Unusual Work-related Fatality: importance of scene investigation combined with autopsy findings

After attending this presentation, attendees will understand the importance of the reconstruction of an unusual fatal occupational accident by a detailed workplace investigation, combined with the evaluation of all circumstantial, radiological, surgical, and, most of all, autopsy’s findings. The definition of fatal accident at work adopted by the European Statistics of Accidents at Work project is that of “accidents at work leading to the death of the victim within a year (after the day) of the accident”. In Italy the main source of information about occupational injuries is the Institute of Insurance for Occupational Illness and Injury (Istituto Nazionale per l’Assicurazione degli Infortuni sul Lavoro; INAIL). According to INAIL, in 2011, 920 Italian workers died from work-related injuries. The majority of the accidental deaths occur either immediately at the time of the accident, or within a few days or a few weeks after the accident. This presentation will impact the forensic community and/or humanity by emphasizing the fact that the autopsy can have a key role about the reconstruction of the dynamics involved in the occupational event, allowing the identification of any legal responsibilities of the worker or the employers. The authors present a case of a 44-year-old man who was working in a building site, driving a tractor with a rear mounted flail mower. While he was mowing grass close to a crane, he was hit to his left eye by something leapt out of the mower’s blades. The victim was rescued by his co-workers, and brought to local Emergency Department being in a coma. At the hospital, a CAT scan of brain diagnosed a metallic foreign body in the left occipital area, which was penetrated through the left eyelid and orbital bone, making a channel into the left fronto-temporo-parietal side. Despite early craniotomy and intensive cares, the victim died four days after the recovery and the organ donation was authorized. In the aim of better understand the dynamics of the event, a medico-legal autopsy was performed. The external examination of the body showed a 0,6 centimetres (cm) wound on the left superior eyelid. A 0,6 cm keyhole wound was found on superior wall of the orbital bone; during the gross examination of brain, subdural haemorrhage of the left hemisphere, subarachnoid hemorrhage intra-axial hematoma were detailed. In the occipital lobe, a fragment of a copper cable was found; the cable had frayed extremities, 4 cm long with 0,3 cm in diameter. No alcohol, or drugs of abuse were found in the blood and urine collected at autopsy. The cause of death was identified as diffuse brain damage because of a penetrating head injury. The workplace investigation showed the presence of a cut electric cable, partially buried, coming out from the ground just beneath the mower. The cable has the same compounds such as the fragment found in the brain. Therefore, it was thought that, as the man was driving the tractor, the mower’s blades moved and hooked the electrical cable, bringing it out from the ground, and cutting it; a piece of that cable was projected foreword and it hit the victim’s head while he was turning back due to mechanic obstacle to the procedure. In the case here presented, the reconstruction of the fatal work-related accident, before the autopsy, was incomplete because of the lack of detailed information concerning the event. In fact, it is known that there are many potential contributing factors to work-related accidents, including type and length of the work, type of the equipment and the machineries used, the environment itself, and the behaviour of the worker. In the majority of cases, the information provided by the work inspectors and the police, allow to reconstruct the occupational accident, but sometimes only the autopsy may detect the real cause of the death, and what was happened to the victim.