Medical Examiner Reports Research Articles

The Political Economy of Death: Do Coroners Perform as well as Medical Examiners in Determining Suicide?

The determination of death in the United States can have strong financial implications. For example, a declaration of suicide can nullify life insurance benefits. However, the intent of death may be made by an elected official who is not required to have any medical training. Medical examiners and coroners determine cause of death when the death is sudden, violent, or untimely. Consequently, these officials can affect counts of sudden infant death syndrome, homicide, and suicide in a state. This paper uses a difference-in-differences model to estimate the effect of elected coroners versus appointed medical examiners on a state’s suicide rate. Elected coroners need not receive training in 13 states, must receive initial and continuous training in 16 states, and are required to be physicians in 4 states. We exploit state policy changes to the minimum required training elected coroners must complete. Data on the underlying intent of death is collected from the CDC Wonder mortality files from 1968 - 2016. We find strong evidence that states with a centralized medical examiner reports between 11 - 16 percent higher rate of suicides than coroner controlled states. Likewise, coroner states with a state medical examiner report a similar increase in suicide rates of 11 percent.

When bathing leads to drowning in older adults

Introduction: Bathing is the most problematic activity of daily living for aging adults, and the ability to perform it is influenced by physical capabilities that decrease with age. Drowning is an under-documented event related to bathing for older adults. This study investigates the circumstances of these tragedies, to prevent them. Methods: Census of 2005–2014 bathtub drownings in the province of Quebec (Canada) involving victims aged 65+. Coroner's reports were analyzed using a grid based on factors previously associated with bath-related drownings in literature, iteratively modified. Results: Among the 92 bathtub drowning victims inventoried, 42% were aged 65+. The average age of older victims is 79 (65–97, ±9 years). Main probable cause of drowning is a cardiac problem, although only 19% of victims had a medical history of heart disease. Most victims were alone in their apartment or residence when drowning occurred. Risky periods appear to be springtime, Sundays, and evenings. Despite expectations, relevant information about the physical environment is very scarce. Conclusions: At least 39 Quebecers, aged 65+, drowned in their bathtubs over a 10-year period. More older adults than children are victims of bathtub drownings in community-dwellings. It seems that bathing may induce heart distress, leading to an appreciable number of drownings. Practical implications: Since cardiac health problems are present in these deplorable events, promoting access to safety devices in the environment (emergency button, grab bars) and modified personal hygiene habits (bathing chair, showering) might be potential ways to prevent drowning and improve safety in older adults while they perform their personal hygiene, an essential activity for health and human dignity.

Coroner's report on the death of a baby from complications of herpes simplex virus type 1 infection

Coroner's report on the death of a baby from complications of herpes simplex virus type 1 infection

Aberration of Mind: Suicide and Suffering in the Civil War-Era South by Diane Miller Sommerville

