DEATH DUE TO FIRE

By : Ferryal Basbeth
Scope of Investigation
The scope of investigation of thermal death requires careful in
order to resolve the medicolegal questions from this tragic
event.
The death investigation should be directed toward providing
factual answer to these questions :
How was identification of deceased established?
Was the victim dead or alive at the time of
exposure?
What caused the victim death and is the caused of
death related to the exposure?
Why didn’t the victim escape?
What injuries or disease does the victim exhibit and how do
they related to :
a. Exposure to the excessive heat (direct effect) extent
and severity.
b. The circumstances of the exposure – injuries
produced by the surrounding, such as collaps
of structure surrounding the victim, caused by fire damage.
c. Injuries and disease present before the exposure
and their relationship to the death.
d. Injuries due to medical treatment or recovery the
body – resuscitation, surgical procedures,
postmortem injuries etc.
Who is the burned victim?
Identification of the deceased is established by performing
personal identification, photographs, and or fingerprints.
Aside from this, only a tentative identification based on
circumstances, personal possession, or nonspecific
characteristics, such as tattoos, scars, or absence of organs,
can be made.
The most common and the most reliable is the use of dental
identification, since the teeth are relatively resistant to fire.
Another method of identification that can be just as reliable as
dental identification, but is less commonly utilized, is the
comparison of postmortem x-rays to x – ray taken antemortem of
the suspected individual. Especially head x-ray.
(superimposed)
If a body is charred to such a degree that facial structures are
mutilated and no fingerprints can be obtained, other methods of
identification must be used.
If identification cannot be made by fingerprints, dental charts,
dental x-rays, or ante mortem x-rays, then positive identification
cannot, as a general rule, be made. The only exception to this is
DNA typing.

Who the burned victim depends on how far your

knowledge and your experiences to identified the
victim
Was the victim alive or dead at the time of the
fire?
Indication that the victim was alive at the time of the fire include
the following:
١. Presence of smoke particles in the distal respiratory tract
This proves that the subject inhaled smoke and was breathing
during the fire. The soot must be located distal to the nose or
mouth. Grayish-black or black amorphous material adherent to
the mucosae of the larynnx, trachea and bronchi in a corpse
indicates that the victim inhaled smoke (soot), thus
proving that active respiration occurred during the fire.
Absence of this objective indication of smoke inhalation should
arouse the suspicion that death probably occurred before the
victim was exposed to fire and smoke, it means that death
preceded the conflagration.
However, it is possible for fire victims to die rapidly in extremely
hot fires or explosions that they had little or no opportunity to
inhale smoke.
Once again, absence of soot, however, does not necessarily
mean that the individual was dead prior to the start of the fire.
Was the victim alive or dead at the time of the
fire?

۲. Evidence of thermal injury of the respiratory tract.

Inhaled hot gases or heat usually cause thermal damage of the
mucosa and acute laryngeal edema. The lips and mouth usually
show signs of burning and the same changes will be present
throughout the respiratory tract.

۳. Elevated blood carbon monoxide saturation.

This blood level must be greater than 10 % saturation since it has
been shown that heavy smokers can attain a level of 7 to 10 %.
However, the absence of an elevated carbon monoxide
level does not mean that the subject was dead
at the time of the fire. This is particularly true in
explosive type fires.
Moreover,the presence of elevated carbon monoxide saturation
alone does not prove that the victim was alive at the time of the
fire. Death may have resulted from carbon monoxide intoxication
from some other source (e.g., auto exhaust fumes) before the fire
started.
Anemic individuals or those with heart disease may reach a fatal
saturation more rapidly than a normal person.
One must be aware that the level of carbon monoxide saturation
of the blood is depend on a number of factors including the
concentration of carbon monoxide in the inhaled air, the
duration of exposure, the rate and depth of respiration,
and the hemoglobin content of the blood.
For example, smoldering type fire in a closed room, the
accumulation of carbon monoxide in the air may be rapidly
increased to a high concentration. By contrast, in a flame type fire
in a open field.

Thus, the interpretation of the results of a carbon monoxide

blood analysis in the fire victim must be correlated with the
scene investigation, the anatomic findings, and all other
known factors in order to reach a logical conclusion.
The flaming combustion of wood and man made plastic polymers
(e.g., polyvinyl chloride, polystyrene and polyurethane) adds
exceptionally toxic gases to the smoke; these include hydrogen
cyanide and many other organic and inorganic hydrocarbons
which are rapidly lethal when inhaled.
The effects of cyanide and of carbon monoxide, also formed in
fires, are additive because they both contribute to tissue hypoxia
by different mechanisms. The two gases are major causes of
combustion-related fatalities
In residential fires, cyanide poisoning may be more significant
than has previously been appreciated. The short half-life of
cyanide in blood contributes to the low concentrations of cyanide
found in fire victims when blood is drawn after the victims reach
the hospital.

