Survivability and injuries from use of rocket-assisted ejection seats: analysis of 232 cases

INTRODUCTION: Ejection injury has been documented with respect to non-rocket-assisted seats, but there is little information on injuries associated with rocket-assisted seats. This study analyses the survivability of military accidents and the injuries associated with rocket-assisted ejection. METHODS: A total of 232 Royal Air Force accident reports were accessed and aircrews' injuries were related to the aircraft parameters of ejection, aircrew anthropometry, and the ejection seat and parachute dynamics. Ejection sequences were simulated using a computerized modeling tool to provide information relating to the dynamic response index, acceleration of the ejection seats, and performance of the parachutes. RESULTS: Ejection survival was 89.2% overall, 95.7% for within envelope ejections and 23.8% for out of envelope ejections. There were 29.4% of aircrew who sustained spinal fractures. Another 14.2% of aircrew sustained a head injury and the incidence of head injury in Tornado ejectees was higher than the other aircraft types. Compared with 5.8% of ejectees from aircraft with an arm restraint system, 11.2% of aircrew sustained upper limb flail injuries from ejecting from aircraft without an arm restraint system. Arm flail injuries occurred at a higher aircraft speed at ejection compared with ejections where no arm flail injuries were sustained. There was also 18% of aircrew who sustained lower limb parachute landing injuries. DISCUSSION: Information from this study has lead to a redesign of the Tornado ejection seat headbox, an improvement in the Tornado ejection catapult dynamics, an upgrade of escape system parachutes, and provided evidence that future aircraft should be fitted with an arm restraint system.     

Road-traffic accidents--a demographic and topographic analysis

Injuries and fatalities occur in all forms of transportation, but numerically, road-traffic accidents account for the great majority worldwide. There is little that the autopsy surgeon can contribute to the elucidation of factors leading to the accident as it is largely the circumstantial and forensic laboratory evidence which is likely to reveal a non-accidental cause. However, the doctor's role in detecting the compatibility/incompatibility of the injuries with those usually sustained in traffic accidents (to detect any which are 'atypical', e.g. focal depressed fracture of the skull), distinguishing antemortem from postmortem injuries, demonstrating the presence of any disease capable of creating sudden incapacity and analysing samples for alcohol/drugs, etc., can go a long way in assigning roles to the human and to some extent vehicular and environmental factors. This warrants that a meticulous autopsy be conducted and not merely a catalogue of injuries. It must be appreciated that a fatal accident is likely to result in litigation and the extent of litigation cannot be anticipated at the time of the autopsy. One must, therefore, aim at the close study of any accident victim and a careful assessment of the case is always rewarding. The present study was undertaken in the Department of Forensic Medicine at (a) Government Medical College, Jammu (1991-93), (b) Mulana Azad Medical College, New Delhi (1993-95) and (c) Government Medical College, Chandigarh (1994-June 2000), with the object of doing a comparative analysis of the various aspects of the road-traffic accidents and accidental deaths in three topographically and demographically different cities in India and to suggest remedial measures to bring down the accident rate.     

Military parachute mishap fatalities: a retrospective study

Military parachuting is relatively safe. Most injuries involve vertebral bodies or the lower extremity, and fatalities are rare. We studied 49 military parachute accident facilities occurring during 1964-1989. Causes of the accidents included accidental deployment of reserve parachute in aircraft, static line failures and entanglements, equipment (canopy) failures, in-air collisions, landing injuries, drowning, and dragging. Rarely, preexisting illness such as coronary artery disease caused or contributed to an accident. Pathologic findings revealed a high proportion of deceleration and blunt force injuries: cardiac, aortic and liver laceration, and skull, pelvic and extremity fractures. Isolated head injury, strangulation, and post traumatic pulmonary embolus were occasionally noted. Toxicological examination demonstrated contributing factors such as alcohol intoxication or antihistamine use in a small number of cases. Background investigations, scene inspections, autopsy and toxicology studies all yielded important data or pertinent negatives during investigations. We propose an investigation protocol.     

Cardiac injuries in aircraft occupants resulting from aircraft accidents.

