Journal of Forensic and Legal Medicine 32 (2015) 21e24
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m
Case report
A rare case of a scuba diver's death due to propeller injuries of a desalination pump G. Perilli a, B. Di Battista a, A. Montana c, J. Pavia b, S. Cauchi b, N.M. Zerafa b, C. Pomara a, b, * a
Department of Forensic Pathology, University of Foggia, Ospedale Colonnello d'Avanzo, Viale degli Aviatori 1, 71100 Foggia, Italy Department of Anatomy, University of Malta, Msida, Malta c Department of Forensic Toxicology “G.F. Ingrassia”, University of Catania, via S. Sofia 87, Comparto 10, 95123, Catania, Italy b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 20 January 2015 Accepted 7 February 2015 Available online 17 February 2015
Water skiing, boat racing, skin and scuba diving, as well as pleasure boat cruising are becoming increasingly popular hobbies. As a result, the incidence of injuries secondary to motor propellers is becoming more frequent. Injuries by propellers, amputation, death by drowning, and bleeding are rare reported events in forensic literature. The most common circumstances surrounding boat-propellerrelated injuries are concerned with getting into or out of the boat, personal watercraft use or water skiing, and falling or being thrown from the boat. A case of a scuba diver's death that occurred during an illegal scuba fishing trip around a desalination plant is presented. A complete autopsy and histological study of all organs and surfaces of dismembered cadaveric sections, performed in order to determine the phases of death, are reported. An underwater scene investigation was conducted by an engineering team studying the mouth of the pump and the dynamic characteristic of rotating propeller blades. © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords: Propeller injuries Desalination plant Drowning Acute haemorrhage
1. Introduction Water skiing, boat racing, skin and scuba diving, and pleasure boat cruising are hobbies whose popularity is on the increase. As a result, the incidence of injuries secondary to motor propellers is becoming more frequent.1,2 According to previous reports, the frequency of propeller accidents is greater than 1 in every 20 boating accidents, with a fatality rate of 15e23%. 75% of the victims are male.3,4 The sharp blades of propellers rotating at high speeds cause multiple serious injuries such as bruises, contusions, deep lacerations, chop wounds, open wounds, musculoskeletal and vascular injuries, bone fractures, traumatic mutilation of extremities, and death.5,6 2. Case report A 56-year-old man was at a scuba diving fishing trip at around 6:30 am with two other scuba divers. The men were fishing at
* Corresponding author. Department of Forensic Pathology, University of Foggia, Ospedale Colonnello d'Avanzo, Viale degli Aviatori 1, 71100 Foggia, Italy, Tel.: þ39 3332466148 (mobile), fax: þ39 0881736903. E-mail address: [email protected] (C. Pomara).
3e4 m depth, about 30 m away from the beach. It was decided that fishing will occur close to a disused desalinization plant, as the enormous quantity of “big mussels” attached onto the surface of the underwater part of the desalination pump probably served as an element of attraction. A large, bloody patch in the water surrounding a lifeless corpse of one of the crew member attracted the attention of the crew shortly after an unexpected burst of activity of the desalination pump. The corpse was rescued to shore and the local authorities were alerted. The autopsy was performed 24 h after death. The external examination of the body showed an abrasion of the neck of a length of 12.5 cm and a width of 11 cm (Fig. 1a). A large bluish/red abrasion/ contusion of the right thoracic wall extending to the superior part of the ipsilateral abdominal wall was also noticed. Multiple amputations of the arm and leg were observed, particularly left hand amputation that showed the distal epiphysis of the radius and ulna (Fig. 1b); right upper limb amputation in which the proximal portion of the humeral epiphysis was recognizable (Fig. 1c); and right foot amputation in which the heel, the distal epiphysis of the tibia and fibula were identified (Fig. 1d). Multiple abrasions of the right lower limb were observed. Portions of the right hand and a part of the right foot were found near the propeller. Autopsy confirmed the complete sectioning of the right arm, the left forearm and both ankles and corresponding great vessels (both
http://dx.doi.org/10.1016/j.jflm.2015.02.006 1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
22
G. Perilli et al. / Journal of Forensic and Legal Medicine 32 (2015) 21e24
Fig. 1. a) Excoriations and contusions of the neck; b) Mutilated left hand; c) Mutilated right upper limb; d) Mutilated right foot.
