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Background Fatal trauma is one of the leading causes of death in Western industrialized countries. The aim of the present study was to determine the preventability of traumatic deaths, analyze the medical measures related to preventable deaths, detect management failures, and reveal specific injury patterns in order to avoid traumatic deaths in Berlin. Materials and methods In this prospective observational study all autopsied, direct trauma fatalities in Berlin in 2010 were included with systematic data acquisition, including police files, medical records, death certificates, and autopsy records. An interdisciplinary expert board judged the preventability of traumatic death according to the classification of non-preventable (NP), potentially preventable (PP), and definitively preventable (DP) fatalities. Results Of the fatalities recorded, 84.9 % ( n  = 224) were classified as NP, 9.8 % ( n  = 26) as PP, and 5.3 % ( n  = 14) as DP. The incidence of severe traumatic brain injury (sTBI) was significantly lower in PP/DP than in NP, and the incidence of fatal exsanguinations was significantly higher. Most PP and NP deaths occurred in the prehospital setting. Notably, no PP or DP was recorded for fatalities treated by a HEMS crew. Causes of DP deaths consisted of tension pneumothorax, unrecognized trauma, exsanguinations, asphyxia, and occult bleeding with a false negative computed tomography scan. Conclusions The trauma mortality in Berlin, compared to worldwide published data, is low. Nevertheless, 15.2 % ( n  = 40) of traumatic deaths were classified as preventable. Compulsory training in trauma management might further reduce trauma-related mortality. The main focus should remain on prevention programs, as the majority of the fatalities occurred as a result of non-survivable injuries.

Background The epidemiology of traumatic deaths was periodically described during the development of the American trauma system between 1977 and 1995. Recognizing the impact of aging populations and the potential changes in injury mechanisms, the purpose of this work was to provide a comprehensive, prospective, population-based study of Australian trauma-related deaths and compare the results with those of landmark studies. Methods All prehospitalization and in-hospital trauma deaths occurring in an inclusive trauma system at a single Level 1 trauma center [400 patients with an injury severity score (ISS) >15/year] underwent autopsy and were prospectively evaluated during 2005. High-energy (HE) and low-energy (LE) deaths were categorized based on the mechanism of the injury, time frame (prehospitalization, <48 hours, 2–7 days, >7 days), and cause [which was determined by an expert panel and included central nervous system-related (CNS), exsanguination, CNS + exsanguination, airway, multiple organ failure (MOF)]. Data are presented as a percent or the mean ± SEM. Results There were 175 deaths during the 12-month period. For the 103 HE fatalities (age 43 ± 2 years, ISS 49 ± 2, male 63%), the predominant mechanisms were motor vehicle related (72%), falls (4%), gunshots (8%), stabs (6%), and burns (5%). In all, 66% of the patients died during the prehospital phase, 27% died after <48 hours in hospital, 5% died after 3 to 7 days in hospital, and 2% died after >7 days. CNS (33%) and exsanguination (33%) were the most common causes of deaths, followed by CNS + exsanguination (17%) and airway compromise 8%; MOF occurred in only 3%. Six percent of the deaths were undetermined. All LE deaths ( n  = 72, age 83 ± 1 years, ISS 14 ± 1, male 45%) were due to low falls. All LE patients died in hospital (20% <48 hours, 32% after 3–7 days, 48% after 7 days). The causes of deaths were head injury (26%) and complications of skeletal injuries (74%). Conclusions The HE injury mechanisms, time frames, and causes in our study are different from those in the earlier, seminal reports. The classic trimodal death distribution is much more skewed to early death. Exsanguination became as frequent as lethal head injuries, but the incidence of fatal MOF is lower than reported earlier. LE trauma is responsible for 41% of the postinjury mortality, with distinct epidemiology. The LE group deserves more attention and further investigation.

