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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 2  |  Page : 54-57

Fatal traumatic slicing injuries of the chest: An industrial death and safety concerns


Department of Pathology and Forensic Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria

Date of Web Publication9-Aug-2017

Correspondence Address:
Francis A Faduyile
Department of Pathology and Forensic Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajt.ajt_16_16

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  Abstract 

A 36-year-old male truck driver of a mattress manufacturing company in Lagos was allegedly found dead on the rotary conveyor belt of a foam slicing machine in the factory. A visit to the scene of the event including examination of the conveyor belt and interrogation of the industrial nurse and chief security officer was made. Postmortem examination revealed single transverse incised wound on the chest, left and the right arms. Internal examination revealed incision on the 6th rib anteriorly, right hemothorax and a linear incision on the base of the left ventricle. Other findings included incision on the liver, the left hemidiaphragm, and hemoperitoneum. Death was ascribed to multiple injuries following sharp force trauma to the chest and abdomen in an industrial accident. Due to lack of toxicological facilities, blood level analysis of alcohol, other intoxicants, or substance abuse could not be checked for. This would have ruled out alcohol intoxication, substance abuse, or drug overdose. Suicide was ruled out judging from the decedent's medical and social history. The manner of death, in this case, was in our opinion accidental. This case has brought to the fore one of many occurrences of industrial deaths following inadequacy of safety measures and equipment in the company. There has never been a situation where culpable individual in charge of safety is brought to book in this environment. It has also highlighted the problems that could be faced by forensic pathologist in deciding manner of death in this type of situation.

Keywords: Industrial accident, injuries, machine, safety, trauma


How to cite this article:
Soyemi SS, Obafunwa JO, Faduyile FA, Williams OO, Emiogun FE, Osuolale FO, Kila OO. Fatal traumatic slicing injuries of the chest: An industrial death and safety concerns. Afr J Trauma 2016;5:54-7

How to cite this URL:
Soyemi SS, Obafunwa JO, Faduyile FA, Williams OO, Emiogun FE, Osuolale FO, Kila OO. Fatal traumatic slicing injuries of the chest: An industrial death and safety concerns. Afr J Trauma [serial online] 2016 [cited 2017 Oct 22];5:54-7. Available from: http://www.afrjtrauma.com/text.asp?2016/5/2/54/212631


  Introduction Top


Any person that is fatally injured following conditions suffered at the workplace by their actions and or inactions as well as those of others in the work environment is said to have suffered a work-related death.[1] Machine-related deaths are one of the leading causes of traumatic occupational deaths.[1] The first study on accidental mortality in Nigerian factories over a 10-year period from 1987 to 1996 reported a total of 3183 injuries out of which 71 deaths were recorded. Some of these deaths were caused by power driven machines.[2]

Industrial death continues to represent a serious public health concern for workers all over the world.[3] It occurs regularly in the workplace and many could have been prevented with proper safety precautions.

We present a 36-year-old male truck driver who supplied large foam blocks for a mattress manufacturing company. The decedent was allegedly found dead on the rotary conveyor belt of a foam slicing machine in the factory premises of the company where he regularly supplied the large foam blocks. Suicide notes were not found. Interactions with the victim's colleagues, associates, and family members revealed that the deceased suffered no physical or mental disorders. He also had no work or family problems and had made no suicidal attempt in the past.


  Case Report Top


We report a case of a 36-year-old male truck driver who supplied large foam blocks for a mattress manufacturing company in Lagos, Nigeria. He was brought in dead into the surgical emergency unit of the Teaching Hospital after being allegedly found dead on a rotary conveyor belt of a foam slicing machine in the factory premises.

Visit to the scene of the incident: On receipt of the information of the death in a factory, the pathology team visited the scene of death in company of the Investigating Police Officer. The supervising machine technician, industrial nurse, and chief security officer at the factory premises were interviewed. They revealed that the victim was reportedly making a phone call as he walked into the factory that housed the foam slicing machine. He allegedly lost concentration while on the phone and apparently accidentally climbed onto the conveyor belt which was working at that time. Within a few minutes, he screamed and other factory workers rushed to the scene and found him lifeless in a pool of blood on the conveyor platform of the machine.