Reviewed by: Aberration of Mind: Suicide and Suffering in the Civil War-Era South by Diane Miller Sommerville Brian Matthew Jordan (bio) Aberration of Mind: Suicide and Suffering in the Civil War-Era South. By Diane Miller Sommerville. (Chapel Hill: University of North Carolina Press, 2018. Pp. 448. $105.00 cloth; $34.95 paper; $27.99 e-book) In this exhaustively researched, methodologically innovative, and brilliantly executed book, historian Diane Miller Sommerville describes "the psychological and emotional damage of the Civil War on Southerners" (p. 12). In the author's sensitive hands, suicidal activity and the responses it stimulated in Southern society and culture yield new clues about the ways in which soldiers and veterans, wives and widows, the enslaved and newly-freed people wrestled with the period's "uncharted territory and unrelenting hardship" (p. 81). Allowing that motivations for suicide "are complicated, multilayered, and largely obscured," Sommerville explains that the Civil War was nonetheless "the social and cultural context" for many self-murders (p. 8–9). Building ties between the war's trauma, personal biographies, and individual "lived experience"—connections that historical actors were unequipped to make—the result is a much "fuller accounting of the war's costs on its participants" (p. 12). Aberration of Mind unapologetically joins a wave of neo-revisionist scholarship focused on the war's less than ennobling characteristics and enormous human consequences. Some critics have dismissed the so-called "dark turn" for purportedly misrepresenting "marginal" experiences as mainstream; others allege presentism. Sommerville smartly responds that "it is unreasonable to expect historians to refrain from considering links between psychiatric distress among soldiers and their experiences in military service, knowledge that we have at our disposal, simply because nineteenth-century Americans did not" (p. 272, n13). Further, she makes clear that taking the war's psychological and emotional scars seriously does not make an argument about their typicality, something that her necessarily qualitative evidence proscribes (p. 14–15). Sommerville's book is divided into three parts. The first considers [End Page 398] Confederate men and women during the war itself. While a "flurry of wartime suicides" became "less stigmatized than in earlier periods," at the same time, "few Southerners seemed willing or able to link the war to the mental distress of combatants" (pp. 37, 41). Though southern women were less inclined than men to commit suicide, they "appear to have been much more engaged in contemplating death as an exit from their suffering" on the home front, something Lost Cause narratives effaced after the war (p. 50–51). The second part examines African Americans in slavery and after emancipation. In the book's most powerful chapter, Sommerville maintains that using "slave suicide as prima facie evidence for resistance . . . risks ignoring or discounting slaves' suffering as a motive for suicide" (p. 97). Slaves resorted to taking their own lives because it "brought an immediate end to emotional or physical pain" (p. 99). Of necessity, southern whites denied the frequency of slave suicides—a pattern that persisted after the war, when African-Americans were deemed "constitutionally incapable of experiencing the same emotions as whites" (p. 147). Only whites could suffer or experience loss; instead, blacks were diagnosed with "mania," which some white southerners interpreted as the predictable result of emancipation. The final part probes the experiences of Confederate veterans and widows. Southern asylums teemed with new patients who not only witnessed the horrors of a brutal war but experienced the humiliating sting of defeat. Emasculated, Confederate men faced "financial ruin" and "dim job prospects" as they returned to civilian communities that seemed unable to comprehend their experiences (p. 179). At the same time, foisted into new and often disconcerting roles, their nerves frayed and emotions knotted, "thousands of southern women . . . collapsed in the wake of defeat" (p. 210). In the last chapter, Sommerville ties together the threads of her argument that the war invited a "change in the cultural meaning of suicide" (p. 48). The enormity of pain and suffering unleashed by the Civil War demanded that white southerners rework antebellum ideas about suicide. Obituaries and coroner's reports began to evince sympathy [End Page 399] for those who took their own lives. Edmund Ruffin was...

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015.

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City.Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences.Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20–24 and 75–79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions.Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

Medico-legal implications of toluene abuse and toxicity. Review of cases along with blood concentrations.

Toluene, a liquid aromatic hydrocarbon, is one of the most widely used industrial solvents, and is present in numerous paints, paint thinners, glues and other industrial and household products. It has become the most abused solvent in the world due to its rapid effects following inhalation. However, the numerous cases of fatal and non-fatal toluene-related intoxication reported in the literature have not yet been collected and discussed in the forensic setting. In this paper we aim to provide a review of the cases of toluene abuse and intoxication and the state of the art of the forensic toxicological analysis of toluene intoxications in the living and in the dead subject, from the early identification to the medico-legal interpretation of the toxicological result. We have identified a total of 45 papers regarding different aspects of toluene abuse, and divided them into three sections, namely sampling, storage and techniques of analysis, assessment in living subjects and post-mortem assessment. This article reports toluene concentrations in blood from 202 living subjects, 23 fatal toluene intoxications and 85 toluene related deaths. Toxicological results are discussed in relation to the clinical presentation (living subjects, including impaired drivers), and the manner of death according to the medical examiner reports (post-mortem examinations). Finally, we discuss the strengths and limitations of the review.

