country of birth and length of time in Australia. Implications for public health: Holistic drowning prevention strategies and policies are required to effectively lower drowning risk among migrant communities.

Muertes en el buceo: un modelo de investigación multidisciplinar / Diving deaths: A multidisciplinary research model

El buceo es una de las actividades subacuáticas más practicadas en el litoral español. Los sistemas más comunes utilizados son el buceo con escafandra autónoma con circuito abierto, cerrado o semicerrado. Aunque hoy en día el buceo con escafandra autónoma se considera una práctica segura, cada año se describen nuevas muertes relacionadas con esta actividad. El ahogamiento es la principal causa de muerte, pero se han descrito otras, como la embolia gaseosa arterial, la enfermedad por descompresión, la enfermedad natural asociada y los traumatismos. Las autopsias de muertes relacionadas con el buceo son un gran desafío para cualquier patólogo forense, y es aconsejable poseer conocimientos sobre fisiopatología del buceo y experiencia en la práctica de técnicas de autopsia específicas. Colaborar con un equipo multidisciplinar proporciona información, evidencias y hallazgos patológicos suficientes para una investigación altamente calificada de los casos y poder resolver las principales cuestiones médico-legales

Diving is one of the most practiced underwater activities on the Spanish coast. The most common methods used in diving activities are SCUBA (self-contained underwater breathing apparatus), CCR (closed circuit rebreather) and SCR (semi-closed circuit rebreather). Although recreational diving is safe overall, diving accidents are potentially serious and even fatal. Despite all the precautions taken by divers, fatalities related to this activity are reported every year. Drowning is the main cause of death, but others have been described, such as arterial gas embolism, decompression sickness, natural pathology, and trauma. Autopsies of SCUBA diving-related deaths are a big challenge for any forensic pathologist. It is advisable to have some knowledge about diving physiopathology and experience in the practice of special autopsy techniques. Collaboration with a multidisciplinary team provides enough information, evidence and pathological findings for highly-qualified investigation of the incidents to be able to prevent similar incidents in the future

A forensic analysis on 53 cases of complex suicides and one complicated assessed at the Bureau of Legal Medicine of Milan (Italy).

Complex suicides are highly uncommon suicides in which multiple detrimental methods are used simultaneously or in chronological succession. We retrospectively analyzed through our database the 25512 autopsy reports registered at the Bureau of Legal Medicine of Milan in the last 27 years from 1993 until 2019, where 4498 suicides were documented. We assessed 53 cases of complex suicides and only one case of complicated suicide: for all of them we analyzed both data collected during the on-site investigation and the autopsy. In our case series, we identified a total number of 113 methods chosen and variably combined by the victims, which were classified into 17 categories. On the whole the most frequent association of suicide methods resulted in the combination of the plastic bag suffocation with inert gas inhalation (13 out of 53 complex suicides; 24.5%). We also analyzed our cases of simple suicides (1993-2019), to compare them with the complex suicides. In this study, we present a complete analysis regarding our cases of complex suicides, discussing the challenges and the interpretative issues which a forensic pathologist might deal with. A thorough on-site judicial inspection and a careful autopsy examination are crucial in such cases. Moreover, the clinical history of the victims and laboratory findings are supplemental elements to be necessarily considered to establish the actual manner of death and avoid any misinterpretations.

Factors associated with pediatric drowning admissions and outcomes at a trauma center, 2010-2017.

BACKGROUND: Drowning is a leading cause of preventable mortality and morbidity in children. Its high fatality rate and frequent severe sequelae (e.g. brain damage and permanent loss of functioning) place a premium on preventive efforts. METHODS: A retrospective analysis of patients ≤21 years of age admitted between 2010 and 2017 to a pediatric trauma center was conducted to identify factors associated with drowning admissions, fatal drowning, and severe outcome (ventilator use, ICU admission, or death). Outcomes were modeled and estimated by use of logistic regression and Poisson regression. RESULTS: Drowning accounted for 153/4931 (3.1%) trauma admissions between 2010 and 2017. The risk of death (13.1% vs. 1.5%, p < .01), and severe outcome (24.8% vs. 7.8%, p < .01) was significantly higher for drownings vs. other causes. All 20 drowning deaths occurred among children left unattended. In Poisson regression analysis, weekends, summer breaks, and hotter days were independently associated with a higher probability of drowning admissions. Additionally, in analyses excluding indicators of severity, the odds of severe outcome were higher for children age ≤ 2 years [adjusted odds ratio (AOR) = 3.88 95% CI (1.58, 9.53)], and injury downtime of >5 min or unknown length [AOR = 6.66 95% CI (2.74-16.15)]. Immediate intervention after the discovery was associated with ~70% lower odds of a severe outcome. CONCLUSIONS: Drowning admissions were both more severe and more often fatal compared to other pediatric injury causes of admission. Enhanced and targeted educational messages for parents of young children, focused on prevention behaviors on high-risk days and immediate bystander intervention, may reduce the occurrence and severity of these tragic accidents. TABLE OF CONTENTS SUMMARY: A retrospective multi-year cohort study to identify modifiable factors associated with drowning admissions, severe complications, and death from a large trauma registry database. WHAT'S KNOWN ON THIS SUBJECT: Drowning is a leading cause of unintentional injury that results in severe morbidity and a high rate of mortality. Children are disproportionately affected by drowning and have a higher risk of long term sequelae and death. WHAT THIS STUDY ADDS: This study identified high-risk populations and periods for drowning, the importance of supervision, and the effectiveness of immediate intervention in reducing unfavorable outcomes after drowning. It also highlights a need for heightened local intervention for drowning prevention.

