Pathologic features of farm and tractor-related fatalities in children

A study of 15 childhood fatalities due to farm or tractor-related accidents demonstrated extensive injuries typified by crushing, evisceration, and amputation of limbs. Although these injuries are characteristic of industrial accidents in adults, such accidents do not commonly occur in children. However, the unique circumstance of the farm, which incorporates home and industrial environments, results in particularly severe patterns of injuries in accidental childhood deaths. A knowledge of the range of machines that are used and the environment of the farm facilitates assessment of the types of injuries that may be found at autopsy in cases of pediatric farm accident.     

Pathologic features of fatal shark attacks

To examine the pattern of injuries in cases of fatal shark attack in South Australian waters, the authors examined the files of their institution for all cases of shark attack in which full autopsies had been performed over the past 25 years, from 1974 to 1998. Of the seven deaths attributed to shark attack during this period, full autopsies were performed in only two cases. In the remaining five cases, bodies either had not been found or were incomplete. Case 1 was a 27-year-old male surfer who had been attacked by a shark. At autopsy, the main areas of injury involved the right thigh, which displayed characteristic teeth marks, extensive soft tissue damage, and incision of the femoral artery. There were also incised wounds of the right wrist. Bony injury was minimal, and no shark teeth were recovered. Case 2 was a 26-year-old male diver who had been attacked by a shark. At autopsy, the main areas of injury involved the left thigh and lower leg, which displayed characteristic teeth marks, extensive soft tissue damage, and incised wounds of the femoral artery and vein. There was also soft tissue trauma to the left wrist, with transection of the radial artery and vein. Bony injury was minimal, and no shark teeth were recovered. In both cases, death resulted from exsanguination following a similar pattern of soft tissue and vascular damage to a leg and arm. This type of injury is in keeping with predator attack from underneath or behind, with the most severe injuries involving one leg. Less severe injuries to the arms may have occurred during the ensuing struggle. Reconstruction of the damaged limb in case 2 by sewing together skin, soft tissue, and muscle bundles not only revealed that no soft tissue was missing but also gave a clearer picture of the pattern of teeth marks, direction of the attack, and species of predator.     

Pathologic features of suicidal complete decapitations

Despite high suicide rates all over the world, complete decapitation as a consequence of violent suicide methods is exceptionally rare and there is always a potential for confusion with homicide as well as with body dismemberment or mutilation. We analyzed the phenomenology and morphology of 10 cases (six male, four female; individual age 18-60 years) of suicidal complete decapitation that were subjected to medico-legal autopsies at the Institute of Legal Medicine, University of Hamburg, Germany, between 1995 and 2002. All decapitations occurred while the person was alive as proven by signs of vitality. Blood alcohol levels were positive in five cases and ranged between 28 and 202 mg/dl. The applied methods of suicide were running over by a train in eight cases and hanging in two cases. In suicidal hanging resulting in complete decapitation the wound margins were clear-cut with an adjacent sharply demarcated circumferential band-like abrasion zone showing a homogenous width, the latter determined by the thickness of the rope. In decapitations due to railway interference a broad spectrum of pathologic alterations such as the co-existence of irregular, ragged and sharp-edged wound margins, vascular and nervous pathways forming bridges in the depth of the wound and bruising could be observed. In such cases skin abrasion zones were generally not circumferential and showed a heterogenous width. Concerning hanging-related complete decapitations, our findings are well in line with those of other authors, namely that heavy body weight of the suicidal, fall from a great height and in some cases inelastic and/or thin rope material used for the noose are the determining factors decisive for complete decapitation.     