Coroner's Report from the Maternal &amp; Fetal Death Committee

Coroner's Report from the Maternal &amp; Fetal Death Committee

Medication Use in Women and Men With Sudden Unexpected Death.

In Wake County, NC, sudden unexpected death accounts for 10% to 15% of all natural deaths in individuals 18 to 64 years old. Medications such as aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and β-blockers are recommended in guidelines to reduce cardiovascular events and even sudden death (β-blockers). However, guidelines are often underpracticed, even in high-risk patients, with noted disparities in women. We assessed the relation between prescription of evidence-based medications and sudden unexpected death in Wake County, NC. We analyzed 399 cases of sudden unexpected death for the time period March 1, 2013 to February 28, 2015 in Wake County, NC. Medications were assessed from available medical examiner reports and medical records and grouped using the third level of the Anatomical Therapeutic Chemical Classification System (ATC) codes. This study was reviewed and exempt by the University of North Carolina's institutional review board. Among 126 female and 273 male victims, women were prescribed more medications overall than men (6.5 vs 4.3, P = 0.001); however, the use of guideline-directed therapies was not different between genders in the chronic conditions associated with sudden death. Overall, there was remarkably low use of evidence-based medications. Our findings highlight the need to improve prescribing of evidence-based medications and to further explore the relationship between undertreatment and sudden unexpected death.

What is the Evidence That Very Elderly Patients (Over 80) Benefit From the Current Treatment Protocols in Acute Coronary Syndromes? Do We Do More Harm Than Good?

Mr NB, a 91-year-old male, presented to the Emergency Department (ED) with collapse and lateral chest wall pain. While in the ED he developed inferior ST-elevation myocardial infarction (STEMI). He was transferred to the Cathlab, where his right coronary artery and left anterior descending were stented. When transferred to the Coronary Care Unit, his haemoglobin dropped from 150 g/dL to 63 g/dL. His blood pressure dropped and he became too unstable. A portable chest x-ray showed a ‘white out’ left lung, suggestive of haemothorax. The patient was palliated after discussion with the family. The causes of death on Coroner's report were complications of myocardial infarction and its treatment.

Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles

ABSTRACTObjective: There have been substantial reductions in motor vehicle crash–related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database.Methods: Instances of non-traffic injuries and fatalities in the United States to children 0–14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication.Results: Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths.Conclusions: Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.

Violent Death Reporting in Maryland: Demographic Variability in Data Completeness.

To analyze the completeness of precipitating circumstance information recorded in the Maryland Violent Death Reporting System and identify limitations that could affect the system's utility. We reviewed all violent deaths among Maryland residents for the years 2003 through 2014 (n = 19 161). We assessed the presence of precipitating circumstance data (abstracted from medical examiner and police reports) by manner of death and demographic characteristics. We further evaluated homicide records with multivariable regression. Demographic variation in circumstance reporting was most pronounced for homicide. Circumstances were known for 53.2% of homicide cases, and this percentage was lower among non-Latino Blacks (48.2%), males (50.7%), those aged 18 to 25 years (47.9%), those residing in jurisdictions with higher-than-average homicide rates (46.1%), and those who died outside in a public place (43.4%) or in a correctional facility (48.9%). With the exception of male gender, these factors were significantly associated with circumstance reporting when we controlled for demographic and situational variables. Circumstance reporting was least likely among groups most at risk for homicide in Maryland. Collection of circumstance data for the most affected groups should be strengthened to help develop better prevention strategies.

