Our finding was similar to that in previous studies [ 6 , 12 , 18 ]. Hanging was the most common type of self-inflicted deaths, followed by jumping and poisoning by gas. The manner of self-inflicted deaths varied among countries. For example, firearms are most frequently used in the United States, as are pesticides in rural areas of developing countries [ 19 , 20 ]. In Japan, ever since charcoal burning suicide news made national headlines in , the incidence has been increasing [ 20 , 21 ].
This increase might be explained by the news of such charcoal burning suicide via the Internet or the widespread of Internet-related suicide pacts [ 20 — 23 ].
The most important factor for self-inflicted injuries and suicide is the accessibility to the means [ 24 ]. Therefore, in order to prevent self-inflicted injuries or suicide, there must be restriction of the access to the means. Previous studies reported that the onset of self-inflicted injuries might be caused by puberty [ 26 , 27 ]. The increasing trend of self-inflicted injuries during adolescence may be attributed to multiple factors as follows: economic status, educational status, abuse, bullying, negative life events such as parent death, environmental factors such as social transmission of self-inflicted injuries, and increasing prevalence of psychiatric disorders [ 28 ].
Social transmission of self-inflicted injuries or increasing prevalence of psychiatric disorders might have an especially strong influence on increasing the incidence of self-inflicted injuries among women [ 29 , 30 ]. Although the effect of female hormones on self-inflicted injuries is still under debates [ 31 ], a report shows that female hormones may cause the increased prevalence of self-inflicted injuries among women at reproductive age 10—49 years [ 32 , 33 ].
Indeed, the higher incidence of self-inflicted injuries among women at reproductive age was also noted in this study. Although it is not clear whether those previous findings may be plausible explanations for our findings, the time has come for us to take measures so that there is a prevention and intervention strategy for self-inflicted injuries among younger women. Our findings here might be explained by psychiatric disorders, age-related disability, and social factors such as deaths of close relatives, loneliness from living alone, and socioeconomic status with increasing age [ 34 , 35 ], but definite reasons for the higher incidence of self-inflicted deaths injuries among men were unclear.
It is well-known that the incidence of severe self-inflicted injuries is higher among men than women regardless of age [ 1 ]. Indeed, the proportion of severe self-inflicted injuries was also greater among men than women in this study. A further detailed investigation is also needed to provide an effective suicide prevention strategy for men, especially elderly men.
Although there have been many studies on temporal patterns of suicide, little is known about those of self-inflicted injuries themselves [ 6 , 12 ]. The present study also showed that the highest incidence of self-inflicted injuries is on Monday. An epidemiological study on temporal patterns concerning self-inflicted injuries would be very important for the prevention and intervention regarding self-inflicted injuries or suicide, as would be hospital staffing and medical resource allocation as a health policy.
Furthermore, these findings should be confirmed in other cohorts from different communities.
In Osaka City, Japan, many emergency patients who died from hanging and poisoning by CO were not transported to any hospitals. Importantly, these patients were not enrolled in the All-Japan Utstein registry of out-of-hospital cardiac arrests OHCAs , because most of them had definite signs of death on EMS arrival [ 40 ].
Therefore, burn patients require not only acute primary treatment but also subsequent rehabilitation, reconstruction and long-term anti-scar therapy. On 26 August , the unit started to move to the Somme battlefield on foot and then by train in the usual box cares through Calais, Boulogne, Etaples and Conteville, arriving at the Somme front on 14 September, Archived from the original on 22 April Fill in your details below or click an icon to log in:. By late January, the Free Syrian Army launched a full-scale attack against the government in Rif Dimashq , where they took over Saqba , Hamoreya, Harasta and other cities in Damascus's Eastern suburbs. Hagar Cohen : One day in , he gave in. Few studies have evaluated the actual situations of emergency patients with self-inflicted injuries treated by emergency-medical-service EMS personnel.
Similarly, OHCA patients with rigor mortis, decapitation, incineration, dependent cyanosis, or decomposition were not transported. In other words, all resuscitated OHCA patients are transported to hospitals, but the prevalence of OHCAs in Japan based on the Utstein-style would underestimate them statistically, resulting in a high survival rate after OHCAs because of the exclusion of un-resuscitated patients. The number of emergency patients with self-inflicted injuries is an urgent problem [ 1 ], and a comprehensive strategy will be of help in the prevention of self-inflicted injuries and suicide.
Primary care providers, of course may well have an important role in preventing suicide. For example, a review reported that about twice as many patients who committed suicide had contact with primary care providers as mental health services within one month of their suicide [ 41 ]. Another recent systematic review also showed the effectiveness of intervention and prevention of suicide by using social network services [ 42 ].