Pathologic features of fatal falls from height

Deaths due to falls from height are common in urban settings. At the time the body is found, it is often unclear whether the mode of death is accident, suicide, or homicide. To assess the injury pattern in fatal falls from height with special regard to criteria that might be helpful in discrimination between accident, suicide, and homicide, respectively, we reviewed 68 medicolegal autopsy cases (22 females, 46 males, age range 13-89 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Among the 68 cases, there were 34 suicides, 23 accidents, and 11 unclarified cases, in 3 of which homicide was suspected. In general, suicides were from greater heights than accidents (mean height 22.7 m for suicides and 10.8 m for accidents, respectively; 79% of suicides from more than 16 m). Strikingly, severe head injuries predominantly occurred in falls from heights below 10 m (84%) and above 25 m (90%), whereas in the group of falls from 10 to 25 m, these lesions were seen less frequently (28%). Neck injuries like muscle bleeds and fractures of the hyoid bone were found in 33% of falls from more than 10 m and did not occur from less than 10 m. Our data stress that the evaluation of pathologic features alone is not sufficient to assess the mode of death in fatal falls from height. Instead, postmortem findings have to be considered within the framework of the subject's social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results to obtain the clearest possible picture of the circumstances of death.     

Pathologic features of suicidal deaths caused by explosives

Suicidal explosions that lack a terrorist background are only rarely encountered in the field of forensic pathology. The investigation of explosion-related fatalities can be a substantial challenge in medicolegal casework. Determining whether the manner of death is suicide, homicide, or accident in such cases can present an especially difficult task to the forensic pathologist. This study considers the pathologic features of suicidal deaths caused by explosives without a terrorist background. The modus operandi of the decedents reflected familiarity and proficiency, or at least a degree of specialized knowledge, with the construction and use of explosive devices. All explosions were set off in confined spaces. The injury patterns consisted of a combination of primary blast injuries (e.g. decapitation, traumatic amputation of limbs, gross lacerations of the body surface, blast injuries of gas-containing and hollow organs), secondary blast injuries (e.g. splinter-induced penetrating trauma), tertiary blast injuries (e.g. abrasions and contusions), and burn injuries (mostly of the flash type). The previously described symmetric distribution pattern of injuries in suicidal explosions was apparent only to a certain degree in the present series. Our observation of superficially sharp-edged wound margins with bridging in the depths of the lesion in blast-induced lacerations of the skin should deserve further attention in forthcoming cases of explosion-related fatalities because this finding is a diagnostic possibility that may support the theory of an explosion-related fatality under special circumstances, e.g. when the body has been dumped away from the place of death. Because a terrorist attack may be initially suspected in each case of suicide involving explosives, the importance of a joint inquiry based on expertise from police investigators, bomb experts, and forensic pathologists is evident.     

Athletic fatalities

In 1985, we began studying athletic fatalities in Marion County, Indiana (city of Indianapolis, population 779,966) U.S.A. We previously reported the data for calendar year 1985. The reviewed cases include all sudden, unexpected, or traumatic deaths of conditioned, competitive athletes in Marion County. This follow-up is a review of all athletic fatalities in Marion County that occurred from January 1986 through July 1988. All deaths during or immediately after athletic activity were reviewed, whether or not the participant was a conditioned athlete. Natural disease, especially heart disease without prior diagnosis, continues to be the most prevalent modality of death.     

Theophylline fatalities

Two fatal cases are presented involving the acute ingestion of theophylline resulting in blood theophylline concentrations greater than one hundred times the accepted therapeutic range.     

Firearm fatalities.

One hundred and twenty eight cases of shooting fatalities were investigated during an 11-year period. Of these 57% were homicidal shootings with 34% suicidal in nature. Only two suicidal fatalities were female. Analysis of the sites of entrance wounds confirmed the 'sites of election' in suicidal shootings, whilst homicidal wounds showed a much wider distribution. Multiple entrance wounds were seen in 42% of homicidal shootings. Injuries to hands were seen in 7 homicidal fatalities.     

Analysis of cocaine-positive fatalities

A review of all autopsy and toxicology reports for persons dying in New York City in an 11-month period found 935 persons dying with cocaine in their bodies. Cocaine-positive fatalities were more likely in the young black and Hispanic and male population. In addition to cocaine and its metabolites, heroin and other opiates were found in 39% of persons and ethanol in 33% and barbiturates and minor tranquilizers in only 2% of the deceased. Cocaine overdose was responsible for 4% of the deaths and overdose with heroin and cocaine for 12% of the deaths. Violence was often the cause of death. Thirty-eight percent died of homicide, seven percent of suicide, and eight percent from accidents. Of particular interest were 6 persons who died of acute cardiac events directly related to cocaine as well as 4 cases of ruptured dissections of the ascending aorta, and 9 cases of cerebral hemorrhage. Autopsy findings for these individuals are described, and possible mechanisms of death are discussed.     