Medicolegal Death Scene Investigations after Natural Disaster- and Weather-Related Events: A Review of the Literature

The number of disaster-related deaths recorded by vital statistics departments often differs from that reported by other agencies, including the National Oceanic and Atmospheric Administration-National Weather Service storm database and the American Red Cross. The Centers for Disease Control and Prevention (CDC) has launched an effort to improve disaster-related death scene investigation reporting practices to make data more comparable across jurisdictions, improve accuracy of reporting disaster-related deaths, and enhance identification of risk and protective factors. We conducted a literature review to examine how death scene data are collected and how such data are used to determine disaster relatedness. Two analysts conducted a parallel search using Google and Google Scholar. We reviewed published peer-reviewed articles and unpublished documents including relevant forms, protocols, and worksheets from coroners, medical examiners, and death scene investigators. We identified 177 documents: 32 published peer-reviewed articles and 145 other documents (grey literature). Published articles suggested no consistent approach for attributing deaths to a disaster. Researchers generally depended on death certificates to identify disaster-related deaths; several studies also drew on supplemental sources, including medical examiner, coroner, and active surveillance reports. These results highlight the critical importance of consistent, accurate data collection during a death investigation. Review of the grey literature found variation in use of death scene data collection tools, indicating the potential for widespread inconsistency in data captured for routine reporting and public health surveillance. Findings from this review will be used to develop guidelines and tools for capturing disaster-related death investigation data.

Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013.

In Iraq, where Islamic State of Iraq and Syria (ISIS) and other groups have contributed to escalating violence in recent years, understanding the epidemiology of intentional firearm-related fatalities is essential for public health action. The Iraqi Ministry of Health (MoH; Baghdad, Iraq) compiles surveillance of fatal injuries in eight of Iraq's 18 governorates (Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya). Information is collected from coroner's reports and interviews with family members. Analysis was performed on intentional firearm-related injuries, excluding injuries from intentional self-harm or negligent discharges, that occurred during 2010-2013, a subset of all fatal injuries, and compared to previously published explosive-related fatalities. Overall, the dataset included 7,985 firearm-related fatalities. Yearly fatalities were: 2010=1,706; 2011=1,642; 2012=1,662; and 2013=2,975. Among fatalities, 86.0% were men and 13.7% women; 83.4% were adults and 6.2% children <18 years of age. Where age and sex were both known, men aged 20-39 years accounted for 56.3% of fatalities. Three "high-burden" governorates had the highest fatality rate per 100,000 population-Baghdad (12.9), Ninevah (17.0), and Al-Anbar (14.6)-accounting for 85.9% of fatalities recorded in the eight governorates. Most fatalities occurred in the street (56.3%), followed by workplace (12.2%), home (11.3%), and farm/countryside (8.4%). Comparing the ratio of firearm-related fatalities to explosives-related fatalities revealed an overall ratio of 2.8:1. The ratio in Baghdad more than doubled from 2.9 in 2010 to 6.1 in 2013; the highest ratios were seen outside the high-burden governorates. Firearm-related fatalities remained relatively stable throughout 2010-2012, and almost doubled in 2013, correlating with increased ISIS activity. Three governorates contributed the majority of fatalities and experienced the highest fatality rates; these saw high levels of conflict. Firearm-related fatalities disproportionately affected younger men, who historically are over-represented as victims and perpetrators of violence. More than one-half of fatalities occurred in the street, indicating this as a common environment for conflict involving firearms. Firearms appear to account for more fatalities in Iraq than explosives and largely accounted for escalating violence in Baghdad during the study period. The high ratio observed outside the high-burden governorates is reflective of very low numbers of explosives-related fatalities; thus, violence in these governorates is likely non-conflict-related. These observations provide valuable public health information for targeted intervention to prevent violence. Nerlander MP , Leidman E , Hassan A , Sultan ASS , Hussain SJ , Browne LB , Bilukha OO . Fatalities from firearm-related injuries in selected governorates of Iraq, 2010-2013. Prehosp Disaster Med. 2017;32(5):548-555.

Identifying preventable trauma death: does autopsy serve a role in the peer review process?

