title: Suicide fads: frequency and characteristics of hydrogen sulfide suicides in the United States.
abstract: OBJECTIVE
  To assess the frequency of hydrogen sulfide (H(2)S) suicides and describe the characteristics of victims in the United States (U.S.) since the technique became common in Japan in 2007.
  
  
  METHODS
  To ascertain the frequency of intentional H(2)S related deaths in the U.S. prior to the start of the Japanese trend in 2007, we searched the multiple-cause-of-death data from the National Vital Statistics System. To collect as much information about the victims as possible, we sent an email to the National Association of Medical Examiners (NAME) listserv asking for their cooperation in identifying cases of H(2)S suicide. To identify cases that were not voluntarily reported by medical examiners but were reported by the media, we conducted Google searches using the search terms: "hydrogen sulfide suicide," "H(2)S suicide," "detergent suicide," "chemical suicide," and "suicide fad." We obtained all available autopsy reports and abstracted information, including the site of the incident, the presence of a note warning others about the toxic gas and the demographic characteristics of the victims. We contacted medical examiners who potentially had custody of the cases that were identified through media reports and requested autopsies of these victims. When unable to obtain the autopsies, we gathered information from the media reports.
  
  
  RESULTS
  Forty-five deaths from H(2)S exposure occurred in the U.S. from 1999 to 2007, all unintentional. Responses from the NAME listserv yielded autopsy reports for 11 victims, and Google searches revealed an additional 19 H(2)S suicides in the U.S. since 2008. Overall (n=30), two cases were identified during 2008, 10 in 2009, and 18 in 2010. The majority of victims were white males, less than 30-years-old, left a warning note, and were found in cars. There were five reports of injuries to first responders, but no secondary fatalities.
  
  
  CONCLUSIONS
  H(2)S suicides are increasing in the U.S., and their incidence is probably underestimated by public health officials and physicians. First responders are at risk when assessing these victims due to the severe toxicity of the gas. Emergency providers must be aware of H(2)S suicides to educate others and care for the rare survivor.
authors: Emory University, Department of Emergency Medicine, Atlanta, GA.
authors: Sarah Jane D
authors: SJ
authors: Reedy
authors: Michael D
authors: MD
authors: Schwartz
authors: Brent W
authors: BW
authors: Morgan