From April 1988 through April 1989, a team French investigators,

collected samples on the scene from 109 victims of residential
fires in and around Paris, France. The data they gathered were
compared with data from a control group (N = 114) individuals
whose injuries were not caused by fire.
Blood cyanide concentrations were much higher in the fire victims
than in the control group (Table10-2), and victims who died had
significantly higher levels (> 5-fold) than victims who survived.
Contrary to what previous researchers have concluded, the
results from this study “suggest that cyanide poisoning may
prevail over carbon monoxide poisoning as the cause of
death in some fire victims.”

Therefore, medical officers need to be aware that victims of

smoke inhalation from fires may be suffering the effects of cyanide
poisoning, and might benefit from early antidotal cyanide therapy.
Therapy will be discussed in cyanide poisoning
Okay…!
Was the victim alive or dead at the time of the
fire?
٤. Cutaneous reaction to heat and flame.
Some authors state that formation of fluid filled vesicles (blisters)
and reddening of the skin associated with burn occur only in the
live person subjected to thermal injury. Other authors dispute this
observation and state that vesicles having erythematous margins
can be produced postmortem. These findings, therefore, are
argumentative as far as resolving the dead or alive question.
Microscopic examination of the burns is not helpful unless the
victim has survived long enough to develop an inflammatory
response.
Lack of such a response does not necessarily indicate that
the burn was postmortem. One of the authors (VJMD) had
occasion to examine microscopic slide of the third degree burns
incurred in Vietnam with the patients subsequently evacuated to
Japan where they died 2-3 days later. In some of these burns,
there was no inflammatory reaction, presumably due to heat
thrombosis of dermal vessels such that inflammatory cells
could not reach the area of burn and produce a reaction.
Was the victim alive or dead at the time of the
fire?
٥. Subendocardial Left Ventricular Hemorrhage
Grossly visible focal and confluent areas of subendocardial left
ventricular hemorrhage can occur from hyperthermia. Because
identical hemorrhages are produced by other lethal mechanisms,
this finding is not specific insofar as cause of death is concerned.
What caused the victim`s death and is cause
of death related to the fire?
Some causes of death unrelated to the fire often occur in a
number of fire cases. Precise determination of the cause and
manner of death depend on correlation of autopsy and laboratory
findings and detail of the circumstances of the death.
A man may have a heart attack or stroke and die, dropping his
smoking materials and causing a fire which may produce
extensive postmortem burns.
A woman may take a overdose of sedatives and drop her smoking
materials as she lapses into coma, producing the same sequence
of event.
What caused the victim`s death and is cause
of death related to the fire?
Deaths due to fire may be either immediate or delayed
Immediate deaths are due to either direct thermal injury to the
body, burns of the skin, or more commonly, to a phenomenon
called “smoke inhalation”
Delayed deaths within the first two or three days are due to
shock, fluid loss, or acute respiratory failure due to inhalation
of hot gasses with injury to the respiratory insufficiency,.
Free radicals have been proposed as one possibility in causing
death, because they can inactive surfactants, thus preventing
oxygen from crossing the alveoli into the blood
What caused the victim`s death and is cause
of death related to the fire?
The two most important causes of death are septicaemia and
smoke inhalation
Septiceamia is less likely to progress to multiple organ failure as
more powerful antibiotic agent available
Smoke inhalation is now the single most important factor in
mortality in fire deaths not due to burns.
In 1980, 81 people died in the MGM Grand Hotel Las Vegas, only
two died from results of burn; all the others succumbed to smoke
inhalation, mostly in rooms many level above the fire itself.
None of the 560 victims admitted to hospital with
respiratory symptoms had burns.
What caused the victim`s death and is cause
of death related to the fire?
Curling Ulcer
The etiology of these ulcers has not been completely established.
Sepsis, hemoconcentration, shock with decreased cardiac output,
and absolute hyperacidity, either alone or combined, do not offer
an adequate explanation for the development of the destructive
mucosal lesions.
Another theory for the appearance of Curling`s ulcers in
implication of capillary endothelial injury by circulating cellular
“toxin” arising from protein breakdown in necrotic
tissue.Capillary injury is decided to responsible for the
submucosal petechiae, and such a locus minoris
resistentie then progress to ulceration as
a consequence of peptic digestion and secondary
bacterial infection.
What injuries or disease does the victim
exhibit and what is their significant?
The pathologist must differentiate injuries which are a result of
direct exposure from those which occurred prior to the fire, during
the exposure, or postmortem.
Exposure of a dead body to heat and flame can produce
anatomic changes which can be confused with antemortem
non fire injuries. If the pathologist is not aware of the origin of
these dermal and visceral alterations, he may misdiagnose
postmortem thermal artifacts as intravitam traumata.
Skin splits
Contraction of the burned tissues often causes splitting of the skin
in the charred body. The resulting artifacts greatly resemble
incised wounds and may be so misinterpreted. Absence of
hemorrhage and location only in areas damage by the fire help
differentiate these defect from antemortem incised wounds.
Occasionally, intact blood vessels are observed extending across
heat splits.