The author reports that relatively frequent injuries to the thorax and to the heart are established in autopsies of aircraft fatalities. A review of 128 autopsy protocols of aircraft accident fatalities revealed 111 cases of severe contact injuries to the thorax and 98 cases of traumatic injuries to the pericardium and the heart. Accepting the fact that persons injured if traffic accidents display cardiac injuries in 25% of the cases, the number of traumatic heart lesions inflicted in persons in aircarft accidents is three times as high, a fact which may be attributed to the far higher speeds of the aircraft at the moment of impact with resultant forces of deceleration. Causes and mechanisms of the development of cardiac lesions as well as necessary recommendations for the improvement of the health protection of aircraft occupants are discussed.     

Balloon crash damage and injuries: an analysis of 86 accidents, 2000-2004

BACKGROUND: General aviation accounts for the majority of aviation crashes and casualties in the United States. The role of ballooning in these statistics is not regularly studied. Since 2001, the National Transportation and Safety Board has made its accident reports more readily available, which presents opportunities for further study. OBJECTIVE: This study analyzes and compares a 5-yr period of accident reports and includes an analysis of injuries and balloon damage in hot-air and gas balloon accidents. METHODS: Balloon crash 2-page briefs and 5-page accident reports published by the National Transportation and Safety Board for the 5-yr time period 2000-2004 were examined. Data collected in the investigation of these crashes were analyzed and compared with the epidemiological data collected in earlier research. RESULTS: In 86 crashes during a 5-yr period, there were 4 fatalities and 75 people were seriously injured. Only one accident was reported involving a student pilot. Broken ankles and legs have been the most commonly recorded serious injury, but could not be linked to the severity of damage to the balloon. CONCLUSIONS: The absence of student pilot accidents may be explained by possible stricter supervision. Balloon basket and envelopes appear of sufficient quality to withstand crashes, but improving the protection of passengers during hard landings should help to decrease the number of serious injuries in ballooning.     

The significance of preexisting medical conditions,alcohol/drug use and suicidal behavior for drivers in fatal motor vehicle crashes: a retrospective autopsy study

Driver fatalities in motor vehicle collisions (MVCs) encompass accidents, suicides, and natural deaths when driving. The objective of this study was to determine the significance of pathology and other autopsy findings for drivers in fatal MVCs. Forensic autopsy records of driver fatalities in southeast Norway between 2000 and 2014 were studied retrospectively. Data from individual police and collision investigation reports were also collected and analyzed. In 406 driver fatalities, the male/female ratio was 340/66; 9% died from natural causes, 9% were suicides, 65% were culpable accidental deaths, 14% were nonculpable deaths, and 3% were undetermined deaths. Head injuries and thoracic injuries were the most common causes of death. A seatbelt had been worn in 50% of the fatalities, and its prevalence did not differ between accidental deaths and suicides. Blood levels of alcohol and/or drugs that indicated impairment at the time of the collision were found in 40% (105/262) of all culpable accidental deaths but in 50% (64/127) of drivers aged up to 35 years. Pathology (most often cardiovascular disease) suggestive of sudden incapacitation before the collision was present in 24% (62/264) of drivers who were culpable in the accident and in 70% (46/66) of culpable drivers older than 55 years. A substantial proportion of drivers are killed in accidental collisions that may have occurred as a result of either alcohol/drug impairment or preexisting disease. Suicides and natural deaths both constitute significant proportions of MVC fatalities and may be misclassified unless a full inquest including an autopsy is performed.     

The incidence, nature, and severity of injuries in New Zealand civil aviation

BACKGROUND: Strategies to improve aviation safety can be directed at the pre-crash, in-crash, or post-crash phases of aircraft crashes. For resources to be made available for in-crash interventions, and for these to be well designed, it is necessary in the first instance to have a detailed understanding of the injuries sustained in crashes. The purpose of this study was to describe the incidence, nature, and severity of injuries sustained in aircraft crashes and other related events in civil aviation in New Zealand. METHODS: National injury databases were searched for fatalities and hospitalizations sustained in aircraft crashes and related events, and cases were linked with Civil Aviation Authority accident records to identify the aircraft involved. Rates were based on estimates of total hours flown by active pilots. RESULTS: There were 104 fatalities identified for the period 1988-1992, giving a rate of 2.57 per 100,000 flight hours. There were 120 hospitalizations identified for the period 1988-1993, giving a rate of 2.45 per 100,000 flight hours. Most fatalities involved injury to multiple body regions, with at least one injury being sufficient in itself to cause death in 48% of cases. For hospitalizations, the lower extremities (23%), spine (20%), and head and face (18%) were the body regions most commonly injured, with fractures being predominant. While the majority of fatalities and hospitalizations occurred in fixed- and rotary-wing aircraft, the highest rates were for microlight and home-built aircraft. CONCLUSIONS: Different patterns of injury were evident for fixed- and rotary-wing aircraft. Reasons for these are suggested. Future research will seek to determine the relative risk associated with potentially modifiable risk factors.     