Thus, to reduce emergency patients transported to hospitals by EMS, community-based interventions via primary care or the Internet may be of considerable help. The present study has several limitations. First, in Japan, deceased patients who were not transported were managed by police, and their sex and age were not available in our ambulance records. However, we have been prospectively collecting such data on emergency patients in Osaka Prefecture since October, and will reveal more detailed information on emergency self-inflicted injuries in the future [ 43 ].
Third, although a previous study demonstrated that the number of patients who did not visit hospitals with self-inflicted injuries is about eight times as large as those who did, we did not, unfortunately, obtain any information on these patients [ 44 ], and we should, therefore, make a greater effort to grasp the total incidence of self-inflicted injuries in this area. Finally, our findings may not be generalizable to other districts because our study was conducted in a single big city. The proportion of self-inflicted deaths was approximately one-sixth in whole self-inflicted injuries, and most frequent manner among deceased patients was by hanging, followed by jumping and poisoning by gas.
Organization for economic co-operation and development. World Health Organization. Carbon monoxide. Risk ratios. Confidence interval. Out-of-hospital cardiac arrest. Standard deviation. We are greatly indebted to all of the EMS personnel at the Osaka Municipal Fire Department and to the concerned physicians in Osaka City for their indispensable cooperation and support. Original research Open Access. Characteristics and outcomes of emergency patients with self-inflicted injuries: a report from ambulance records in Osaka City, Japan.
Abstract Background Few studies have evaluated the actual situations of emergency patients with self-inflicted injuries treated by emergency-medical-service EMS personnel. Results During the study period, a total of 8, patients with 9, incidents of self-inflicted injuries were documented.
Discussion Using large-scale EMS records, we investigated characteristics and outcomes of emergency patients with self-inflicted injuries treated by EMS personnel. Conclusions In the total population, the annual incidence of self-inflicted injuries responded to by EMS personnel was higher among women than among men. Self-inflicted injuries Epidemiology Population-based study Emergency medical service. Data collection and quality control The following data were uniformly collected via regular forms including age, sex, location of call, type of self-inflicted injuries, time and date of all events, time-course of transportation, type of hospitals transported to, and their clinical departments, and patient outcomes.
Endpoints The endpoint of this study was the annual incidence per , population in Osaka City of emergency patients with self-inflicted injuries by age and sex. Population During the study period, a total of , emergency patients were documented in ambulance records in Osaka City. Among them, a total of 8, patients with 9, incidents of self-inflicted injuries were identified. Annual incidence of self-inflicted injuries per , men and women by year strata age groups is shown in Fig.
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Incidence was higher among women than men in the total population Among both sexes, self-inflicted injuries occurred from the 10—19 years, and the incidence reached its peak in 20—29 years The number of self-inflicted injuries with temporal patterns is described in Fig. Regarding influence of day of week, self-inflicted injuries were most frequent on Mondays, least on Tuesdays RR, 1.
As for seasons, 1. While Median age was 37 interquartile 27—49 years.
The types of self-inflicted injuries were as follows: In this area, all CO poisoning were due to charcoal burning. There were no self-inflicted firearms in this study. Patients transported to medical institutions were treated at the following departments: Table 1 Characteristics of emergency self-inflicted injuries in Osaka City. EMS emergency medical service, CO carbon monoxide, SD standard deviation a Calculated only for self-harms transported to institutions b 9.
About one-fifth of patients There were no significant sex differences in the proportion of transport refusal. Approximately one-third of patients who presented with self-inflicted injuries were only treated after transportation and were not admitted to a hospital. The proportion of hospital admissions was higher among women than among men The proportion of self-inflicted deaths was overall The most frequent type of self-inflicted deaths was hanging, which was responsible for The proportion of severe self-inflicted injuries was greater among men than women Table 2 Outcomes of emergency self-inflicted injuries in Osaka City.
Men had a higher rate of death by self-inflicted hanging than women Table 3 Lethality of self-inflicted injuries by sex and means. Acknowledgements We are greatly indebted to all of the EMS personnel at the Osaka Municipal Fire Department and to the concerned physicians in Osaka City for their indispensable cooperation and support. Financial support None. References World Health Organization. First WHO world suicide report. Accessed Sept 02, Self-harm and ethnicity: a systematic review.
Int J Soc Psychiatry. Fatal and non-fatal repetition of self-harm.
Systematic review. Brit J Psychiatry. Accessed Sep 02, Deliberate self-harm in Oxford, — a time of change in patient characteristics. Psychol Med. National registry of deliberate self harm ireland annual report Accessed September 02, Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. Suicide, and other causes of death, following attempted suicide. Suicide in affectively ill adolescents: a case—control study. J Affective Disord. Epidemiology and trends in non-fatal self-harm in three centres in England: — Self-harm and suicide attempts among high-risk, urban youth in the U.
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