Motor Vehicles All Manners of Death

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Although most cases of fatalities involving motor vehicles are caused by accidents, the pathologist must be aware that other manners of death do occur (484,688,689). Natural deaths of drivers behind the wheel (e.g., myocardial infarction or heart attack) do happen. Drivers may have warning symptoms that allow them to take appropriate actions to prevent serious injuries to themselves and others (690-693). Some drivers lose consciousness before the vehicle stops (693). The trauma in this situation is insufficient to account for death (693). Implanted heart rhythm devices can assist in determining the events preceding death (694). The pathologist must assess either the role of disease in accident causation or trauma exacerbating disease (695). Although many deaths from accidents occur shortly after the incident, some deaths are delayed due to various complications (see Chapter 1, Heading 11.). Some injuries sustained during an accident may mimic a homicide (Fig. 85). Other forms of accidents can occur in association with motor vehicles (e.g., carbon monoxide poisoning owing to faulty exhaust system; see Chapter 3, Subheading 3.9.1.). Acute intoxication by ethanol and other drugs, alcoholism, and psychiatric impairment increase the risk of motor vehicle collision (696,697). A motor vehicle may also be used as an instrument of suicide (697). A driver may deliberately drive either off the road (e.g., into a fixed object, another vehicle, water) or from a height (553,689,697-700). In these instances, there is an absence of skidmarks, indicating that braking did not occur, and an accelerator imprint may be present on the shoe sole (Fig. 86; refs. 483,688,689,697,701, and 702). Acceleration may be witnessed. A vehicle may be deliberately stopped on railroad tracks (see Heading 15). A pedestrian may step in front of a vehicle. An individual can deliberately be asphyxiated with carbon monoxide (e.g., running engine in closed

Fig. 85. Suspicious laceration of neck of truck driver, alone while driving on an interstate highway. Vehicle observed veering off road. Origin of injury in occupant compartment possibly from broken glass. (Courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC.)
Fig. 86. Brake pad imprint on sole of deceased's driver's right shoe indicating braking prior to impact.
Forensic Pathology Vehicle
Fig. 87. Motor vehicle-train collision.

garage; see Chapter 3, Subheading 3.9.1., Fig. 66; refs. 698 and 699). Unusual suicides (e.g., gunshot injury, self-immolation, hanging) arouse suspicions (Chapter 4, Fig. 1; refs. 698, 699, 701 and 703-705). Homicides can be committed using a motor vehicle (563). An individual may be deliberately run over by a vehicle. The more common situation is "hit-and-run." Trace evidence collection, in these cases, is imperative (706,707). Homicides can masquerade as accidents (Chapter 4, Fig. 3).

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