Fatal occupational injuries in the South Delhi construction industry: a retrospective study

One hundred and forty-five unselected autopsy cases of construction site accidents received from South Delhi were studied during the period from 1996--2002. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.61% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, the part of the body involved, the manner of accident, the cause of death and the pattern of injuries in different body regions. Death occurred at the scene of the fatal event in thirty-four cases; forty-three cases were dead on arrival at the hospital; sixty-eight cases died after being admitted to the hospital. Ethanol was detected in the blood of 16% of the cases.     

In-flight hypoxia incidents in military aircraft: causes and implications for training

BACKGROUND: Hypoxia has long been recognized as a significant physiological threat at altitude. Aircrew have traditionally been trained to recognize the symptoms of hypoxia using hypobaric chamber training at simulated altitudes of 25,000 ft or more. The aim of this study was to analyze incidents of hypoxia reported to the Directorate of Flying Safety of the Australian Defence Force (DFS-ADF) for the period 1990-2001, as no previous analysis of these incidents has been undertaken. The data will be useful in planning future training strategies for aircrew in aviation physiology. METHOD: A search was requested of the DFS-ADF database, for all Aircraft Safety Occurrence Reports (ASOR) listing hypoxia as a factor. These cases were reviewed and the following data analyzed: aircraft type, number of persons on board (POB), number of hypoxic POB, any fatalities, whether the victims were trained or untrained as aircrew, if the symptoms were recognized as hypoxia, symptoms experienced, the altitude at which the incident occurred, and the likely cause. RESULTS: During the period studied. 27 reports of hypoxia were filed, involving 29 aircrew. In only two cases was consciousness lost, and one of these resulted in a fatality. Most incidents (85.1%) occurred in fighter or training aircraft with aircrew who use oxygen equipment routinely. The majority of symptoms occurred between 10,000 and 19,000 ft. The most common cause of hypoxia (63%) in these aircraft was the failure of the mask or regulator, or a mask leak. Rapid accidental decompression did not feature as a cause of hypoxia. Symptoms were subtle and often involved cognitive impairment or light-headedness. The vast majority (75.8%) of these episodes were recognized by the aircrew themselves, reinforcing the importance and benefit of hypoxia training. CONCLUSION: This study confirms the importance and effectiveness of hypoxia training for aircrew. Hypoxia incidents occur most commonly at altitudes less than 19,000 ft. This should be emphasized to aircrew, whose expectation may be that it is only a problem of high altitude. Proper fitting of masks, leak checks, and equipment checks should be taught to all aircrew and reinforced regularly. Current hypobaric chamber training methods should be reviewed for relevance to the most at-risk aircrew population. Methods that can simulate subtle incapacitation while wearing oxygen equipment should be explored. Hypoxia in flight still remains a serious threat to aviators, and can result in fatalities.     

Injury severity in motor vehicle occupants

We performed a retrospective analysis of injury severity and the effect of seat belt use with findings from forensic autopsies of 50 persons who had died in motor vehicle accidents. From autopsy findings and accident reports, the abbreviated injury scale (AIS) and the injury severity score (ISS) were calculated and analyzed epidemiologically. Among unrestrained occupants, drivers usually sustained more severe chest and abdominal injuries. Furthermore, three-point seat belts significantly decreased the severity of drivers' chest and abdominal injuries. Our results may be useful for forensic pathologists and clinicians and for mechanical engineers who investigate new safety devices for vehicle occupants.     