the axillary, the cephalic and basilic veins). A contusion of the thoracic soft tissue with multiple fractures (the left sixth rib from the fifth to the eighth right rib) were also decribed. Examination of all other organs was unremarkable, except for pulmonary and cerebral oedema. The autopsy findings of lungs showed oedema and were increased in volume and size, with few sub-pleural haemorrhagic spots. Vessels were completely free of blood. Histological examination with standard H&E staining showed mild cerebral oedema with focal subcortical haemorrhagic spots and focal pulmonary oedema associated with extended areas of atelectasia, acute emphysema (Fig. 2a), and “ballonee” cells inside the alveolar spaces (Fig. 2b). The skin revealed the presence of red blood cell infiltration into derma (Fig. 2c,d) of all dismembered surfaces. The toxicological analysis did not reveal the presence of drugs or alcohol. An underwater scene investigation was conducted by an engineering team, studying the mouth of the pump and the dynamic characteristic of rotating propeller blades. The prosecutor's office immediately verified and confirmed that the desalinization plant was in action only for a few minutes (approximately 5 min) due to exceptional technical servicing. Consistent with the data obtained and with the dynamics of the fatal event, the cause of death resulted by drowning and massive haemorrhage due to propeller injuries. 3. Discussion Propeller injuries are rare events and are thus seldom reported in literature. According to previous reports, the fatality rate in propeller accidents is 15e23%, with an incidence of propeller accidents being greater than one in every 20 boating accidents.1,4,7,8 Most propeller injuries occur at water recreational facilities such as those equipped for water skiing, boat racing, and skin and scuba diving.7,9 Due to an increase in the popularity of such activities, the number of boat propeller accidents are on the rise.1,2 Injuries
caused by the propeller can be very serious; they typically cause multiple, deep, parallel lacerations that can result in permanent scarring, substantial blood loss, traumatic or surgical amputation, or death.3,9 Death can often result due to the physical trauma sustained from the propeller blades, such as severe chop wounds on the head or thorax, with head injury being the commonest cause of death in such accidents. If the wounds sustained are not immediately fatal, massive haemorrhaging from the propeller wounds could ensue, which could itself be the primary cause of death. In addition to the wounds sustained by the propellers, the victims are at risk of drowning; a factor that increases the risk of mortality in such accidents.10 To the best of our knowledge there have been no reported injuries or deaths related to propellers from a desalination plant prior to this case. This case shows the severity of injuries and their sequelae, until the death caused by high-speed propellers of the desalination pump. Theoretically, it has been shown that a typical three-blade propeller rotating at 3200 rpm and with a blade length of 33.2 cm can cut an average person from head to toe in less than one tenth of a second.3,8 In this case the engineering findings showed that the man, while fishing, was aspirated from the terminal part of the desalination pump (Fig. 3 a, b, c). It is possible that the man had approached the final stretch of the desalination pump when it was turned off. The sudden turning on of the desalination pump with the current of the intake flow and the rapid rotation of the desalination pump propellers violently sucked the man towards the rapidly rotating blades, slicing the entire right arm, left hand, and right foot. An opinion is held that in the type of accident that has just been described, autopsy remains the only option to elucidate both the manner and the cause of death. The histological study of all organs, in particular the skin surfaces of the dismembered sites, is essential to determine the vitality of injuries, whilst that of the lungs is essential to establish drowning diagnosis and qualifying the phases of death.
G. Perilli et al. / Journal of Forensic and Legal Medicine 32 (2015) 21e24
23
Fig. 2. a) Focal pulmonary oedema associated with extended areas of atelectasia, acute emphysema (H&E x 250 magnification); b) “Ballonee” cells inside the alveolar space. (black arrows) (H&E x 250 magnification); c,d) Red blood cell infiltration into derma of skin wounds (insert) (H&E x 250 magnification).
The study of pathophysiology and timing of death, become fundamental to exclude others reasons, including industrial liability such as in the presented case. A complete toxicological analysis should always be performed. In accordance with the obtained data, we were able to reconstruct the dynamic of the phatal event and the phases of death,
concluding that the cause of death resulted by drowning and massive haemorrhage due to propeller injuries. Histological study of organs and mutilated skin must be required as forensic approach to similar cases. In the reported case, despite the warning signals that were posted on the columns of the desalinization plant, according to the
Fig. 3. a) Terminal part of the desalination pump with “big mussels” attached onto the surface of the underwater part (white arrow); b, c) Rotating propellers (white arrows).
