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was mainly a reduction in vehicle-related deaths (15,147 in 1995 to 5,717 in 2014). On the other hand, deaths associated with bathing increased from 3,190 in 1995 to 5,362 in 2014 (68%), and foreign body airway occlusion (FABO) increased from 7,104 to 9,806 (38%).4 These increased numbers of deaths were mainly in the elderly population (Figure).4 For elderly people, death from disease might be a natural course, but accidental death can be avoided. To avoid and prevent accidental deaths, we have to know the detailed characteristics of both the accidents and the deaths. Kiyohara et al describe a seasonal dependency among the characteristics of bath-related OHCA, which occurred mainly in winter, and more than 90% of the OHCA patients who died in home baths had good activity in daily life (ADL) before the arrest.3 Hori5 reported the same finding that deaths in bathtubs occurred mainly in winter in Yamagata, Tokyo and Saga. Bath-related accidents, which included rescue from the bathtub, and acute illness or trauma in the bathroom, but did not include bath-related cardiac arrest, also occurred mainly in winter.5 Because of the same seasonal distribution of deaths in bathtubs and rescue from bathtubs, and of the longer bathing apan is facing upcoming unprecedented population problems as the proportion of elderly persons increases year by year. Fortunately, survival with favorable neurological outcome in elderly individuals with out-of-hospital cardiac arrest (OHCA) has been improving in Japan,1 as well as in the pediatric generation, especially at school.2 Survival from OHCA is mainly dependent on whether it is witnessed or unwitnessed, initial shockable rhythm or not, and bystander CPR performed or not. These findings have been mainly obtained from endogenous cardiac arrest data. In this issue of the Journal, Kiyohara and colleagues3 focus on accidental OHCA during bathing in Japan and report exceedingly poor outcomes; only one neurologically good survival out of 642 bath-related cardiac arrests during 3 years from 2012 to 2014.

Specific Problems With Accidental Deaths in Japan – Cardiac Arrest From Hot Baths and Foreign Body Airway Obstruction in Elders –