Unemployment and highway fatalities

We considered unemployment, an often overlooked covariate of highway fatalities, hypothesizing that (1) as unemployment rises, aggregate driving decreases, especially among the unemployed, and as driving decreases, fatalities should decrease; (2) unemployment may influence drinking--some among the unemployed may drink less due to lower incomes, while others may drink more due to stress so the net effect would be ambiguous; and (3) unemployment may increase aggregate levels of stress and unhappiness, which can result in poor concentration on driving and thus, in turn, should result in more accidents and deaths. We used data from fifty states and the District of Columbia from 1976-1980, representing 255 observations. (No prior study has as many observations or controls for as many covariates.) Using econometric models of the data, we present evidence for two of the three hypothesized effects of unemployment. We conclude that, if the number of miles driven is held constant, worsening unemployment leads to higher fatality rates, most likely due to stress effects. But because more unemployment means less driving, increases in unemployment, on balance, are associated with decreases in fatalities.     

Pediatric drowning: a 20-year review of autopsied cases: II. Pathologic features

The pathologic findings in autopsies of drowning victims are nonspecific and vary from case to case. However, most reported pathologic series of drowning cases exclude children and do not take into consideration the unique circumstances surrounding bathtub drownings. In addition, the effect of resuscitation on the autopsy findings has not been studied in children. A retrospective review of autopsy records of non-bathtub drownings from a 20-year period (1984-2003) was performed and 63 cases were identified in 45 males and 18 females (age range 9 months to 17 years). The incidence of frothy exudate, pleural effusion, and increased lung weight was 43%, 36%, and 80%, respectively. The incidence of frothy exudate and the combination of all 3 factors was significantly higher in cases with no resuscitation compared with those cases with attempted resuscitation with or without delayed death. As the interval between the drowning episode and autopsy increased, the incidence of frothy exudate decreased significantly. There was no relationship between these findings and the age and sex of the decedent. Other clinical conditions or occult pathologic findings that may have contributed to death were found in 8 cases (13%). The findings highlight the need for thorough clinicopathologic correlation in cases of drowning to accurately interpret the pathologic findings.     

Accidental firearm fatalities during hunting

Swedish legislation concerning firearms is highly restrictive. It is illegal to possess weapons (except airguns) without a license. From 1970 through 1982, there were 79 accidental firearm fatalities in Sweden. This number, corresponding to 0.074/100,000/year, is very low in comparison with similar statistics worldwide. Of these fatalities, 47 were associated with hunting and were studied carefully. Despite an increase in both the popularity of hunting and in licensing of weapons, on change in the number of accidents per year could be confirmed. Twenty-nine accidents occurred during small game hunting, of which 24 involved shotguns, and 18 occurred during moose hunting. The mean age overall was 46 years. All victims and shooters were men. Most accidents occurred before noon and during the autumn. During moose hunting, the victim most commonly was either mistaken for game or was standing beyond game. During small game hunting, the most common reason for death was improper handling of the weapon. Firing of defective weapons caused at least 10 fatal accidents. Alcohol inebriation was uncommon. It is unlikely that more restrictive firearm legislation would further decrease the number of fatal accidents. Instead, we believe that accidental firearm fatalities during hunting can be prevented by safer and more careful handling of weapons, including unloading weapons before transporting them; by replacing older weapons with more modern and safer ones; and by not allowing children to handle weapons. No shots should be fired until it is clarified that the target really is a game animal, and when hunting with rifles, the fields of fire should be clarified beforehand. Shooters at stand must be instructed not to leave their stands until explicitly told to do so.     

