Circumstances Of Incidents Research Articles

Changes in Skiing and Snowboarding Injury Epidemiology and Attitudes to Safety in Big Sky, Montana, USA: A Comparison of 2 Cross-sectional Studies in 1996 and 2013.

BackgroundDespite a risk of harm, the past 20 years have seen dramatically increased participation in snow sports such as skiing, and particularly, snowboarding. This period has also seen revolutions in piste maintenance and paradigm developments in the use of safety equipment. Consequently, the numbers and characteristics of injury may be very different from those traditionally quoted.PurposeTo compare and evaluate the injury patterns among skiers and snowboarders in a North American ski resort in 1996 and 2013.Study DesignCross-sectional study; Level of evidence, 3.MethodsQuestionnaire-based cross-sectional studies were carried out independently in a North American ski resort between the dates of March 6 and April 11 in both 1996 and 2013. Demographic data and information about incident circumstances were collected from injured patients who visited the local on-site clinic. Data were compared statistically to assess for significant changes in injury characteristics between the 2 time periods.ResultsThe 1996 report consisted of 148 injured participants, and the 2013 study included 156 participants. Results from 2013 demonstrated significant increases in helmet use, the number of snowboarders injured, and shoulder injuries. Injury was also more likely in those aged 46 to 55 years, those never having had professional instruction, or those with rented equipment. Significant reductions were seen in those injured with other people close by and in the 36- to 45-year age group. Overall, the knee was the most commonly injured body part in both periods (1996: 31%, n = 38; 2013: 33%, n = 36), although upper limb injuries were predominant in snowboarders.ConclusionSnow sports injury characteristics of patients presenting to a ski resort medical clinic have changed between 1996 and 2013. These findings can be used to further inform safety recommendations and areas to target with further research.

Introducing a Low‐Head Dam Fatality Database and Internet Information Portal

AbstractLow‐head dams can cause dangerous currents near the downstream face of the structure. Fatalities at low‐head dams with such currents, often referred to as “drowning machines,” are poorly documented. This technical note presents a new database of fatalities at low‐head dams in the United States together with an interactive map and web‐based user interface. The primary purpose of the system is to raise awareness, generate interest, and educate the general public and decision makers regarding these dangerous structures and the need for remediation. The database was designed as a normalized relational database of event dates, severity, location, reporter, and other circumstances. The open‐access user interface allows the general public to browse fatal incidents by geographic location and to read incident circumstances. The system allows submission of new contributions from users including all metadata needed to characterize the incident. The database is structured to include documentation verifying each entry. The site can be viewed at http://dams.byu.edu/.

Epidemiology of dog bite, a potential source of rabies in Guilan, north of Iran

ObjectiveTo determine epidemiological aspects of dog bite in Guilan Province, north of Iran. MethodsAn analytical cross-sectional study was conducted on 1 643 cases of dog bites who presented at rabies vaccination centers in Guilan, Iran from June 2011 to May 2012. Data including demographic characteristics of dog bite cases, characteristics of biting dog, treatment and preventive measures carried out, and dog bite incident circumstances were collected. Independent t-test, ANOVA, Fisher exact test and chi-square test were used. ResultsDog bite incidences in men and women were 179.4 and 55 in 100 000 populations, respectively. Incidences in urban and rural were 72.8, and 181.9 in 100 000 population, respectively. The highest percentage of victims (20.1%) was in 20-29 years old age group. Majority of dogs (92%) were owned. Victims in the highest percentage (26.6%) were dog owners. Most of dog bites were occurred in houses (58.5%). Entering to the dog's guarding territory was the most common circumstances (27.6%). Injuries most commonly involved the lower extremities (51%). Rabies vaccine, rabies immunoglobulin, tetanus vaccine and tetanus immunoglobulin were administered for 100%, 23.2%, 74.8%, and 9.1%, respectively. There were significant differences between men and women in term of area and place of bite incidence and dog ownership (P < 0.05). Mean age differences among categories of dog ownership, dog bite circumstance, and bitted site of body were significant (P < 0.05). ConclusionsDesigning comprehensive educational programs to reduce dog bite incidence based on gender and age of target groups can be useful.

Elaborating the Correlates of Firearm Injury Severity: Combining Criminological and Public Health Concerns

This research addresses recent calls to incorporate multidisciplinary approaches in the study of firearm violence by utilizing an elaborated criminal events perspective to explore the correlates of firearm injury severity. A unique dataset of nonfatal firearm injury data are derived from official police reports, allowing the use of a medically validated measure of injury trauma in place of more typical injury indicators. The relative and collaborative contributions of criminological and public health indicators for explaining variation in levels of injury severity are assessed. Multinomial logit models suggest that critical injuries are more likely among older victims, victims who knew their assailants, and victims who refused to cooperate with police. Additionally, the likelihood of critical victim injuries decreased as the time to report an incident to the police increased. The strongest correlates were measures of incident circumstances and the number of gunshot wounds a victim received. In all, these results reveal that a combination of measures from both fields is needed to provide a deeper understanding of injury severity outcomes.