Phobic fear of flying in aircrews: epidemiological aspects and comorbidity

BACKGROUND: Phobic fear of flying may affect aircrew members during any phase of their flying careers. Symptoms are beyond voluntary control and may lead patients to avoid flying and seek medical advice. METHODS: Of 1101 psychiatric files from our institute for 1985-2002, 150 represented cases of fliers who suffered from phobic fear of flying. Data collected from those files included assessment of fear-evoking situations, type of aircraft, class of aircrew duties, aircraft accident history, past medical history, age, and associated psychiatric comorbidity. RESULTS: We compared a group of 56 pilots with 94 other aircrew members. Results included 143 cases of flight phobia behavior and 7 cases of anxiety about parachuting. Flight phobia was less frequent among pilots (37.4%) than the other aircrew members (62.6%). We found a history of aircraft accident to the patient or an acquaintance in 25% of the cases. Observed comorbid psychiatric disorders (54%) consisted of depressive disorders (22%), anxiety disorders (16%), and personality disorders (7.4%). Fixed-wing pilots and aircrews members had a higher incidence of depression than did rotary-wing pilots and crewmembers (p < 0.05). Rotary-wing pilots and crewmembers had a higher rate of anxiety disorders (p < 0.05). DISCUSSION: Flight phobia encompasses a wide spectrum of clinical origins that may lead pilots or other aircrew members to refuse to fly. We recommend a careful psychiatric evaluation and close follow-up to adequately diagnose fliers with flight phobic reactions, as well as establishing adequate medical and/or psychological treatment.     

64层螺旋CT在道路交通事故尸体检验中的初步应用

目的 探讨64层螺旋CT在道路交通事故全身尸体检验中的应用价值.方法 根据事故现场监控录像、现场勘查照片等获得本例行人道路交通事故的发生过程.由专业的法医于事故当天对遇难者尸体进行尸表检验,得出尸体检验报告.采用64层螺旋CT对遇难者尸体进行全身扫描,并在后处理工作站对CT断面图像进行多平面重建和三维重建.将CT图像所见与尸体检验报告进行比较.结果 尸表检验发现遇难者全身多处软组织损伤、蛛网膜下腔出血、血胸、多发肋骨骨折、鼻骨骨折.认为遇难者系交通事故致颅脑损伤、胸腔脏器损伤死亡.64层螺旋CT扫描结果显示遇难者颅脑、胸部、腹部、骨盆及脊柱多器官、多脏器发生严重的损伤.结论 64层螺旋CT可获得比尸表检验更多、更重要的组织器官和脏器损伤信息,两者联合应用,可为道路交通事故伤情鉴定提供更充分、可靠的依据.     

Carboxyhemoglobin and blood cyanide concentrations in relation to aviation accidents

INTRODUCTION: It is important in aviation accident investigations to determine if a fire occurred during flight or after the crash and to establish the source(s) of the toxic gases. METHODS: Bio-specimens from aviation accident fatalities are submitted to CAMI for analyses. In blood, CO is analyzed as carboxyhemoglobin (COHb) and hydrogen cyanide as cyanide (CN-). Analytical data were stored in a database, and this database was searched for the period of 1990-2002 for the presence of COHb and CN in the submitted cases. RESULTS: Out of 5945 cases, there were 223 (4%) cases wherein COHb was > or = 10%. Of the 223 cases, fire was reported with 201, no fire with 21, and undetermined fire status with 1. CN concentrations were at or above 0.25 microg x ml(-1) in 103 of the 201 fire-related cases. None of the 21 non-fire cases had CN-, but nicotine was detected in 9 of the cases. All non-fire cases with COHb > 30% (four cases) were associated with exhaust leaks. Of the 223 cases, COHb-CN- fractional toxic concentration (FTC) was lethal only in 31 cases with elevated CN levels. CONCLUSIONS: The presence of COHb and CN in elevated concentrations in the blood of victims found by autopsy to have died on impact would indicate an in-flight fire. In the absence of fire and CN-, the elevated COHb concentrations would suggest an exhaust leak, particularly at COHb > 30%. The findings of this study also suggest that, in addition to COHb, CN plays a detrimental role in fire-associated aviation accident fatalities.     

The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents

Since traffic accidents are an important problem in forensic medicine, there is a constant search for new solutions to help with an investigation process in such cases. In recent years there was a rapid development of post-mortem imaging techniques, especially post-mortem computed tomography (PMCT). In our work we concentrated on a potential advantage of PMCT in cases of motorcycle accident fatalities. The results of forensic autopsy were compared with combined results of the autopsy and PMCT to check in which areas use of these two techniques gives statistically important increase in number of findings. The hypothesis was confirmed in case of pneumothorax and fractures of skull, spine, clavicle, scapula, lower leg bones. As for majority of other bone fractures locations and brain injures there were single cases with pathologies visible only in PMCT, but too few to reach expected level of p-value. In case of injuries of solid organs and soft tissues statistical analysis did not confirmed any advantage of unenhanced PMCT use. On the whole it has been shown that PMCT used as an adjunct to forensic autopsy can cause an increase in information about vitally important regions in case of motorcycle accident fatalities.     

