EMERGENCY AIRWAY MANAGEMENT IN HANGING VICTIMS

Study objective: To determine the incidence, demographics, clinical in dicators of survival, and frequency of cervical-spine fractures to def ine appropriate emergency airway management in hanging victims. Design : Medical examiner records, paramedic reports, and emergency departmen t and hospital medical records were reviewed retrospectively for the p eriod January 1, 1978, to January 1, 1990. Setting: Urban paramedic sy stem with nine receiving hospitals. Participants: A total of 160,724 m edical examiner and paramedic records were reviewed to identify a tota l study population of 306 hanging victims. One hundred eighty-two vict ims (59%) were found dead at the scene, and the emergency medical syst em was not notified. An additional 57 (19%) were seen by paramedics an d declared dead at the scene. Sixty-seven (22%) were treated and trans ported to nine receiving EDs; 39 of these 67 received oral or nasal en dotracheal intubation. Results: The incidence of hanging was 0.19% of all medical examiner cases and paramedic runs during the 12-year study . Those hanging victims who survived to receive paramedic transport an d treatment by physicians were typically male and attempted suicidal h anging in a public place (most frequently jail) with available bedding or clothes. No hanging victim treated and transported by paramedics h ad documentation of cervical-spine or spinal cord injury. Conclusion: In nonjudicial hanging victims seen by paramedics and transported to a n ED, cervical-spine injury is rare. Cerebral hypoxia rather than spin al cord injury is the probable cause of death and should be the primar y concern in treatment of this patient population. Following external stabilization of the neck, nasal or oral endotracheal intubation is ap propriate emergency airway management in hanging victims.