Three-Level Supply Chain Coordination under Disruptions Based on Revenue-Sharing Contract with Price Dependent Demand

Considering the market demand is stochastic and dependent on price, this paper shows that the revenue-sharing contract could coordinate a three-level supply chain consisting of one manufacturer, one distributor, and one retailer under normal environment. However, the original revenue-sharing contract cannot coordinate the supply chain under disruptions in circumstances of certain incidents leading to significant changes in market demand and causing additional deviation costs. To solve the problem, this essay introduces two improved forms of revenue-sharing contract: a mixed contract form based on a quantity discount policy and a pure form, which are characterized by antidisruption ability. The model of improved revenue-sharing contract is optimized when the market demand is in the additive form or in the multiplicative form with price dependent demand. Formulas are given to calculate the optimal contract parameters. Finally, this essay demonstrates the accuracy of the model of improved revenue-sharing contract with the help of numerical examples.

Occupational Injury and Fatality Investigations

The forensic evaluation of trauma in occupational injuries and fatalities can provide the benefit of a more thorough analysis of incident causation. Forensic nursing science applied during workplace investigations can assist investigators to determine otherwise unknown crucial aspects of the incident circumstances that are important to event reconstruction, the enforcement of occupational health and safety requirements, and the direction of workplace prevention initiatives. Currently, a medical and forensic medical knowledge gap exists in the subject-matter expertise associated with occupational accident investigations. This gap can be bridged with the integration of forensic nursing in the investigation of workplace fatalities and serious injuries.

Electrical Mark in Electrocution Deaths - A 20-Years Study

An electrical mark is one of the crucial morphological findings on the body of a person who received a fatal electric shock and it is often the only evidence of contact between the body and electricity. In cases where the electrical mark on the skin is absent, the cause of death is often established by exclusion of other possible causes and supported by circumstantial evidence. In our study, the data were obtained from autopsy reports of all persons whose cause of death was electrocution and whose post mortem examination was performed at the Department of Forensic Medicine and Criminology in Zagreb between 1991 and 2010. We collected the data on victim demographics and incident circumstances including sex, age, manner of death, alcohol concentration, place and time of death, and presence and site of the electric mark. A total of 89 electrocution cases were identified. An electrical mark was detected in 79% of the cases, whereas no detectable changes on the skin were in the remaining 21% of the cases. The entry wound was present in 43% of the cases, both entry and exit wounds were found in 20%, while in 16% of the cases with extensive burns neither entry nor exit point could be detected. Most victims of fatal electrocution were men aged between 20 and 50. Most cases were accidents (83%) and the rest were suicides (14%) or the manner of death was undetermined. Although inconsistently present on the victims' body, the electrical mark is of great diagnostic value as confirmative evidence in cases of suspected electrocution.

Localized Homicide Patterns and Prevention Strategies: A Comparison of Five Project Safe Neighborhood Sites

Research has produced a wealth of knowledge on the victims, offenders, and circumstances of homicide incidents. This research, however, is seldom tied to community-based homicide prevention initiatives. This article compares patterns of homicide across five Project Safe Neighborhood sites and presents an example of how homicide characteristics in local communities can be tied to specific local prevention strategies. Finally, the article concludes with a discussion of how homicide research can provide the first step in developing community-based, data-driven violence prevention programs.

Frequency and Causes of Nonbattle Injuries Air Evacuated from Operations Iraqi Freedom and Enduring Freedom, U.S. Army, 2001–2006

Medical information systems during past military deployments had limited injury surveillance capability as data were not accessible during deployments and did not capture causes of injury. This paper describes nonbattle injury (NBI) results from an ongoing surveillance program that identifies injury occurrences and causes during deployments for Operations Iraqi Freedom (Iraq) and Enduring Freedom (Afghanistan). U.S. Army soldiers medically air evacuated from Iraq (March 2003-December 2006) or Afghanistan (October 2001-December 2006) were identified from air evacuation records that provided demographics, casualty type, diagnosis, and patient history. For NBI cases, the patient history was used to identify and code injury cause, incident circumstances, and body region. Descriptive statistics were used to describe and compare NBIs evacuated from Iraq and Afghanistan. In all, 27,563 soldiers in Iraq and 4165 in Afghanistan were air evacuated. NBIs accounted for 35% and 36% of cases, respectively, and were the largest single category of evacuations for both operations. Distributions for leading categories of NBI diagnosis (fracture, inflammation/pain, and dislocation) and body region (back, knee, and wrist/hand) were similar for both operations. Leading NBI causes were the same for both operations-sports/physical training (19%-21%), falls/jumps (18%), and motor vehicle-related incidents (12%-16%)-but the proportion of motor vehicle incidents was higher in Iraq (p<0.001). Routinely collected air evacuation records provided the basis for ongoing injury surveillance for Iraq and Afghanistan. NBI was the largest category of evacuations from both operations. Leading NBI causes were similar to those identified for previous deployments and many should be preventable.

Brain biomarkers for identifying excited delirium as a cause of sudden death

Excited delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety excited delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 °C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8–4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in excited delirium. When combined with descriptions of the decedents’ behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the excited delirium syndrome at autopsy.