Autoerotic fatalities in Greater Dusseldorf

Autoerotic fatalities in the Greater Dusseldorf area correspond to the relevant medicolegal literature. Our results included exclusively young to middle-aged, usually single men who were found dead in their city apartments. Clothing and devices used showed a great variety. Women's or fetish clothing and complex shackling or hanging devices were disproportionately frequent. In most cases, death occurred due to hanging or ligature strangulation. There was no increased incidence of underlying psychiatric disorders. In most of the deceased no or at least no remarkable alcohol intoxication was found. Occasionally, it may be difficult to reliably differentiate autoerotic accidents, accidents occurring in connection with practices of bondage & discipline, dominance & submission (BDSM) from natural death, suicide or homicide.     

Analysis of fatalities in road accidents

This paper is based on the analysis of 524 autopsies carried out on the victims of road accidents at the Office of the Judicial Medical Officer, Colombo for a 2-year period ending December 1985. 51.4% of the fatalities were among pedestrians. The highest number of fatalities were in the age group 20-29 years. Cranio-cerebral injury was the commonest cause of death in all groups of victims.     

Investigation of hot air balloon fatalities

The rising popularity of the sport of hot air ballooning has been accompanied by several recent incidents, both in this country and other parts of the world, where mechanical defects and the improper operation of balloons have resulted in several fatalities. A study was conducted to identify the location and frequency of hot air ballooning accidents. Furthermore, the study attempted to identify those accidents that were the result of improper handling on the part of the balloon operators and those that were related to specific defects in the construction of the balloon. This paper presents a background of the sport of hot air ballooning, together with an analysis of the construction of a typical hot air balloon, pointing out the specific areas where defects may occur that could result in a potential fatal balloon crash. Specific attention is given to the two recent balloon crashes that occurred in Albuquerque, N.M., hot air balloon capital of the world, and that resulted in multiple fatalities.     

Accidental sharp force injury fatalities.

The authors review all accidental sharp force injury deaths investigated at the Southwestern Institute of Forensic Sciences from 1990 to 1999. Twenty-two cases of accidental sharp force injury were identified, accounting for 0.29% of all accidental deaths (9,562) during the 10-year study period. Included in this series are 5 incised wounds, 11 stab wounds, 4 chop wounds, and 2 deaths caused by dog attacks. About half of the cases involved some type of motorized machinery. The victims' ages ranged from 2 years to 71 years, with most deaths occurring in older teenagers and younger adults. Male subjects (17) were involved much more frequently than female subjects (5). In 50% of the cases, ethanol or other drug use was a possible underlying contributing factor in the accident. The cases are briefly reviewed, and the importance of detailed investigation in manner-of-death certification is emphasized.     

Gas taxes and motor vehicle fatalities

Economists view taxes as a more efficient means of reducing the consumption of a product than regulation. They have therefore suggested raising cigarette and alcohol taxes to reduce the undesirable effects of tobacco and alcohol on the public's health. This essay suggests that a gasoline tax can have similar beneficial influences on reducing highway deaths and injuries. Moreover, if some proceeds of the tax are used to finance mass transit, the regressivity of the tax can be ameliorated.     

Amoxapine fatalities: three case studies

Amoxapine (Asendin), a recently introduced dibenzoxazepine, has been effective in clinical studies for the treatment of various types of depression. Three amoxapine-related deaths are reported. Quantitation of amoxapine was carried out by gas chromatography using 3% OV-17 column. Blood amoxapine concentrations were 11.5 mg/l, 2.8 mg/l, and 0.89 mg/l. The concentrations are many-fold higher than the reported therapeutic serum concentrations of 0.21 mg/l. These cases illustrate the potential toxicity and lethality of amoxapine overdose and the need for caution in prescribing a large amount of amoxapine to patients with suicidal tendencies.     

Injury patterns in motor vehicle fatalities

A retrospective pilot study of motor vehicle incident fatalities was conducted to determine what relationships exist between injuries received by deceased drivers, passengers, and a control population of pedestrians, and some of the environmental factors existing at the time of the incident. A number of correlations were established between the types and locations of injuries received, seat belt use, position of the injured party, and so forth. A study of this type, if performed on a large enough population, could lead to predictive models for the determination of position of the victims within a motor vehicle at the time of a fatal crash, based on a unique clustering of injuries.