Studying outcome predictors of drowning at the scene: Why do we have so few answers?

BACKGROUND: Identification of predictors of outcome at the scene of drowning events could guide prevention, care and resource utilization. This review aimed to describe where, what and how scene predictive factors have been evaluated in drowning outcome studies. METHODS: We reviewed studies reporting scene drowning predictors published between 2003 and 2019. Data extraction included study populations, data sources, predictor factors (victim, incident, rescue, resuscitation and hospital-related), outcome measures and type of analyses. RESULTS: Of 49 studies, 87.6% were from high-income countries, 57.1% used data from only one source (92.9% of these from either hospital or EMS), 73.5% included cases who received medical care and 53.1% defined outcomes as survival or death. A total of 78 different factors were studied; the most commonly studied group of factors described victim demographics, included in 42 studies (85.7%), followed by resuscitation factors, included in 30 studies (61.2%). Few studies described rescue (6.1%). The most frequent statistically significant single predictors of outcome known at the scene were submersion duration (evaluated in 19, predictor in 14) and age (evaluated in 31, predictor in 16). Only 38.7% of studies employed multivariable methods. CONCLUSIONS: Gaps to be addressed in drowning outcomes research include data from low- and middle-income countries, standardized definition of factors to allow evaluation across studies, inclusive study populations that can be generalized beyond those receiving medical care, study rescue and resuscitation factors, use of more meaningful outcomes (survival with good neurologic status) and advanced analyses to identify which factors are true predictors versus confounding variables.

WHO Guideline on the prevention of drowning through provision of day-care and basic swimming and water safety skills

This guideline addresses: provision of day-care for children under the age of 6 years and provision of basic swimming skills and water safety training to children aged 6 years and older. Developed following GRADE methodology, approved by the WHO Guideline Review Committee and intended for use by policy-makers and practitioners, the guideline issues strong recommendations in favour of both interventions for drowning prevention.

Fatal coastal drowning incidents: A 10-year review of body recovery times in New Zealand.

Despite drowning being a leading cause of unintentional injury worldwide, gaps in the data still exist. One area where limited data is available to guide lifeguards, police, search and rescue agencies, accident and forensic investigators, ocean scientists, and the coroner, is how far from the last known point (displacement) a missing person is likely to be found, and the time frame for this to occur. This lack of certainty can exacerbate the emotional toll on family, friends, and rescuers. This study aimed to describe body recovery times and displacement for fatal coastal drowning incidents in New Zealand. Using DrownBase™, the National Coronial Information System, and media reports, data were extracted for all fatal coastal-missing-person drowning incidents from 2008 to 2017. A total of 219 cases were selected. Almost all incidents involved males (92%) and minority groups (e.g., Maori and Pasifika) were over-represented. Older adults (> 42 years) were more likely to be engaged in boating, whereas for younger adults (≤ 42 years), it was swimming. Most missing persons were described as good swimmers (51%) and wearing everyday clothing (48%), yet only 4% wore a lifejacket. Most incidents were observed (63%), and rescue was attempted in 86% of cases. Most bodies (58%) were recovered within 24h, and only 15% were not found (9%) or not reported (6%). Most missing persons (64%) were either found in the same location (57%) or <1km from where they entered the water (7%). The quality of on-scene data limited some analysis, and the results of this study may not apply to all aquatic locations. Improved data collection could inform real-time predictive modelling of where and when a missing person might be found. The involvement of forensic and ocean scientists in future study design to widen applicability to these domains is also recommended. Fewer lives would be lost to drowning, however, if safer practices were adopted when recreating or working in, on, or around water.