Toxicology and Circumstances of Death of Homicide Victims in New South Wales, Australia 1996–2005

To determine the prevalence and circumstances of psychoactive substances amongst homicide victims, 485 consecutive cases autopsied at the NSW Department of Forensic Medicine (1/1/1996-12/31/2005) were analyzed. Substances were detected in 62.6% of cases, and illicit drugs in 32.8%. Alcohol, cannabis, opioids, and psychostimulants were most commonly detected. Alcohol and cannabis were both more prevalent amongst males. Mean ages were significantly younger for decedents who tested positive for a substance and for an illicit drug. Cases where death resulted from a physical altercation were more likely to have had alcohol and cannabis present. Illicit drugs were prominent amongst firearms deaths. The proportion of alcohol positive cases increased from 25.0% on Monday to 49.4% for Saturdays/Sundays. Alcohol was more common in incidents in the 0001-0600 h and 1800-2400 h periods. Psychoactive substances appear to substantially increase the risk of homicide, although there are important differences between drug classes in the circumstances of such incidents.

Policy, Place, and Perpetrators: Using NIBRS to Explain Arrest Practices in Intimate Partner Violence

This study presents the results of a multilevel analysis of arrest outcomes in intimate partner incidents reported to the police. Using NIBRS data for 2000 in combination with data from other sources, we investigate how arrest policies, levels of urbanization, incident circumstances and offender characteristics influence arrest outcomes in domestic violence incidents. Our results indicate that arrest outcomes for intimate partner violence are influenced not only by mandatory arrest legislation, but also by level of urbanization and incident circumstances. The findings demonstrate the need for continued research that considers agency-level as well as offender- and incident-level characteristics in accounting for arrest outcomes.

Rapid Bridge Replacement: Processes, Techniques, and Needs for Improvements

The terrorist attack on September 11, 2001 and subsequent potential threats to the United States transportation systems have presented an urgent need to develop emergency response plans in order to quickly react to the possible consequences of an extreme event. Highway bridges, as critical components of the nation's transportation network, have received increased attention. To respond to the potential threats on highway bridges, a research project was conducted to identify rapid bridge replacement processes, techniques, and needs for improvements. To achieve the research objectives, the research team studied three cases of previous bridge replacements following extreme events. By studying these cases, the research team first sought to identify and expand on lessons learned and then addressed which actions did and did not work effectively under the incident circumstances. Using the lessons learned government agencies and engineering and construction communities could enhance their emergency response plans for future incidents. Next, the research team identified needed improvements so that the research community could investigate new technologies to advance current practices.

Children at play: the death and injury pattern in New South Wales, Australia, July 1990-June 1994.

To describe and to understand the pattern of play-related deaths and injury (excluding organized sports) among children in New South Wales (NSW), Australia. This study utilized a state-wide prospective surveillance data collection of paediatric traumatic deaths and injuries at the Royal Alexandra Hospital for Children. Deaths and injury cases were selected from the NSW Trauma Death Registry and Childsafe NSW database. Information including basic demographics, the surrounding circumstances of death and injury incidents, and the required treatment was collected. There were 30 play-related deaths and 92 drownings over the 4-year period. The male to female ratio was about 2:1. Excluding drowning, which has been reported elsewhere, and sports, the leading causes of play-related deaths were burns (eight) and asphyxiation (eight). An average of 6444 presentations to the emergency departments per year were recorded with sex ratio and age distribution pattern similar to the deaths. The home was the most common place (55.5%) of play-related injury, specifically the living and sleeping area. Falls, both under and above 1 metre, were the most common causes of injury (50.9%). The leading mechanism was cuts and lacerations (21.2%). Nearly one-third (32.7%) of all injuries were to the head, with face, cheek, forehead and scalp as the most common injured body part. Significant associations between place of injury, injured body parts and age were observed. Play-related injury is common among children, and in some cases causes severe injury and death. To tackle the problem of play-related deaths and injuries, a holistic approach is suggested. This includes the provision of a safe environment, supervision by parents, education of children and detailed data collection.

Clinical and demographic characteristics of 15 patients with repetitively assaultive behavior.

The 15 patients with the highest numbers of assaultive incidents over a one year period in a state mental hospital were identified and information collected regarding a variety of clinical and demographic characteristics. The results showed a group of patients who are relatively young, manifest severe symptomatology that is generally unresponsive to treatment, and have now been hospitalized continuously for greater than four years. The patients experienced the onset of symptoms as teenagers in most cases, showed poor psychosocial adjustment beyond childhood, and had positive family histories for mental illness or alcohol abuse. Patients with psychotic disorders predominated and tended to have positive symptoms rated as severe to very severe on the Global Rating Scale for Psychosis. Patients with nonpsychotic or personality disorders always showed a high frequency of self-injurious behavior in addition to their aggressive behavior toward others. A number of patients had a history of head trauma with EEG abnormalities. This information provides a starting point for subsequent studies examining potential distinctions between this subpopulation of patients and others, the motivation and circumstances of such incidents, and the interaction between the behaviors and their effects on those around them.