Thorough examination of the scene of incident revealed a large factory which housed a foam slicing machine at approximately the center of the building [Figure 1]. The components of the machine include a rotary conveyor belt platform, an engine operated transverse metal blade which measures 270.0 cm in length and 9.0 cm in breadth. The blade is at a level of 155.0 cm above the surface of the platform [Figure 2].
Figure 1: The foam slicing machine with transverse metal blade (arrowed)

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Figure 2: The platform and measuring the distance between the platform and the blade

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There are small precautionary safety statements pasted on the wall inside the machine room. The dimensions of the machine components were measured, and extensive photographs of the scene including building layout and the foam slicing machine were documented and archived.

Further interviews with the family did not reveal any significant medical history of suicidal tendency or any psychiatric disorder.

The body was transferred to the hospital's morgue for a postmortem examination.


  Autopsy Findings Top


External findings

There is a curvilinear incision running from the left upper limb through the chest just above the nipples to the right upper limb. The incised wound on the chest measures 51.0 cm in length and gapes by a maximum of 11.0 cm. The edges are smooth and sharp with no bridging tissue underneath. Its upper margin is 20.0 cm below the shoulder level while the lower margin is 155.0 cm above the level of the heels. Protruding through the incision are large portions of the omentum. Other visible structures include the sternum, incised segments of the left and right fifth to seventh ribs with intercostal muscles and the upper portions of both hepatic lobes [Figure 3].
Figure 3: The incision running through the chest and both upper limbs

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On the upper part of the left forearm is a linear incision extending radially from the medial surface to the lateral part. This wound exposes the cubital region, measures 10.0 cm in length, gapes by a maximum of 7.0 cm and with a depth of 3.0 cm. Its upper margin is 27.0 cm below the shoulder level. Protruding through the incision are the severed ends of the flexor muscles.

There is another superficial incision below this wound; it measures 7.0 cm × 1.3 cm. Its upper margin is at a point 38.0 cm below the shoulder level and its lower margin is at a point 23.0 cm above the wrist joint [Figure 3].

There is a curved incision with a raised flap measuring 18.0 cm in length and gapes by a maximum of 10.0 cm on the anterior-medial aspect of the right forearm. It has a depth of 3.0 cm. Its upper margin measures 40.0 cm below the shoulder level and its lower margin is 9.0 cm above the wrist joint. There were no hesitation marks. Unfortunately, the rents on the shirt and undershirt could not be described because these items of clothing had been tampered with by the first responders.

Internal findings

The thoracic cage has a transversely aligned incised wound at the level of the 5th and 6th ribs with an accompanying linear incision measuring 6.5 cm around the base of the left ventricle. The left and right pleural cavities contain 250 ml and 200 ml of blood, respectively. The abdomen revealed a completely sliced liver in the transverse plane at the level of its upper third. In addition, there is a linear transverse incision on the posterior-superior surface of the left hemidiaphragm measuring 5.0 cm with an accompanying hemoperitoneum measuring 300 mls. Death was ascribed to multiple injuries following sharp force injuries to the chest and abdomen.


  Discussion Top


In this index case, the crime scene examination and the victim's medical history did not suggest suicide as the manner of death. There was no suicide note; overlying clothing showed a tear and no visible hesitation marks were present. It is the opinion of the authors that this death resulted from an accident.

This then raises the issue of safety in the workplace. The victim was not a staff of the factory primarily and should not have had access to the main operational area. There was clear evidence that proper safety measures were lacking in the factory. A factory of such should have in place adequate precautionary measures that would completely keep away visitors from the machine environment. Only staff trained to operate the slicing machine should have access to this part of the factory. Such staff must have documentary evidence of having undergone the requisite training and passed. Furthermore, there must be evidence of retraining exercises in addition to the staff signing-up to having had the training(s).

Although small safety labels were pasted on the wall on the inside, these are too small and should have been of large fonts and boldly written on both the inside and more importantly, on the outside.