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G. Perilli et al. / Journal of Forensic and Legal Medicine 32 (2015) 21e24
data by the autopsy and the crime scene, the prosecutor decided to take penal and civil action for negligence against the propriety, since the rarity of the event (exceptional technical servicing) did not warrant a prevision of exceptional signposting and preventing measures given the close proximity of the beach. Conflict of interest The authors confirm that this article content has no conflicts of interest. Funding None declared. Ethical approval None declared.
References 1. Mann RJ. Propeller injuries incurred in boating accidents. Am J Sports Med 1980;8:280e4. 2. Mann RJ. Propeller injuries. South Med J May 1976;69:567e9. 3. Hargarten SW, Karlson T, Vernick JS, Aprahamian C. Motorboat propeller injuries in wisconsin: enumeration and prevention. J Trauma 1994;37:187e90. 4. Kutarski PW. Outboard motor propeller injuries. Injury 1989;20:87e91. 5. Hummel G, Gainor BJ. Waterskiing-related injuries. Am J Sports Med 1982;10: 215e8. 6. Chalmers DJ, Morrison L. Epidemiology of non-submersion injuries in aquatic sporting and recreational activities. Sport Med 2003;33:745e70. 7. From the Centers for Disease Control and Prevention. Boat-propeller-related injuries-Texas 1997. J Am Med Assoc 1998;279:1858. 8. Mendez-Fernandez MA. Motorboat propeller injuries. Ann Plast Surg 1998;41: 113e8. 9. Giersten JC. Drowning. In: Mason JK, Purdue BN, editors. The pathology of trauma. London: E-Publishing Inc; 2000. p. 263e4. 10. Ihama Y, Ninomiya K, Noguchi M, Fuke C, Miyazaki T. Fatal propeller injuries: three autopsy case reports. J Forensic Leg Med 2009;16:420e3.
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m
Case report
A rare case of a scuba diver's death due to propeller injuries of a desalination pump G. Perilli a, B. Di Battista a, A. Montana c, J. Pavia b, S. Cauchi b, N.M. Zerafa b, C. Pomara a, b, * a
Department of Forensic Pathology, University of Foggia, Ospedale Colonnello d'Avanzo, Viale degli Aviatori 1, 71100 Foggia, Italy Department of Anatomy, University of Malta, Msida, Malta c Department of Forensic Toxicology “G.F. Ingrassia”, University of Catania, via S. Sofia 87, Comparto 10, 95123, Catania, Italy b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 20 January 2015 Accepted 7 February 2015 Available online 17 February 2015
Water skiing, boat racing, skin and scuba diving, as well as pleasure boat cruising are becoming increasingly popular hobbies. As a result, the incidence of injuries secondary to motor propellers is becoming more frequent. Injuries by propellers, amputation, death by drowning, and bleeding are rare reported events in forensic literature. The most common circumstances surrounding boat-propellerrelated injuries are concerned with getting into or out of the boat, personal watercraft use or water skiing, and falling or being thrown from the boat. A case of a scuba diver's death that occurred during an illegal scuba fishing trip around a desalination plant is presented. A complete autopsy and histological study of all organs and surfaces of dismembered cadaveric sections, performed in order to determine the phases of death, are reported. An underwater scene investigation was conducted by an engineering team studying the mouth of the pump and the dynamic characteristic of rotating propeller blades. © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords: Propeller injuries Desalination plant Drowning Acute haemorrhage
1. Introduction Water skiing, boat racing, skin and scuba diving, and pleasure boat cruising are hobbies whose popularity is on the increase. As a result, the incidence of injuries secondary to motor propellers is becoming more frequent.1,2 According to previous reports, the frequency of propeller accidents is greater than 1 in every 20 boating accidents, with a fatality rate of 15e23%. 75% of the victims are male.3,4 The sharp blades of propellers rotating at high speeds cause multiple serious injuries such as bruises, contusions, deep lacerations, chop wounds, open wounds, musculoskeletal and vascular injuries, bone fractures, traumatic mutilation of extremities, and death.5,6 2. Case report A 56-year-old man was at a scuba diving fishing trip at around 6:30 am with two other scuba divers. The men were fishing at
* Corresponding author. Department of Forensic Pathology, University of Foggia, Ospedale Colonnello d'Avanzo, Viale degli Aviatori 1, 71100 Foggia, Italy, Tel.: þ39 3332466148 (mobile), fax: þ39 0881736903. E-mail address: [email protected] (C. Pomara).
