Foot-Launched Flying Sport Fatalities in the Canton of Berne, Switzerland.

INTRODUCTION: Foot-launched flying sports such as paragliding, hang gliding, and speedflying are popular recreational activities that all pose a significant risk of accidents resulting in injuries or fatalities. We describe the epidemiology, incident circumstances, and findings of forensic examinations of fatalities in these sports. METHODS: In this retrospective analysis, we analyzed different parameters of paragliding, hang gliding, and speedflying fatalities in the canton of Berne, Switzerland, between 2000 and 2018. The data sources were police reports, forensic medical reports, the Swiss Hang Gliding Association, and the Swiss Council for Accident Prevention. RESULTS: In the given period, 40 incidents resulting in 42 fatalities were recorded (2 incidents involved 2-seaters). Three of the 40 incidents did not fulfill the inclusion criteria and were excluded. The deadliest phase was midflight. Collapse of the glider (n=9; 36%) was the leading cause of accidents among paraglider pilots. Multiple trauma (n=21; 54%) was the most frequent cause of death. In the forensic examination, all deaths (n=39) were assessed as accidents. CONCLUSIONS: The different categories of foot-launched flying sports varied in the causes of accidents and deaths. Fatalities in speedflying involved young pilots exposing themselves to high-risk situations. Fatalities may be prevented by enhancing education and training and promoting a cautious attitude among pilots.

How safe is BDSM? A literature review on fatal outcome in BDSM play.

A noteworthy number of people are interested in BDSM (bondage and discipline, dominance and submission, sadism, and masochism). Fatal outcomes while participating in BDSM activities occur. The aim of this literature review is to give a better insight into potential dangerous BDSM play by summarizing published data on BDSM fatalities. A literature search was conducted. It was searched for non-natural death related to BDSM activity. Seventeen cases were found. The age of the deceased ranged between 23 and 49 years (mean age 34.9 years). Strangulation in the course of erotic asphyxiation was the most common cause of death (88.2%). In 13 cases, a toxicology report for the deceased was mentioned, of which in eight cases (61.5%) toxicology analysis was positive. In four of these cases, the BDSM partner was also tested positive with the same substance. Drugs or alcohol was involved in 64.3% of fatal BDSM play. In nine cases, the level of experience in BDMS activity of the deceased and the partner was described, and in all of them, the deceased and the partner were not new to BDSM play. Fatal outcomes of BDSM plays are rarer than autoerotic fatalities and natural deaths related to sexual activities. Safeguards and education on medical aspects exist in the BDSM communities. If they are followed by the practitioners, the risks of BDMS play can be reduced. Cases of non-natural death connected to BDSM are rare incidents and can be prevented.

Fatal strangulation during consensual BDSM activity: three case reports.

Autoerotic accidents are well-known occurrences in forensic casework. Reports about unintentional deaths in a sexual context involving other persons are much rarer. Three cases of fatal incidents related to asphyxiophilia during consensual BDSM activity are reported. Two men died while visiting a dominatrix, the third one in the presence of a male casual sexual partner. Paraphernalia associated with BDSM/fetishism were found at the scene in all cases. Autopsy findings were compatible with death by strangulation. The cases are compared with published autoerotic accidents and similar unintentional deaths involving other individuals. The difficulties concerning the forensic assessment and reconstruction of the cases are discussed.

Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom).

Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics.

Circumstances and causes of death of hikers at different altitudes: A retrospective analysis of hiking fatalities from 2003-2018.

INTRODUCTION: The number of hikers and the popularity of hiking in the Alpine region is great. Inevitably linked to this, natural deaths as well as fatal and non-fatal accidents occur. Nevertheless, there is little data available on hiking accidents in particular. This study examines the circumstances of accidents and the causes of death of hikers who have suffered fatal accidents. METHODS: Retrospectively, the police files and forensic medical reports of hiking fatalities in the Canton of Berne (Switzerland) from 2003 to 2018 were analyzed. In this process 25 predefined parameters were collected (e.g. manner of death, causes of death, height of fall). Subsequently, all fatal hiking accidents were evaluated and compared by altitude (<1800 m vs. >1800 m). RESULTS: 77 fatal hiking accidents were recorded in the given period, all of which were caused by a fall. Over 1800 m significantly more traumatic brain injuries occurred than under 1800 m (85 vs. 62.2 %, p = 0.022). Besides, significantly more accidents occurred during descent in the group above 1800 m than below 1800 m (60.9 vs. 84.8 %, p = 0.041). A large share of accidents occurred off official hiking trails (45.9 vs. 32.5 %). Significantly more equipment shortages were found in the group below 1800 m (32.4 vs. 12.5 %, p = 0.035). The accident victims with equipment shortages were on average 10.35 years younger. CONCLUSION: Causes and circumstances of death of hikers differ in some points significantly at different altitudes. Prevention in the form of education about the dangers of hiking off the official hiking trails and equipment shortages could prevent deaths in the future. The education should primarily be aimed at foreign, young and inexperienced hikers.

Rigor mortis at the myocardium investigated by post-mortem magnetic resonance imaging.