BackgroundMissing life-threatening injuries is a persistent concern in any trauma program. Autopsy is a tool routinely utilized to determine an otherwise occult cause of death in many fields of medicine. It has been adopted as a required component of the trauma peer review (PR) process by both the American College of Surgeons and the Pennsylvania Trauma Foundation. We hypothesized that autopsy would not identify preventable deaths for augmentation of the PR process. Materials and methodsA retrospective chart review using our institutional trauma registry of all trauma deaths between January 2012 and December 2015 was performed. Per the protocol of our level 1 center, all trauma deaths are referred to the medical examiner (ME) and reviewed as part of the trauma PR process. All autopsy results are evaluated with relation to injury severity score (ISS), trauma injury severity score (TRISS), nature of death, and injuries added by autopsy. ME reports are reviewed by the trauma medical director and referred back to the trauma PR committee if warranted. Trauma injury severity score methodology determines the probability of survival (Ps) given injuries identified. A patient with Ps of ≥0.5 is expected to survive their injuries. Cohorts were created based on when in the hospitalization death occurred: <24 h, or immediate death; 24 to 48 h, or early death; and death >48 h, or late death. A comparison was conducted between the ISS and Ps calculated during trauma workup and on autopsy using chi-square and Fischer's exact tests. ResultsA total of 173 patient deaths were referred to the ME with 123 responses received. Average length of stay was 2.61 d. Twenty-six patients had autopsy declined by the ME, 25 received an external examination only, and 72 received a full autopsy. Autopsy identified one case that was reconsidered in PR (P = 0.603) and added diagnoses, but not injuries, to one patient in the early death group (P = 1) and two in the late death group (P = 0.4921). No preventable cause of death was uncovered, and educational use was minimal. Autopsy did identify injuries in seven cases that were initially not consistent with expected mortality, but postmortem Ps was consistent with expected mortality (P = 0.254). Mean ISS was 34.48, and mean Ps was 0.275 among all patients. The most commonly identified injuries added by autopsy were rib injuries, lung injuries, and intracranial hemorrhage. ConclusionsAutopsy does not identify causes of preventable in an otherwise highly functioning trauma program and may be a poor use of institutional resources. In fact, it adds few diagnoses when death occurs after a full trauma assessment has had time to take place. Autopsy may be of use to identify protocol failure in maturing trauma programs, to give answers to grieving families and in select situations where death was unanticipated even after a full evaluation took place.

The pharmacist's role in overdose: Using mapping technologies to analyze naloxone and pharmacy distribution

ObjectivesTo present preliminary research using geographic information system (GIS) mapping as a tool that can be integrated into pharmacy practice to increase access to and utilization of pharmacy-based interventions, including the distribution of naloxone. MethodsOverdose death data was collected from medical examiner reports in an online database, and pharmacies carrying and distributing naloxone were determined by ZIP Code Tabulation Areas (ZCTAs) in Allegheny County, PA. The distribution of overdose death rates was analyzed in relation to naloxone-carrying pharmacies and all licensed pharmacies in the county with the use of GIS mapping. ResultsEighty-seven ZCTAs were included. Of 322 active licensed pharmacies, 28 pharmacies were confirmed to carry and distribute naloxone. The number of overdose deaths in ZCTAs that have naloxone-distributing pharmacies was significantly higher than the average number of deaths in all ZCTAs in Allegheny County: 7.38 deaths versus 4.84 deaths, respectively (P = 0.021). ConclusionThis report illustrates the value of GIS mapping in monitoring the impact of overdose death prevention efforts, including the availability of naloxone in pharmacies. Analysis of these data over the next 5 years will provide valuable information on the potential impact of naloxone-distributing pharmacies on overdose rates, which, in turn, will inform pharmacists and pharmacy organizations on the value of carrying naloxone in pharmacies and inform local communities of its availability.