3e4 m depth, about 30 m away from the beach. It was decided that fishing will occur close to a disused desalinization plant, as the enormous quantity of “big mussels” attached onto the surface of the underwater part of the desalination pump probably served as an element of attraction. A large, bloody patch in the water surrounding a lifeless corpse of one of the crew member attracted the attention of the crew shortly after an unexpected burst of activity of the desalination pump. The corpse was rescued to shore and the local authorities were alerted. The autopsy was performed 24 h after death. The external examination of the body showed an abrasion of the neck of a length of 12.5 cm and a width of 11 cm (Fig. 1a). A large bluish/red abrasion/ contusion of the right thoracic wall extending to the superior part of the ipsilateral abdominal wall was also noticed. Multiple amputations of the arm and leg were observed, particularly left hand amputation that showed the distal epiphysis of the radius and ulna (Fig. 1b); right upper limb amputation in which the proximal portion of the humeral epiphysis was recognizable (Fig. 1c); and right foot amputation in which the heel, the distal epiphysis of the tibia and fibula were identified (Fig. 1d). Multiple abrasions of the right lower limb were observed. Portions of the right hand and a part of the right foot were found near the propeller. Autopsy confirmed the complete sectioning of the right arm, the left forearm and both ankles and corresponding great vessels (both
http://dx.doi.org/10.1016/j.jflm.2015.02.006 1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
22
G. Perilli et al. / Journal of Forensic and Legal Medicine 32 (2015) 21e24
Fig. 1. a) Excoriations and contusions of the neck; b) Mutilated left hand; c) Mutilated right upper limb; d) Mutilated right foot.
the axillary, the cephalic and basilic veins). A contusion of the thoracic soft tissue with multiple fractures (the left sixth rib from the fifth to the eighth right rib) were also decribed. Examination of all other organs was unremarkable, except for pulmonary and cerebral oedema. The autopsy findings of lungs showed oedema and were increased in volume and size, with few sub-pleural haemorrhagic spots. Vessels were completely free of blood. Histological examination with standard H&E staining showed mild cerebral oedema with focal subcortical haemorrhagic spots and focal pulmonary oedema associated with extended areas of atelectasia, acute emphysema (Fig. 2a), and “ballonee” cells inside the alveolar spaces (Fig. 2b). The skin revealed the presence of red blood cell infiltration into derma (Fig. 2c,d) of all dismembered surfaces. The toxicological analysis did not reveal the presence of drugs or alcohol. An underwater scene investigation was conducted by an engineering team, studying the mouth of the pump and the dynamic characteristic of rotating propeller blades. The prosecutor's office immediately verified and confirmed that the desalinization plant was in action only for a few minutes (approximately 5 min) due to exceptional technical servicing. Consistent with the data obtained and with the dynamics of the fatal event, the cause of death resulted by drowning and massive haemorrhage due to propeller injuries. 3. Discussion Propeller injuries are rare events and are thus seldom reported in literature. According to previous reports, the fatality rate in propeller accidents is 15e23%, with an incidence of propeller accidents being greater than one in every 20 boating accidents.1,4,7,8 Most propeller injuries occur at water recreational facilities such as those equipped for water skiing, boat racing, and skin and scuba diving.7,9 Due to an increase in the popularity of such activities, the number of boat propeller accidents are on the rise.1,2 Injuries
