What are the preventive measures and medical interventions for cases of death due to strangulation with kite thread, particularly in children and young adults?

Kite Thread Strangulation Deaths: Prevention and Emergency Management

Immediate Life-Threatening Emergency Response

If a victim is found with kite thread (manja) around the neck causing strangulation, immediately remove the thread if safely accessible, secure the airway, provide high-flow oxygen at 15 L/min, and activate emergency medical services while preparing for potential cardiac arrest. 1, 2

On-Scene Assessment and Stabilization

• Airway Management: Open the airway using head tilt-chin lift or jaw thrust maneuver in unconscious victims, as loss of consciousness eliminates protective airway reflexes and creates high risk for obstruction 1
• Breathing Support: Administer high-flow oxygen (15 L/min) immediately via face mask or bag-valve-mask ventilation if spontaneous ventilation is inadequate 1
• Intubation Criteria: Electively intubate any victim with Glasgow Coma Score ≤8 or inability to localize pain, as recommended by the American Academy of Pediatrics 1
• Circulation Assessment: Check capillary refill, pulse quality, blood pressure, and establish vascular or intraosseous access immediately 1

Critical Injury Patterns from Kite Thread

The synthetic manja (glass-coated nylon thread) causes devastating injuries that differ from typical strangulation:

• Vascular Injuries: Deep lacerations can sever carotid arteries, internal jugular veins, causing rapid exsanguination and cerebral infarction 3
• Airway Damage: Tracheal transection and thyroid gland laceration occur frequently, particularly in motorcyclists due to high relative momentum 3, 4
• Near-Decapitation: The sharp, glass-coated thread can cause near-complete transection of neck structures, with mortality rates of 9.5% in pediatric series 5, 3

High-Risk Scenarios

Passively involved children (bystanders) face greater injury severity than active kite-flyers, with significantly lower Pediatric Trauma Scores [mean 5.58 vs 8.02]. 5

• Motorcyclists and Two-Wheeler Riders: Highest risk group due to speed amplifying cutting force of thread across neck 6, 3, 4
• Pedestrians: Secondary impact injuries from loose threads strung across streets 6
• Festival Periods: Highest incidence during Lohri, Basant, and Makar Sankranti festivals 7

Prevention Strategies

Legislative and Regulatory Measures

Strict enforcement of bans on synthetic manja (glass-coated nylon thread) is essential, as these non-biodegradable threads have replaced safer cotton threads and caused a surge in fatal injuries. 6, 3

• Ban Enforcement: Current regulatory bans on manja in India require stronger enforcement mechanisms 3
• Public Awareness Campaigns: Education about dangers of synthetic threads, particularly targeting festival seasons 7, 3
• Proper Disposal: Improved disposal practices to prevent loose threads from becoming hazards 3

Safety Regulations for Kite Flying

• Height Restrictions: Prevent falls from rooftops during kite flying, as traumatic brain injury from falls is the most common injury pattern (mortality rate 6.25%) 7
• Designated Flying Areas: Establish zones away from roads and pedestrian traffic 7
• Protective Equipment: Mandate helmets for motorcyclists in areas where kite flying is common 3, 4

High-Risk Period Interventions

• Festival Season Preparedness: Emergency departments should anticipate increased kite-related injuries during harvest festivals 7
• Traffic Advisories: Warning motorcyclists and two-wheeler riders during peak kite-flying seasons 3, 4

Medical Management Considerations

Emergency Surgical Intervention

When vascular injury is suspected from deep neck lacerations:

• Immediate Vascular Reconstruction: Required for carotid artery and jugular vein injuries 3
• Emergency Tracheostomy: Necessary for tracheal damage 3
• Prognosis: Even with aggressive surgical intervention, outcomes remain poor when major vascular structures are severed, with death occurring from cerebral infarction due to shock and hemorrhage 3

Medico-Legal Challenges

These injuries present forensic classification difficulties, as the wounds blur the distinction between blunt and sharp force trauma, complicating legal investigations. 3