Background: How individuals are informed of the traumatic loss of a loved one can influence their grieving process and quality of life. Objective: This qualitative study aimed to explore, through thematic analysis, how life stages might influence the experience and feelings of those who have received communication of a traumatic death from police officers or healthcare professionals. Method: Recruited through social networks and word of mouth, 30 people participated in the study. Subjects were divided into three groups according to age (Group 1: ten participants aged between 20 and 35 years; Group 2: ten participants aged between 45 and 55 years; and Group 3: ten participants aged 60 and over). Participants completed an ad hoc questionnaire online. Atlas.ti software 8 was used to perform thematic analysis. Results: The three age groups had the following four key themes in common: (a) emotional reactions; (b) subjective valuation of the notification; (c) support; and (d) needs. Subtle differences emerged between age groups; yet the quality of the reactions and main themes did not vary greatly between the groups considered. Conclusions: The communication of an unexpected and violent death seems to provoke rather similar effects in survivors of different life stages. A few differences were noted in sub-themes (increased need for professional training in younger recipients; absence of suicidal ideation in older adults); perhaps quantitative designs could provide further details in future investigations.

(1) Background: The loss of a significant person can be especially traumatic when death comes without warning and is due to causes such as suicide, murder and accidents. The way an individual is informed about the loss can affect the way of adapting to the loss and the quality of life of survivors. Communication modalities of the notifier may deeply influence the bereavement process. Aim: The present investigation aimed to explore the experience of those who received communication of such a type of death by a professional figure. (2) Method: Snowball sampling was used to recruit the participants to this qualitative study. Social networks, word of mouth and researchers’ acquaintances were used, including clients of the NGO De Leo Fund. A total of 52 Italian people (eight males and forty four females, mean age = 49.44; SD = 14.23) who received notification of the death of a loved one by police officers or by health professionals participated in the study. Deaths involved cases of suicide, murder, road accident and mountain accident. (3) Results: The following four key themes were identified: (a) how the communication took place; (b) reactions; (c) support; and (d) coping strategies. Only 22 participants reported having received clear information about the dynamics of what happened; the rest of the sample obtained only poor or ambiguous information. The majority of participants sought or received informal support from family and friends immediately after notification; however, some participants experienced a total lack of support. The opportunity to see the body of the loved one for the last farewell, when denied, caused discomfort in recipients of the news. (4) Conclusions: Even the impactful notification of a traumatic death such as suicide or road accident can be mitigated by the appropriate behaviour and attitude of notifiers, who should always avoid providing generic or ambiguous information about what happened. The notification process should not end with the simple transmission of the communication, but should also look at the following phases by including referral to supportive networks or bereavement services, aimed at assisting individuals in the immediate aftermath but also in the long term.

Background: Having someone close die through suicide or another form of traumatic death is a distressing event in the lives of adolescents, putting them at risk of grief and mental health ramifications. As most research in this field has been focused on intrapersonal grief reactions, this study aimed to broaden the perspective by exploring the impact of the death through an interpersonal lens. Methods: The study involved individual and group interviews with bereaved adolescents (n = 20) and parents of bereaved adolescents (n = 18), and thematic analysis of the data. Results: The analysis yielded three themes: (i) the death is a life-changing experience, (ii) the death differentiates you from your peers, and (iii) the death impacts on the family system. Conclusions: The study revealed the devastating impact of the deaths on adolescents, their relationships with peers and the family system. Adolescents’ grief must be understood within the context of their agency and their immediate social environment. The findings clearly indicate that support for bereaved adolescents should incorporate the familial context.

Traumatic deaths are common, with cardiac trauma affecting 7‒12% of patients with thoracic injuries. Blunt cardiac injury (BCI), although rare, is associated with a high mortality rate. This report presents a case of blunt cardiac rupture (BCR) observed at autopsy despite the absence of external chest trauma, suggesting the presence of severe internal injuries. A 19-year-old male was found dead in his vehicle which had collided with a wall. At the crime scene investigation, external examination revealed no substantial chest wall injuries in the individual despite significant damage to the vehicle. Autopsy revealed a 2-cm rupture of the right ventricle (heart), accompanied by 400 cc of partially coagulated blood in the pericardial cavity, consistent with cardiac tamponade. Pregabalin was detected in the toxicology analysis, but not in lethal concentrations. Traffic accidents are a major cause of BCI, typically resulting from compression of the heart between the thoracic structures during high-energy impacts. BCR is particularly fatal and often results in rapid death before arrival to the hospital. The absence of external trauma in the current case underscores the need for thorough internal examination in trauma-related deaths.