The locations of the injuries on the body are also compatible with a person standing on the platform as shown by the height of the blade (155 cm) and the distance between the heel and the lower margin of the wound (155 cm) on the chest of the deceased [Figure 2] and [Figure 3]. In addition, the pattern of the wounds showing extension from the right upper limb through the chest and to the left upper limb is compatible with a sharp force trauma resulting from a blade with a long span. These injuries are compatible with wounds someone would have sustained while standing on the conveyor belt. This is further corroborated by the blood stained conveyor belt.

According to the National Occupational Safety and Health Administration, the USA records 7 million occupational injuries, 3 million are serious and 6500 results in fatality.[4]

It has also been estimated that global annual occupational fatal injury rates are 14 deaths per 100,000 workers. These rates are lower in industrialized countries.[5] In a study done by Ezenwa[2] in Nigeria 16.9% of the fatal injuries were due to power-driven machines, similarly, it was 21% in Kisumu and Siaya[6] districts in Kenya and was the second leading cause of trauma-related occupational fatalities in the USA[7] between 1980 and 1989. These observations indicate that deaths associated with power driven machine contribute significantly to the overall cause of death in occupational injury mortality.

This is just one of the cases of industrial deaths seen daily in Nigeria. The under-reporting of industrial injuries and deaths in Nigeria has previously been documented by Ezenwa.[2] Similarly, the inadequacy of compliance monitoring and enforcement of factory inspectorate has also been attributed to the high incidence of industrial injuries and death. There are still small number of safety inspectors, inadequate provision of technical equipment and few transport facilities.[8] Prosecution of persons in charge of safety in this part of the world is yet to be commenced.

Regular training of staff on safety management, enforcement of Factory Acts stipulation and prosecution of liable factory staff would no doubt reduce the rate of injuries and deaths in industries.

One important drawback of this report is the absence of toxicological studies to determine the possible contributory effect of drugs and alcohol. The reason for the absence of such analysis is the absence of a diagnostic toxicological laboratory of this nature in the country.


  Conclusion Top


The injuries on the body are compatible with that which was produced by a long sharp force trauma. Death scene examination, witness account, and absence of psychiatric history all tend to suggest an accident or misadventure. Regular training of staff on safety management, enforcement of Factory Acts stipulation and prosecution of liable factory staff would no doubt reduce the rate of injuries and deaths in industries.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cecchetto G, Viel G, De Lotto F, Manara R, Montisci M, Zancaner S, et al. Machinery-related deaths: Relevance of workplace investigation and antemortem radiological data in reconstructing the fatality. J Forensic Sci 2010;55:845-8.  Back to cited text no. 1
[PUBMED]    
2.
Ezenwa AO. A study of fatal injuries in Nigerian factories. Occup Med (Lond) 2001;51:485-9.  Back to cited text no. 2
[PUBMED]    
3.
Ahn YS, Bena JF, Bailer AJ. Comparison of unintentional fatal occupational injuries in the Republic of Korea and the United States. Inj Prev 2004;10:199-205.  Back to cited text no. 3
[PUBMED]    
4.
Loomis DP, Richardson DB, Wolf SH, Runyan CW, Butts JD. Fatal occupational injuries in a Southern State. Am J Epidemiol 1997;145:1089-99.  Back to cited text no. 4
[PUBMED]    
5.
Takala J. Global estimates of fatal occupational accidents. Epidemiology 1999;10:640-6.  Back to cited text no. 5
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6.
Muruka AO. Analysis of patterns and trends of occupational accidents from 1980-1989: A preventive approach for Kisuma and Siya districts. Afr Newslett Occup Health Saf 1996;6 Suppl 2:70-4.  Back to cited text no. 6
    
7.
Pratt SG, Kisner SM, Helmkamp JC. Machinery-related occupational fatalities in the United States, 1980 to 1989. J Occup Environ Med 1996;38:70-6.  Back to cited text no. 7
[PUBMED]    
8.
Ezenwa OA. A study of reported accident experiences and safety management practices in Nigerian factories. Niger Med J 1997;32:56-60.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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  In this article
Abstract
Introduction
Case Report
Autopsy Findings
Discussion
Conclusion
References
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