Relation of Household Income to Incidence of Sudden Unexpected Death in Wake County, North Carolina

The incidence of out-of-hospital sudden unexpected death (OHSUD) in a racially and socioeconomically diverse population has been inadequately studied. We collated all OHSUDs over a 24-month period among 18- to 64-year olds in Wake County, North Carolina, to investigate geographic and socioeconomic disparity in incidence of OHSUD. An electronic query of Wake County Emergency Medical Services (EMS) identified all EMS attended out-of-hospital deaths. After excluding trauma, expected deaths, and deaths occurring in non-free-living subjects, medical records and medical examiner's reports were reviewed by a committee of cardiologists to make the determination of OHSUD. Victims were geocoded to census tracts, and demographic and socioeconomic data were obtained from the 2014 American Community Survey and 2010 US Census. Incidence was examined by sociodemographic group with univariate analysis and multivariable regression. There were 397 OHSUDs, and 53% of census tracts had >1 event. The incidence of OHSUD was 64 of 100,000; 107 of 100,000 among blacks; and 60 of 100,000 among whites. Census tracts with >1 OHSUD had a higher population of blacks, a greater proportion unmarried, a lower median household income, and a greater proportion residing in a rural area. Only median household income remained a significant predictor of OHSUD after adjustment in multivariable analysis. Low median household income of a community portends a higher incidence of sudden death. In conclusion, interventions to reduce the incidence of sudden death need to be developed with these specific communities in mind.

Increases in Fentanyl-Related Overdose Deaths - Florida and Ohio, 2013-2015.

In March and October 2015, the Drug Enforcement Administration (DEA) and CDC issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl (IMF), as a threat to public health and safety (1,2). IMF is pharmacologically similar to pharmaceutical fentanyl (PF), but is unlawfully produced in clandestine laboratories, obtained via illicit drug markets, and includes fentanyl analogs. Fentanyl is a synthetic opioid 50-100 times more potent than morphine and approved for the management of surgical/postoperative pain, severe chronic pain, and breakthrough cancer pain.* DEA's National Forensic Laboratory Information System (NFLIS) collects drug identification results from drug cases analyzed by federal, state, and local forensic laboratories throughout the United States.(†) In 2014, 80% of fentanyl submissions (i.e., drug products obtained by law enforcement that tested positive for fentanyl) in NFLIS were identified from 10 states, including Florida and Ohio (2), and seven of these 10 states reported sharp increases in fentanyl-related overdose deaths (fentanyl deaths) (3). This report presents findings of increased fentanyl deaths during 2013-2015 from investigations conducted by the University of Florida and the Ohio Department of Public Health, in collaboration with CDC. Analyses examined the association between trends in fentanyl-related law enforcement submissions and fentanyl deaths and describes groups at risk for fentanyl death using medical examiner and coroner reports. The marked increases in fentanyl death in Florida and Ohio during 2013-2015 were closely associated with parallel increases in fentanyl submissions, with the largest impact on persons who use heroin, consistent with reports that IMF is commonly mixed with or sold as heroin (1,4). In Ohio, circumstances associated with fentanyl deaths included a current diagnosed mental health disorder(§) and recent release from an institution such as a jail, rehabilitation facility, or hospital.

Identifying heat-related deaths by using medical examiner and vital statistics data: Surveillance analysis and descriptive epidemiology — Oklahoma, 1990–2011