2004—2018年中国不同年龄段人群道路交通伤害发展趋势分析

目的:分析2004—2018年中国不同年龄段人群道路交通伤害（RTIs）发展趋势,为针对性预防RTIs提供参考。方法:基于中国交通事故统计年报和中国统计年鉴,将年龄分为0~14岁、15~34岁、35~59岁及≥60岁四个年龄段。计算2004—2018年不同年龄段RTIs事故总起数、死亡人数、受伤人数及年龄构成比,计算不...     

GHEP-ISFG collaborative simulated exercise for DVI/MPI: Lessons learned about large-scale profile database comparisons

The GHEP-ISFG Working Group has recognized the importance of assisting DNA laboratories to gain expertise in handling DVI or missing persons identification (MPI) projects which involve the need for large-scale genetic profile comparisons. Eleven laboratories participated in a DNA matching exercise to identify victims from a hypothetical conflict with 193 missing persons. The post mortem database was comprised of 87 skeletal remain profiles from a secondary mass grave displaying a minimal number of 58 individuals with evidence of commingling. The reference database was represented by 286 family reference profiles with diverse pedigrees. The goal of the exercise was to correctly discover re-associations and family matches. The results of direct matching for commingled remains re-associations were correct and fully concordant among all laboratories. However, the kinship analysis for missing persons identifications showed variable results among the participants. There was a group of laboratories with correct, concordant results but nearly half of the others showed discrepant results exhibiting likelihood ratio differences of several degrees of magnitude in some cases. Three main errors were detected: (a) some laboratories did not use the complete reference family genetic data to report the match with the remains, (b) the identity and/or non-identity hypotheses were sometimes wrongly expressed in the likelihood ratio calculations, and (c) many laboratories did not properly evaluate the prior odds for the event. The results suggest that large-scale profile comparisons for DVI or MPI is a challenge for forensic genetics laboratories and the statistical treatment of DNA matching and the Bayesian framework should be better standardized among laboratories.     

Injury prevention during physical activity in the Australian Defence Force

INTRODUCTION: Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce. METHOD: Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims. RESULTS: Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency. CONCLUSION: Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.     

Rail traffic accidents: a retrospective study

One hundred and twenty-seven autopsy cases of rail traffic accidents received from South Delhi were studied during the period from 1996-2002. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.41% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, the part of the body involved and the pattern of injuries in different body regions. Death occurred at the scene of the fatal event in twenty-eight cases; another twenty-eight cases were brought in dead to the hospital. Seventy-one cases died after being admitted to the hospital. Ethanol was detected in the blood of 17.4% of cases.     

民航飞行人员冠心病19例临床特点分析

目的 通过回顾分析19例民航飞行人员冠心病的临床特点和医学鉴定情况,为飞行人员冠心病医学鉴定和航卫保障工作提供参考. 方法回顾分析我国南方航空公司2002～2006年5年间19例新发冠心病飞行人员的临床和医学鉴定资料,总结其特点. 结果对象均为男性,发病年龄40～57(52.9±3.9)岁,平均飞行时间18 210 h,其中驾驶员12例,机械师7例;2002～2006年年均发病率为2.64‰,各年之间发病率比较无显著差异(x2=1.251,P>0.05);深圳分公司发病例数最多,为9例,年均发病率为9.50‰,与广州、武汉和郑州分公司比较,深圳分公司飞行人员冠心病的发病率明显偏高(P<0.05),其他地区之间冠心病发病率比较无显著差异(P>0.05);冠状动脉造影显示病变血管以中重度狭窄为主,其中单支病变8例,双支病变10例,3支病变1例.4例获特许飞行合格,至今最长安全飞行时间>2000 h. 结论加强心血管病危险因素干预是预防冠心病的根本,冠心病介入治疗为飞行人员冠心病后重获飞行资格创造了条件.