caused by the propeller can be very serious; they typically cause multiple, deep, parallel lacerations that can result in permanent scarring, substantial blood loss, traumatic or surgical amputation, or death.3,9 Death can often result due to the physical trauma sustained from the propeller blades, such as severe chop wounds on the head or thorax, with head injury being the commonest cause of death in such accidents. If the wounds sustained are not immediately fatal, massive haemorrhaging from the propeller wounds could ensue, which could itself be the primary cause of death. In addition to the wounds sustained by the propellers, the victims are at risk of drowning; a factor that increases the risk of mortality in such accidents.10 To the best of our knowledge there have been no reported injuries or deaths related to propellers from a desalination plant prior to this case. This case shows the severity of injuries and their sequelae, until the death caused by high-speed propellers of the desalination pump. Theoretically, it has been shown that a typical three-blade propeller rotating at 3200 rpm and with a blade length of 33.2 cm can cut an average person from head to toe in less than one tenth of a second.3,8 In this case the engineering findings showed that the man, while fishing, was aspirated from the terminal part of the desalination pump (Fig. 3 a, b, c). It is possible that the man had approached the final stretch of the desalination pump when it was turned off. The sudden turning on of the desalination pump with the current of the intake flow and the rapid rotation of the desalination pump propellers violently sucked the man towards the rapidly rotating blades, slicing the entire right arm, left hand, and right foot. An opinion is held that in the type of accident that has just been described, autopsy remains the only option to elucidate both the manner and the cause of death. The histological study of all organs, in particular the skin surfaces of the dismembered sites, is essential to determine the vitality of injuries, whilst that of the lungs is essential to establish drowning diagnosis and qualifying the phases of death.
G. Perilli et al. / Journal of Forensic and Legal Medicine 32 (2015) 21e24
23
Fig. 2. a) Focal pulmonary oedema associated with extended areas of atelectasia, acute emphysema (H&E x 250 magnification); b) “Ballonee” cells inside the alveolar space. (black arrows) (H&E x 250 magnification); c,d) Red blood cell infiltration into derma of skin wounds (insert) (H&E x 250 magnification).
The study of pathophysiology and timing of death, become fundamental to exclude others reasons, including industrial liability such as in the presented case. A complete toxicological analysis should always be performed. In accordance with the obtained data, we were able to reconstruct the dynamic of the phatal event and the phases of death,
concluding that the cause of death resulted by drowning and massive haemorrhage due to propeller injuries. Histological study of organs and mutilated skin must be required as forensic approach to similar cases. In the reported case, despite the warning signals that were posted on the columns of the desalinization plant, according to the
Fig. 3. a) Terminal part of the desalination pump with “big mussels” attached onto the surface of the underwater part (white arrow); b, c) Rotating propellers (white arrows).
24
G. Perilli et al. / Journal of Forensic and Legal Medicine 32 (2015) 21e24
data by the autopsy and the crime scene, the prosecutor decided to take penal and civil action for negligence against the propriety, since the rarity of the event (exceptional technical servicing) did not warrant a prevision of exceptional signposting and preventing measures given the close proximity of the beach. Conflict of interest The authors confirm that this article content has no conflicts of interest. Funding None declared. Ethical approval None declared.
References 1. Mann RJ. Propeller injuries incurred in boating accidents. Am J Sports Med 1980;8:280e4. 2. Mann RJ. Propeller injuries. South Med J May 1976;69:567e9. 3. Hargarten SW, Karlson T, Vernick JS, Aprahamian C. Motorboat propeller injuries in wisconsin: enumeration and prevention. J Trauma 1994;37:187e90. 4. Kutarski PW. Outboard motor propeller injuries. Injury 1989;20:87e91. 5. Hummel G, Gainor BJ. Waterskiing-related injuries. Am J Sports Med 1982;10: 215e8. 6. Chalmers DJ, Morrison L. Epidemiology of non-submersion injuries in aquatic sporting and recreational activities. Sport Med 2003;33:745e70. 7. From the Centers for Disease Control and Prevention. Boat-propeller-related injuries-Texas 1997. J Am Med Assoc 1998;279:1858. 8. Mendez-Fernandez MA. Motorboat propeller injuries. Ann Plast Surg 1998;41: 113e8. 9. Giersten JC. Drowning. In: Mason JK, Purdue BN, editors. The pathology of trauma. London: E-Publishing Inc; 2000. p. 263e4. 10. Ihama Y, Ninomiya K, Noguchi M, Fuke C, Miyazaki T. Fatal propeller injuries: three autopsy case reports. J Forensic Leg Med 2009;16:420e3.
