Driver and front seat passenger fatalities associated with air bag deployment. Part 2: A review of injury patterns and investigative issues

Assessment of the role of air bag deployment in injury causation in a crash of any severity requires analysis of occupant, vehicle, and impact data. The potential injurious role of an air bag is independent of crash severity and is more obvious in minor collisions, particularly those involving "out-of-position" occupants. Factors such as occupant height and other constitutional and medical factors, intoxication, age, type, and proper use of other restraint systems, pre-impact braking and multiple impacts can contribute to an occupant being "out-of-position." Two injury mechanisms are described in out-of-position occupants: "punch-out" when the individual covers the air bag module before deployment and "membrane-force" when the occupant contacts a partly deployed air bag. Each mechanism is associated with injury patterns. In adults, "punch-out" can cause thoraco-abdominal trauma and "membrane-force" loading can lead to craniocervical injury. This can also occur in short-statured occupants including children subjected to both types of loading. In more severe collisions, other factors, e.g., intrusion, steering column and seatbelt loading and other occupant compartment contacts, can contribute to trauma.     

Fire and suicide: a three-year study of self-immolation deaths.

Thirty-two self-immolation deaths by fire, representing about 1% of suicides, occurred in the province of Ontario (population 9 million), Canada, from 1986 through 1988. The victims, mostly male (male/female ratio, 26:6), were between 21 and 71 years old (mean age, 38 years). Although the scene of self-immolation was usually familiar to the deceased, some chose remote locations. Eleven were found dead in motor vehicles. An accelerant, usually gasoline, was used in most cases. Many of these individuals had, at some time, indicated their intent to commit suicide, a few by self-immolation, but only about half had a diagnosed psychiatric illness. Most of the victims had a reason to kill themselves, but the factors that motivated them to chose self-immolation by fire were uncertain. Fourteen individuals died in hospitals from severe burn complications. The remainder were found dead at the scene. The postmortem findings of soot in the airway and elevated carbon monoxide in the blood of most of these victims [the carboxyhemoglobin (COHb) concentration was in one case less than 10%, in ten cases greater than or equal to 10 to 50%, and in seven cases greater than 50%] were helpful in determining that the individuals were not only alive at the time of the fire but also that a significant number died from smoke inhalation and carbon monoxide poisoning. The highest levels of carbon monoxide were observed in victims discovered in motor vehicles.     

Craniocervical injuries in judicial hangings: an anthropologic analysis of six cases

Restoration projects and archaeologic excavations in two Canadian prisons resulted in the recovery of the skeletons of six felons executed by judicial hanging. Damage inflicted by hanging on various skeletal elements was observed. Among the injuries seen were fractures of the hyoid cornua, styloid processes, occipital bones, and cervical vertebral bodies (C2) and transverse processes (C1, C2, C3, and C5). Despite the general uniformity of the hanging technique, which involved a subaural knot, the trauma to the skeletal elements and the cause of death varied among individuals. Although some of this variation was probably due to minor differences in hanging practices, individual anatomic peculiarities of the victims likely also contributed.     

Azygos vein laceration due to blunt trauma

The azygos vein ascends along the thoracic spine through the mediastinum and drains into the superior vena cava at the level of the fourth thoracic vertebra. Fracture-dislocation of the mid-thoracic spine, as a result of blunt thoracic trauma, can tear the azygos vein. Four such fatal cases (three motor vehicle accidents and one fall) were studied, only one of which was recognized prior to death. The vein can also be torn, in the absence of skeletal injuries, by horizontal acceleration/deceleration forces. The pathologist must consider azygos vein laceration as a possible cause of either hemothorax or hemomediastinum or both in a victim of a blunt chest trauma, if that individual had persistent hypotension during the few hours before death and no identifiable source of hemorrhage can be found postmortem in sites such as the heart, great vessels, lung, and chest wall. A fracture-dislocation of the thoracic spine may not necessarily be present. Azygos vein laceration seems to be an uncommon cause of hemothorax and hemomediastinum; however, this injury is probably more frequent than is implied by the few cases described in the medical literature.     

LESSENING THE STING OF ASFA: THE REHABILITATION‐RELAPSE DILEMMA BROUGHT ABOUT BY DRUG ADDICTION AND TERMINATION OF PARENTAL RIGHTS

Congress passed the Adoption and Safe Families Act of 1997 (ASFA) as a response to children waiting in foster homes for years without permanent placement. In addressing the problem of permanency, however, Congress set a strict limit on how long a child could be in foster care (15 out of the most recent 22 months) before a state must either commence a proceeding to terminate parental rights or else lose valuable federal funding. Due to health care funding schemes and quality of treatment, this requirement, in particular, negatively impacts parents currently in drug rehabilitation whose parental rights may be permanently terminated before a realistic chance to recover is permitted. Although ASFA requires that states make “reasonable efforts” to keep families united, it does not define “reasonable efforts,” leaving parental rights and family unity subject to a chaotic interpretation of this requirement from state to state. “Reasonable efforts” should be interpreted to take into account current drug addiction and recovery research and drug court programs should be used to facilitate this goal. Research has shown that focusing on adequate treatment saves states money and improves the lives of children and their families, reducing the need for reliance on termination of parental rights.     

Retrospective Analysis of Hanging Deaths in Ontario

Hanging deaths from investigation standpoint are rarely problematic. Unusual circumstances can on occasion raise suspicion of foul play. Associated neck injuries are reported in the literature with variable frequency (from 0% to 76.8%). This study retrospectively analyzed 755 hanging deaths in Ontario (Canada) to evaluate the demographic features and circumstances of hanging fatalities, and the frequency of hanging‐related neck injuries. A number of cases showed unusual/special circumstances (e.g., complex, double suicides, restraints). Among 632 cases with complete autopsies, hyoid and larynx fractures were present in 46 cases (7.3%) with the most common being isolated hyoid fractures. The incidence of cricoid fractures was 0.5% and cervical spine injuries, 1.1%. A higher incidence of neck injuries occurred among males, long drop hangings, and in cases with complete suspension. There was a tendency for the number of fractures to increase with increasing age and weight of the deceased.     

Injury Patterns Sustained in Fatal Motor Vehicle Collisions with Driver's Third‐Generation Airbag Deployment

The Office of the Chief Coroner for Ontario database for 2011–2012 was used to compare fatal injury patterns in drivers whose third‐generation airbags deployed compared to first‐ and second‐generation airbag deployments and airbag nondeployments with and without seatbelt use. There were 110 frontal and offset frontal crashes analyzed. The small sample size meant that the odds of craniocerebral, cervical spinal, thoracic, and abdominal injuries were not statistically different for airbag generation, deployment status, and seatbelt use; however, the risk of fatal thoracic injuries in third‐ and second‐generation cases was increased. Seatbelt usage in third‐ and second‐generation deployment cases reduced the risk of all injuries except abdominal trauma. High severity impacts and occupant compartment intrusion were frequently observed. The analyses in this retrospective study were challenged by data that were not collated in a standardized way and were limited in details about scene, vehicle, and driver variables.