Other Trauma

Fatal injuries occur prior to a fire (Figs. 22 and 23). Radiographs are necessary prior to dissection, to rule out certain types of injuries (e.g., gunshot wound; see Fig. 3

Fig. 24. Motor vehicle collisions associated with fires. (A) Clotted blood from the ear of a charred victim (arrow). A basal skull fracture was seen. Note skin splits near ear caused by charring. (B) Charred body. Scalp reflected to reveal linear skull fracture (arrows) showing no evidence of heat effects, i.e., charring.

and ref. 4). Charring obscures external injuries (Fig. 24; ref. 67). Distinguishing between antemortem and postmortem heat fractures may require assistance of an anthropologist (85). The base of the skull is relatively protected from the direct effect of heat. A fracture of the uncharred skull base indicates antemortem trauma, and this is supported by the presence of hemorrhage in adjacent soft tissues, and subdural and subarachnoid hemorrhage (Fig. 25; refs. 34 and 86). Accumulation of blood in the subdural space is an antemortem event (see Subheading 3.3. and refs. 4 and 47). Subdural hemorrhages are typically unilateral (49). Intracerebral injuries can be observed (Fig. 25).

Fig. 25. Motor vehicle collisions followed by fires and charring of victims. (A) Rollover. Subdural hemorrhage. (B) Multiple petechial hemorrhages in brainstem (pons) indicative of diffuse vascular injury.

COHb elevation and soot are absent in cases of fatal trauma (42). Trauma can be sustained during the fire (4). A study of motor vehicle-related fires showed three patterns: smoke inhalation and increased COHb; thermal airway injury; and trauma (67). In this series, levels of COHb greater than 30% strongly suggested inhalation of combustion products as the cause of death (67). A concentration of less than 20% suggested that other causes of death needed to be considered, i.e., trauma and thermal injury sustained during the collision (67). Soot and low COHb levels have been noted in injured occupants of cars that caught fire (52).

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