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Introduction: Suicide rates have risen in England over the last decade and hanging, a highly lethal method of suicide, has been the most common method. Previous work in this area identified a lack of literature discussing emergency medical services (EMS) attendance at hangings. This article aims to describe hangings attended by EMS in the North East of England in order to inform future work in this area. Methods: A retrospective service evaluation was conducted using existing data from a comprehensive pre-hospital trauma audit database to describe patients with hanging documented in their records who were attended by ambulance clinicians between 1 December 2018 and 31 November 2020. Results: Hanging was recorded in 604 incidents. Most cases (n = 579/604) involved adults (aged 18 years or older) with a median age of 35 years (IQR 27-45 years), who were male (n = 410/579, 71%). Just over half (n = 341/579, 59%) of adult hangings resulted in cardiac arrest and of these, 10% (n = 33/341) were resuscitated and survived to hospital admission. Threatened and non-fatal hangings appear to have increased dramatically in the latter half of 2020. Previous suicide attempts and mental health issues were frequently reported across this population. Conclusion: Hangings are a method of suicide which frequently result in a cardiac arrest. In the North East of England the ambulance service attends approximately one hanging per day and one fatal hanging every two days. When fatal hangings were resuscitated, pre-hospital outcomes were similar to other causes of cardiac arrest, highlighting that despite the traumatic nature of these cases resuscitation is not futile. In order to better understand this patient group and improve care, pre-hospital data need to be linked to data from other services such as mental health services and acute hospitals. [ABSTRACT FROM AUTHOR]

Hanging was firstintroduced in England after 450 a. Hr., being practiced until 1965 and was the most widespread method of execution during history and because of this reason they were classified as judicial and non-judicial. Hanging consists of a ligature with careful knot placed below the occiput and complete suspension of the entire body weight of the victim. Non-judicial are those that take place in homes and jails and are frequently due to incomplete suspension, with part of the victim's body laying on the ground. [ABSTRACT FROM AUTHOR]

Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/− 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate changes in the range of suicide methods used in two time periods a century apart (1901–1907 and 2001–2007) in England and Wales. Method: Suicide mortality and population data were obtained for England and Wales from the ONS and used to calculate gender and method-specific mortality rates. Results: There have been striking changes in the methods of suicide used since the 1900s. Hanging was the most commonly used method during both time periods. However suicides involving drowning (22.5% of suicides in 1901–1907) and weapons (e.g. firearms and razors, 24.2% of suicides in 1901–1907) were rarely used in 2001–2007 (2.6% and 5.8% respectively). Although the use of poisons was popular in both time periods, the types of poisons used differed substantially over time. Household cleaning products and disinfectants accounted for almost half of poisoning suicides in the early 1900s whereas self-poisoning with medicines accounted for most poisoning suicides in 2001–2007. Limitations: There were changes in the coding of suicides over time. Additionally, deaths by drowning and poisoning are more difficult to confirm as suicides than those that occur due to hanging or the use of weapons. Conclusions: The changes in popularity of some suicide methods can be mainly attributed to changes in the physical availability (access) of these methods over time. Other methods which remain readily available have fallen out of fashion in recent times, suggesting a contributory role of other factors such as cognitive availability and personal preference/acceptability in influencing the choice of suicide method. [Copyright &y& Elsevier]

It is rare to find rates of suicide from previous centuries. Data from a book published in 1662 enabled suicide rates by hanging to be calculated for London, England in the mid-1660s. The estimated suicide rate by hanging was in the range of 2.41 per 100,000 per year to 3.32. [ABSTRACT FROM AUTHOR]

Accurate prediction of the postmortem interval requires an understanding of the decomposition process and the factors acting upon it. A controlled experiment, over 60 days at an outdoor site in the northwest of England, used 20 freshly killed pigs (Sus scrofa) as human analogues to study decomposition rate and pattern. Ten pigs were hung off the ground and ten placed on the surface. Observed differences in the decomposition pattern required a new decomposition scoring scale to be produced for the hanging pigs to enable comparisons with the surface pigs. The difference in the rate of decomposition between hanging and surface pigs was statistically significant (p=0.001). Hanging pigs reached advanced decomposition stages sooner, but lagged behind during the early stages. This delay is believed to result from lower variety and quantity of insects, due to restricted beetle access to the aerial carcass, and/or writhing maggots falling from the carcass., (© 2015 American Academy of Forensic Sciences.)