There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians as participants in adolescent suicide and traumatic death bereavement research. This study aimed to explore the short-term impact of research participation experienced by adolescents, parents, and clinicians. A total of 61 participants (adolescents, n = 17; parents, n = 12; clinicians, n = 32) filled out a short survey within two weeks of having taken part in a qualitative interview study. Data were analyzed descriptively. Most participants had experienced no distress while participating and no negative effects of participating; rather, participation was experienced as helpful for them and they would highly recommend participating in a study like this to others. A few adolescents and parents reported some distress, related to anxiety about participation and the unpleasantness of grief memories. The study clearly indicates that bereaved adolescents, parents and clinicians can safely participate in research interviews regarding their experiences of grief and help after suicide, generally valuing the opportunity to share their experience. To prevent and mitigate potential distress, training of research staff and implementation of appropriate participant distress protocols are imperative. Future studies could include longitudinal follow-up of participants to assess any longer-term consequences.

Background: Usually managed by trained volunteers, crisis helplines services are of primary importance in community care. However, literature has shown that volunteers may be exposed to a high risk of developing negative psychological consequences in relation to the service performed. Although there are numerous studies dedicated to the use of helplines, evidence regarding the experiences of helpers in the context of traumatic losses is still limited. Objective: This study aimed to explore lived experiences of the operators of a crisis line supporting traumatic bereavement. Specifically, it analyzed the psychological impact of interacting with the caller, and the resources and strategies used by the operators themselves. Methods: The study considered 35 operators of the helpline provided by the Italian NGO De Leo Fund, which offers psychological support to survivors of traumatic bereavement. The inclusion criteria were: (a) currently being or having been a helper at the De Leo Fund helpline; and (b) having completed at least 10 shifts in the helpline service. Data were collected through an ad hoc questionnaire, filled online. The thematic analysis technique used Atlas.ti software 8. Results: Four thematic areas emerged from the transcription of the semi-structured interviews. These were: (a) motivation and expectations; (b) emotional and relational impact of the experience as a helper; (c) strategies adopted by operators; and (d) criticalities and strengths. Conclusions: Monitoring helpers’ emotional experiences and the impact of their work overtime emerged in a marked way. The analysis of the strategies and experiences of the operators represents a fundamental factor for the implementation of specific training programs for the management of emergency situations.

Objetivo Examinar la existencia del duelo complicado traumático como un constructo diferente al de duelo complicado analizando si la sintomatología de duelo complicado y de estrés postraumático es diferente en las personas que sufren duelo complicado tras una muerte traumática y no traumática. Método Un grupo de 89 dolientes con duelo complicado tras una muerte por atentado terrorista y un grupo de 54 dolientes con duelo complicado tras una muerte por edad o enfermedad completaron el Inventario de Duelo Complicado (IDC) y versiones de la Escala de Verificación del Trastorno de Estrés Postraumático (PCL-S o PCL-5). Resultados ANCOVA realizados sobre las puntuaciones en los ítems del IDC y en los 16 ítems comunes a las dos versiones de la PCL revelaron que los dos grupos de dolientes no diferían en ninguno de los síntomas de duelo complicado ni de estrés postraumático, salvo en dos síntomas de duelo complicado en los cuales las diferencias iban en direcciones opuestas. Conclusiones Aunque una muerte traumática como, por ejemplo, por atentado terrorista, incrementa la gravedad de las reacciones de duelo y la probabilidad de sufrir duelo complicado, este duelo complicado es similar al que pueden sufrir las personas tras una muerte no traumática, al menos respecto a sus síntomas y a los síntomas simultáneos de estrés postraumático. Por tanto, no se puede hablar de un duelo complicado traumático como diferente al duelo complicado.