INTRODUCTION: Post-mortem cardiac MR exams present with different contraction appearances of the left ventricle in cardiac short axis images. It was hypothesized that the grade of post-mortem contraction may be related to the post-mortem interval (PMI) or cause of death and a phenomenon caused by internal rigor mortis that may give further insights in the circumstances of death. METHOD AND MATERIALS: The cardiac contraction grade was investigated in 71 post-mortem cardiac MR exams (mean age at death 52 y, range 12-89 y; 48 males, 23 females). In cardiac short axis images the left ventricular lumen volume as well as the left ventricular myocardial volume were assessed by manual segmentation. The quotient of both (LVQ) represents the grade of myocardial contraction. LVQ was correlated to the PMI, sex, age, cardiac weight, body mass and height, cause of death and pericardial tamponade when present. In cardiac causes of death a separate correlation was investigated for acute myocardial infarction cases and arrhythmic deaths. RESULTS: LVQ values ranged from 1.99 (maximum dilatation) to 42.91 (maximum contraction) with a mean of 15.13. LVQ decreased slightly with increasing PMI, however without significant correlation. Pericardial tamponade positively correlated with higher LVQ values. Variables such as sex, age, body mass and height, cardiac weight and cause of death did not correlate with LVQ values. There was no difference in LVQ values for myocardial infarction without tamponade and arrhythmic deaths. CONCLUSION: Based on the observation in our investigated cases, the phenomenon of post-mortem myocardial contraction cannot be explained by the influence of the investigated variables, except for pericardial tamponade cases. Further research addressing post-mortem myocardial contraction has to focus on other, less obvious factors, which may influence the early post-mortem phase too.

Influences on the amount of intraperitoneal haemorrhage after blunt liver injury: a retrospective autopsy study.

OBJECTIVE: The amount of intraperitoneal blood loss due to traumatic liver injury is rarely addressed in correlation with concomitant injuries or pre-existing liver disease. METHODS: We carried out a retrospective review of autopsy reports from 1995 until 2007 at the Institute of Forensic Medicine (Bern, Switzerland), and evaluated 126 cases of blunt liver trauma for the amount of blood in the abdominal cavity, severity of liver injury, pre-existing liver disease and concomitant injuries. RESULTS: Grades IV and V liver injuries (American Association for the Surgery of Trauma classification) showed greater blood loss than grades I and II liver injuries. Grade III liver injuries showed no significant difference in the amount of intraperitoneal blood compared with grades IV and V liver injuries and 53 cases of liver injuries (42%) did not bleed at all. The amount of blood found in the abdominal cavity ranged from 0 to 4500 ml. Pre-existing liver steatosis showed no significant difference in injury pattern or bleeding from the liver. Three cases with liver haemangiomas and one with a liver cyst showed no lesion to their focal alteration. Because of the small number of cases, no statistical analysis was made concerning concomitant injuries such as head, thoracic or limb trauma. CONCLUSION: Higher grades of liver injury severity are associated with higher blood loss into the abdominal cavity. In addition, a patient with pre-existing liver steatosis seems not to be at any greater risk of having a larger rupture or having stronger bleeding from the liver after a blunt impact compared with a patient with a normal liver.

Fatal left ventricular rupture and pericardial tamponade following a horse kick to the chest.

Horse kicks are rare incidents-especially, if they end in fatality. In this case, a 13-year-old girl collapsed 3 minutes after sustaining a kick to the chest from a pony. Resuscitation attempts were unsuccessful. Postmortem computed tomography and magnetic resonance imaging were performed before autopsy.Imaging revealed a 3-cm long laceration of the left ventricle and a large pericardial effusion. Using segmentation techniques, the amount of blood inside the pericardium was determined. These findings correlated well with the autopsy findings. Pericardial tamponade was determined at autopsy to be the cause of death.Postmortem imaging may prove useful for the diagnosis of these types of injury, but further studies are needed to document accuracy.

Unusually extensive head trauma in a hydraulic elevator accident: post-mortem MSCT findings, autopsy results and scene reconstruction.

Accidental or intentional falls from a height are a form of blunt trauma and occur frequently in forensic medicine. Reports describing elevator accidents as a small subcategory of falls from heights are rare in the medical literature and no report on injury patterns or scene reconstruction of such an accident was found. A case of an accident in a hydraulic elevator with a man falling 3m was examined using post-mortem multi-slice computed tomography (MSCT) and autopsy. The man suffered an unusually extensive trauma and died at the scene. Post-mortem MSCT examination showed a comminute fracture of the skull, the right femur and the first lumbar vertebra. Severe lacerations of the brain with epidural, subdural and subarachnoidal haemorrhages over both hemispheres were diagnosed. Autopsy confirmed these findings. To reconstruct the accident we used radiological and autopsy results as well as findings at the scene.

[Physical and sexual violence against adult persons - forensic aspects in the daily medical work]. / Körperliche und sexuelle Gewalt an Erwachsenen - vom forensischen Denken und ärztlichen Handeln.

Physical and sexual violence is an increasing issue in daily clinical praxis. The article defines the different kinds of violence like domestic violence, urban violence, accidental and self-inflicted injuries. Medical Doctors should be teached in forensic thinking and acting regarding victims of any kind of violence, especially concerning the disclosure of no accidental injuries and the importance of a complete and standardized forensic documentation.