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Fatal Positional Asphyxia Associated With Rollover Crashes

Conroy, Carol MPH, PhD*; Eastman, A Brent MD, FACS†; Stanley, Christina MD‡§; Vilke, Gary M. MD, FACEP, FAAEM¶; Vaughan, Teresa RN, MFS∥; Hoyt, David B. MD, FACS*; Pacyna, Sharon RN, BSN, MPH**

American Journal of Forensic Medicine & Pathology: December 2007 - Volume 28 - Issue 4 - pp 330-332
doi: 10.1097/PAF.0b013e31815b4c47
Original Article

Motor vehicle rollover crashes result in complex occupant kinematics with the potential for severe injury. Five cases of fatal asphyxia in occupants suspended from their safety belt upside down after a rollover crash are presented. These fatalities accounted for 13.5% of all motor vehicle related asphyxia deaths in San Diego County over a 10-year period. This study supports previous research noting that incapacitation due to other injuries, alcohol, or obesity may be associated with fatal positional asphyxia due to inversion during rollovers. Safety belts are proven to prevent serious injury in motor vehicle crashes and should always be worn. However, redesign of the buckle could be considered to permit easier release by an occupant. We also suggest that pre-existing heart disease may contribute to the possibility of a fatal asphyxia outcome. Although this is a rare cause of motor vehicle related death, our results suggest that these are potentially preventable deaths.

From the *Department of Surgery, University of California, San Diego, California; †Scripps Health, La Jolla, California; ‡Department of Pathology, University of California, San Diego, California; §Office of the Medical Examiner, County of San Diego, California; ¶Department of Emergency Medicine, University of California, San Diego, California; ∥Trauma Research and Education Foundation, Escondido, California; and **Emergency Medical Services, County of San Diego Health and Human Services, California.

Manuscript received February 9, 2006; accepted June 5, 2006.

Views expressed are those of the authors and do not represent the views of any of the agencies.

Reprints: A. Brent Eastman, MD, FACS, Scripps Health, Mail Drop CP-222, 4275 Campus Point Court, La Jolla, CA 92038.

© 2007 Lippincott Williams & Wilkins, Inc.