Abdominal wall destruction

Frequently, the intestines protrude through this defect. Again lack
of hemorrhage, either externally or internally, in the body with a
charred abdominal wall differentiates this artifact from antemortem
injury.
Pugilistic attitude
Many bodies recovered from fires are found in the so-called
pugilistic posture or pugilistic attitude with their arms, forearms
and wrist flexed or semi flexed. Hips and knees may also be
partially or completely flexed. These are produced by heat rigor, a
variety of postmortem muscle stiffening and shortening created by
prolonged exposure of muscle to intense heat.
The pugilistic attitude is not a reflection of the position of the body
prior to burning.
Pseudo epidural Epidural hematom
hematom
☺Usually unilateral
☺Usually bilateral ☺Well circumscribed
☺Diffuse ☺Discoid shape,
☺Usually thin, granular, localized more rubbery
friable, evenly consistency, reddish
distributed /sickle purple
shaped, chocolate
brown. ☺Associated skull
fracture in temporal
☺Skull may be area
fractured ☺Usually located
adjacent to sylvian
☺Located anywhere fissure
☺Frequently has injury
☺No injury to CNS to CNS
Alcohol and fire deaths
Studies have shown that a fair percentage of fire deaths
[58% in one study] have an alcohol involvement, an
average figure in some studies being 229 mg. alcohol
per 100 ml.blood.
It is obvious that when persons are intoxicated the
additional effects of exposure to fire gases will greatly
increase the risk factor by causing them to be limited in
their ability to make rational decision
This is apparent in some instances where persons could
easily have escaped from a fire but have been so
disorientated by a combination of alcohol and carbon
monoxide that they have walked back into a fire.
It should be noted that in the cases of persons removed
to hospital where they subsequently die shortly after,
blood analysis may show a lower alcohol level than was
perhaps expected, this is due to the alcohol level
dropping by normal loss from the body.
The figure quoted as a guide for alcohol loss in average
person is 15 mg.per 100 ml. of blood per hour.
The following table gives an average assessment, but it
must be remembered there can be wide variants and
investigators have to consider all factors.
References
1) Kapita Selekta Kedokteran, Bedah Plastik, Luka Bakar, Media Aesculapius;
2000:44:365-370.
2) Budiyanto, Arif, dkk. Ilmu Kedokteran Forensik. Bagian Kedokteran Forensik FKUI,
1994:49 – 50.
3) Brown, R F; Injury by Burning; The Pathology of Trauma;Edward Arnold, Hodder &
Stoughton Limmited; 1993:14:179-186.
4) Knight Bernard; Burns and scalds; Forensic Pathology; 2nd edition ;Oxford University
Press, Inc;1976:11:305-316.
5) James A. Benz, M.D; Thermal Death; Modern Legal Medicine, Psychiatry, and
Forensic Science;F.A. Davis Company; ;1980:13:269-289.
6) Di Maio Dominick J. and Di Maio Vincent J.M; Deaths Due to Fire; Forensic
Pathology;CRC Press,Inc;1993:13:327-343.
7) Adelson. Lester M.D., Homicide by Fire-The Incendiary Homicide; The Pathology of
Homicide; Charles C Thomas Publisher; 1974: IX: 576-616.
Pertanyaan :
1. Bagaimana anda mengidentifikasi korban kebakaran
yang sudah menjadi arang?
2. Bagaimana anda mengetahui bahwa korban masih
hidup pada waktu terjadi kebakaran?
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bakar?
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melakukan otopsi terhadap korban luka bakar yang
sudah dirawat selama 3 hari?