ObjectivesApproximately 660 deaths occur annually in the United States associated with excess natural heat. A record heat wave in Oklahoma during 2011 generated increased interest concerning heat-related mortality among public health preparedness partners. We aimed to improve surveillance for heat-related mortality and better characterize heat-related deaths in Oklahoma during 1990–2011, and to enhance public health messaging during future heat emergencies. MethodsHeat-related deaths were identified by querying vital statistics (VS) and medical examiner (ME) data during 1990–2011. Case inclusion criteria were developed by using heat-related International Classification of Diseases codes, cause-of-death nomenclature, and ME investigation narrative. We calculated sensitivity and predictive value positive (PVP) for heat-related mortality surveillance by using VS and ME data and performed a descriptive analysis. ResultsDuring the study period, 364 confirmed and probable heat-related deaths were identified when utilizing both data sets. ME reports had 87% sensitivity and 74% PVP; VS reports had 80% sensitivity and 52% PVP. Compared to Oklahoma's general population, decedents were disproportionately male (67% vs. 49%), aged ≥65 years (46% vs. 14%), and unmarried (78% vs. 47%). Higher rates of heat-related mortality were observed among Blacks. Of 95 decedents with available information, 91 (96%) did not use air conditioning. ConclusionsLinking ME and VS data sources together and using narrative description for case classification allows for improved case ascertainment and surveillance data quality. Males, Blacks, persons aged ≥65 years, unmarried persons, and those without air conditioning carry a disproportionate burden of the heat-related deaths in Oklahoma.

Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults.

This study evaluates the potential association of vaccination and death in the Vaccine Safety Datalink (VSD). The study cohort included individuals ages 9 to 26 years with deaths between January 1, 2005, and December 31, 2011. We implemented a case-centered method to estimate a relative risk (RR) for death in days 0 to 30 after vaccination.Deaths due to external causes (accidents, homicides, and suicides) were excluded from the primary analysis. In a secondary analysis, we included all deaths regardless of cause. A team of physicians reviewed available medical records and coroner's reports to confirm cause of death and assess the causal relationship between death and vaccination. Of the 1100 deaths identified during the study period, 76 (7%) occurred 0 to 30 days after vaccination. The relative risks for deaths after any vaccination and influenza vaccination were significantly lower for deaths due to nonexternal causes (RR 0.57, 95% confidence interval [CI] 0.38-0.83, and RR 0.44, 95% CI 0.24-0.80, respectively) and deaths due to all causes (RR 0.72, 95% CI 0.56-0.91, and RR 0.44, 95% CI 0.28-0.65). No other individual vaccines were significantly associated with death. Among deaths reviewed, 1 cause of death was unknown, 25 deaths were due to nonexternal causes, and 34 deaths were due to external causes. The causality assessment found no evidence of a causal association between vaccination and death. Risk of death was not increased during the 30 days after vaccination, and no deaths were found to be causally associated with vaccination.

An estimate of the effectiveness of an in-vehicle automatic collision notification system in reducing road crash fatalities in South Australia

ABSTRACTObjectives: The aim of this study was to estimate the potential effectiveness of an in-vehicle automatic collision notification (ACN) system in reducing all road crash fatalities in South Australia (SA).Methods: For the years 2008 to 2009, traffic accident reporting system (TARS) data, emergency medical services (EMS) road crash dispatch data, and coroner's reports were matched and examined. This was done to initially determine the extent to which there were differences between the reported time of a fatal road crash in the mass crash data and the time EMS were notified and dispatched. In the subset of fatal crashes where there was a delay, injuries detailed by a forensic pathologist in individual coroner's reports were examined to determine the likelihood of survival had there not been a delay in emergency medical assistance.Results: In 25% (N = 53) of fatalities in SA in the period 2008 to 2009, there was a delay in the notification of the crash event, and hence dispatch of EMS, that exceeded 10 min. In the 2-year crash period, 5 people were likely to have survived through more prompt crash notification enabling quicker emergency medical assistance. Additionally, 3 people potentially would have survived if surgical intervention (or emergency medical assistance to sustain life until surgery) occurred more promptly.Conclusions: The minimum effectiveness rate of an ACN system in SA with full deployment is likely to be in the range of 2.4 to 3.8% of all road crash fatalities involving all vehicle types and all vulnerable road users (pedestrians, cyclists, and motorcyclists) from 2008 to 2009. Considering only passenger vehicle occupants, the benefit is likely to be 2.6 to 4.6%. These fatality reductions could only have been achieved through earlier notification of each crash and their location to enable a quicker medical response. This might be achievable through a fully deployed in-vehicle ACN system.